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Images in Neurology
March 2, 2020

Unilateral Leptomeningeal Enhancement in Myelin Oligodendrocyte Glycoprotein Immunoglobulin G–Associated Disease

Author Affiliations
  • 1Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
JAMA Neurol. Published online March 2, 2020. doi:10.1001/jamaneurol.2020.0001

Ogawa et al1 described a unilateral encephalitis with cortical T2 fluid-attenuated inversion recovery (FLAIR) hyperintensity, seizures, and myelin oligodendrocyte glycoprotein (MOG) immunoglobulin G (IgG) positivity. A literature review characterized unilateral cortical FLAIR–hyperintense lesions in anti-MOG–associated encephalitis with seizures (FLAMES) as a distinct clinicoradiographic syndrome that frequently presents with headache, fever, seizures, and/or cortical symptoms.2 A subset of these patients had unilateral leptomeningeal enhancement in addition to cortical T2 FLAIR hyperintensity,2 so we searched the Mayo Clinic MOG IgG–positive patient database looking for cases of unilateral meningeal and/or cortical signal abnormality on magnetic resonance imaging (MRI). Through this search, we identified 2 patients with isolated MOG IgG positivity and unilateral leptomeningeal enhancement in the absence of significant cortical T2-FLAIR hyperintensity, further expanding the neuroimaging spectrum of MOG IgG–associated disease (MOGAD).

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