Recurrent Myelitis Research Articles

Myelin oligodendrocyte glycoprotein antibody–associated disease with histopathologic features of primary CNS angiitis without demyelination: Case report and literature review

Primary angiitis of the central nervous system (PACNS) is a rare inflammatory disease that affects both small- and medium-sized vessels of the CNS, while myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD) is a novel antibody-mediated inflammatory demyelinating disorder that causes damage to the myelin in CNS. We report a case diagnosed as MOGAD due to a history of recurrent myelitis, brain lesions, and positive anti-MOG, but the brain biopsy showed vasculitis without demyelination.

Clinical characteristics and predictive factors of recurrent idiopathic transverse myelitis.

Idiopathic transverse myelitis (iTM) is defined as an inflammatory myelopathy of undetermined etiology, even after a comprehensive workup to identify other possible causes. Generally, the characteristics of recurrent iTM are not clearly defined. This study aimed to identify the clinical characteristics and predictive factors of recurrence in patients with iTM. We retrospectively recruited patients with transverse myelitis (TM) who visited Chungnam National University Hospital between January 2011 and December 2021. We included patients who were followed up for at least 2 years and excluded those diagnosed with multiple sclerosis or neuromyelitis optica spectrum disorder (NMOSD) during the initial episode or follow-up period. Patients with iTM were categorized into two groups: monophasic idiopathic TM (mTM) and recurrent idiopathic TM (rTM). We compared the clinical characteristics and spinal magnetic resonance imaging findings between the two groups. In total, 167 patients were reviewed, of whom 112 were excluded. Finally, we included 55 patients with iTM. In 55 patients, 11 (20.0%) and 44 (80%) were classified into the rTM and mTM groups, respectively. Male predominance was observed in the iTM, rTM, and mTM groups. The percentage of patients with low vitamin D levels was significantly higher in the rTM group (100.0%) compared with the mTM group (70%) (p = 0.049). In addition, longitudinally extensive transverse myelitis (LETM) was observed more frequently in the rTM group, in 8 of 11 (72.7%) patients, compared with 15 of 44 (34.1%) patients in the mTM group, with the difference being statistically significant (p = 0.020). In multivariate regression analysis, female sex, younger age at onset, low serum vitamin D level (<30 ng/mL), and LETM were risk factors for recurrence. LETM was a significant predictor of relapse in iTM (p = 0.043, odds ratio = 13.408). In this study, the clinical features of mTM and rTM are nearly indistinguishable. In conclusion, >20% of the patients with iTM experience recurrence, and LETM is the most significant risk factor for recurrence. In cases of recurrence, there is a favorable response to immunotherapy, and the prognosis is generally good. Although LETM may be the initial symptom of NMOSD, it may be manifestation of iTM, and in cases of idiopathic LETM, it is important to be mindful of the elevated risk of recurrence. Based on these results, idiopathic rTM has good clinical prognosis and response to immunosuppressive treatment.

Autoimmune GFAP Astrocytopathy-Beyond the Known Horizon, India's First Multifaceted Institutional Experience.

Background: Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an immune-mediated inflammatory disease of the central nervous system, the clinical phenotype of which includes meningoencephalitis, myelitis, optic neuritis, seizures, movement disorders, autonomic dysfunction among others, affecting people across all ages. Due to its recent discovery, there is a paucity of literature on this topic and an absolute lack of Indian case series. Purpose: This study aims to shed light on the variable presentations of anti-GFAP astrocytopathy and review the existing literature on the topic. Methods: This was a retrospective study that included all patients who tested positive in the cerebrospinal fluid(CSF) and/or serum for GFAP immunoglobulin G between February 2023 and August 2023, after obtaining ethical clearance. Relevant clinical, demographic data was collected from the electronic medical records. A descriptive analysis of data was done and the current available literature was reviewed. Results: Our case series included four patients (F:M::3:1) with a median age of 28 years at symptom onset. Two of the cases had a relapsing-remitting disease pattern, while the other two had monophasic illnesses. The clinical spectrum we encountered included ataxia, tremors, myoclonus, seizures, recurrent myelitis, brain stem syndromes, autonomic dysfunction and psychiatric manifestations. All four patients responded remarkably to steroids and two patients are on rituximab therapy. Conclusion: Autoimmune GFAP astrocytopathy encompasses an expanding clinical spectrum and should be considered in the context of myelitis, optic neuritis, ataxia, papillitis, seizures, autonomic dysfunction and movement disorders occurring in isolation or more commonly in varying combinations. Our case series, the first in India, shows a favourable clinical profile and the primary hurdle encountered in all four cases was to establish a diagnosis, further stressing the need for a predictive diagnostic algorithm.

Resolution of Recurrent VZV Myelitis With the Use of Intravenous (IV) Immunoglobulin (IG)

Objective To present a case of a patient with recurrent VZV myelitis successfully treated with Intravenous Immunoglobulin (IVIG). Background VZV myelitis is a rare complication of VZV reactivation that tends to be monophasic. There is no solid evidence for a particular treatment regimen for VZV myelitis. No prior reports or studies have looked at using intravenous immunoglobulin for this condition, particularly for refractory cases. Design/Methods 75 year old female with history of hypertension presented with paresthesia on lateral side of right lower extremity, followed by vesicular rash T2 dermatomal distribution. Over a period of 2 weeks patient started experiencing bilateral lower extremity weakness R&gt;L. CNS imaging revealed C3-C6 enhancing lesion and T2 hyperintense lesion. VZV confirmed by skin biopsy. Lumbar puncture (LP) was remarkable only for mildly elevated protein (67 mg/dL), although this LP was 4 weeks after initial symptoms. Patient was treated initially with 5 days of 1 g IV Solumedrol and valacyclovir 1 g TID with improvement of weakness and rash. However, over the next two years, the patient continued to get occasional vesicles with a flare of her myelitis shortly after valacyclovir down-titration trial. She was started on monthly IVIG (1 g/kg IVIG over 2 days) given her refractory and recurrent myelitis. Since starting monthly IVIG, the patient has not had any more zoster outbreaks or further episodes of myelitis. She has gradually improved her balance and gait as well. Results N/A. Conclusions We present an unusual case of recurrent VZV myelitis successfully treated with monthly IVIG. The successful treatment of this patient with IVIG should prompt consideration for its use in similar cases of recurrent VZV myelitis and may provide insight for future studies on how to treat VZV-related diseases. Rapid initiation of this treatment when the condition is recognized early could significantly improve outcomes and patients' quality of life.

AQP4-MOG Double-Positive Neuromyelitis Optica Spectrum Disorder: Case Report with Central and Peripheral Nervous System Involvement and Review of Literature

(1) The co-occurrence of AQP4 and myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with demyelinating disorders is extremely rare. In addition, a concomitant involvement of the peripheral nervous system (PNS) has been described either in association with AQP4 antibodies-positive neuromyelitis optica spectrum disorder (NMOSD), or MOG-associated disease. We report on a case of NMOSD with co-occurrence of AQP4 and MOG antibodies and concomitant central and peripheral nervous system involvement. We also reviewed available cases of AQP4-MOG double-positive patients. (2) Brain and spine MRI, cerebrospinal fluid studies, and electrophysiological test were performed. Serum AQP4 and MOG positivity was assessed with live cell-based assay. (3) A 62-year-old woman presented with recurrent optic neuritis, myelitis, and radiculitis, tested positive for AQP4 and MOG antibodies, and was treated successfully with rituximab. (4) Although few cases of AQP4-MOG double-positive patients were already described mostly affecting females with a concomitant spinal cord and optical nerve involvement, we describe the first case of double-positive NMOSD with the peculiar involvement of both central and peripheral nervous system.

Neuromyelitis-optica-Spektrum-Erkrankungen (NMOSD) und Anti-Myelin-Oligodendrozyten-Glykoprotein-Antikörper-assoziierte Erkrankungen (MOGAD)

Wiederkehrende Episoden entzündlicher Schädigungen des Sehnervs und des Rückenmarks sind als eigenständige Erkrankung schon aus historischen Überlieferungen bekannt. Im Jahr 2004 gelang die Identifikation des pathognomonischen, gegen Aquaporin‑4 auf Astrozyten gerichteten Antikörpers. Zugehörige klinische Manifestationen werden als Neuromyelitis-optica-Spektrum-Erkrankungen („neuromyelitis optica spectrum disorders“, NMOSD) zusammengefasst. Diagnostische Kriterien basieren auf der klinischen Präsentation sowie der Bildgebung und berücksichtigen den Antikörperstatus. Histologisch sind NMOSD durch eine primäre Schädigung der Astrozyten mit sekundärer Demyelinisierung charakterisiert. Nach Gabe von Methylprednisolon und evtl. Anwendung von Plasmapherese in der Akutsituation schließt sich die langdauernde Immunsuppression zur Schubprophylaxe an. Diese basiert auf B‑Zell-Depletion, Interleukin-6-Antagonismus oder Komplementhemmung. Klinisch ähnlich können sich Erkrankungen präsentieren, die mit Antikörpern gegen Myelin-Oligodendrozyten-Glykoprotein assoziiert sind („anti-MOG-antibody-associated diseases“, MOGAD). Hier kommt es zur primären entzündlichen Demyelinisierung im zentralen Nervensystem. Im Gegensatz zu mit Aquaporin-4-Antikörpern assoziierten NMOSD gibt es für MOGAD bisher keine kontrollierten Therapiestudien.

Acute isolated orchalgia as the initial symptom in thoracic cord disorder: 2 case report and literature review

IntroductionOrchalgia is a common andrological disorder and usually results from pathognomonic change of testes and regional structures. However, responsible cause is still unknown in more than one-fourth of patients. MethodsWe report two men who initially suffered an acute, isolated orchalgia and posteriorly complicated with paraparesis. They had previous history of prostate cancer and cervical myelitis. The urological examination was negative in both of them. Finally, prostate cancer metastasis and recurrent myelitis at T2/3 level was identified, respectively. Although their orchalgia progressively subsided, their urological, sexual and neurological dysfunction persisted. ConclusionsIn the literature, the responsible pathology of spinal orchalgia was exclusively found below T10 level, frequently delaying affirmative diagnosis. Therefore, a thorough evaluation of spinal cord above T10 level should be alerted for idiopathic orchalgia with a pre-existing history or risk of spinal cord disorder and a negative urological examination.

Orquialgia aguda aislada como síntoma inicial del trastorno de la médula torácica: informe de 2 casos y revisión de la literatura

IntroductionOrchalgia is a common andrological disorder and usually results from pathognomonic change of testes and regional structures. However, responsible cause is still unknown in more than one-fourth of patients. MethodsWe report 2men who initially suffered an acute, isolated orchalgia and posteriorly complicated with paraparesis. They had previous history of prostate cancer and cervical myelitis. The urological examination was negative in both of them. Finally, prostate cancer metastasis and recurrent myelitis at T2/3 level was identified, respectively. Although their orchalgia progressively subsided, their urological, sexual and neurological dysfunction persisted. ConclusionsIn the literature, the responsible pathology of spinal orchalgia was exclusively found below T10 level, frequently delaying affirmative diagnosis. Therefore, a thorough evaluation of spinal cord above T10 level should be alerted for idiopathic orchalgia with a pre-existing history or risk of spinal cord disorder and a negative urological examination.

Failure of alemtuzumab therapy in three patients with MOG antibody associated disease

BackgroundMyelin Oligodendrocyte Glycoprotein antibody-associated disease (MOGAD) is most classically associated in both children and adults with phenotypes including bilateral and recurrent optic neuritis (ON) and transverse myelitis (TM), with the absence of brain lesions characteristic of multiple sclerosis (MS). ADEM phenotype is the most common presentation of MOGAD in children. However, the presence of clinical phenotypes including unilateral ON and short TM in some patients with MOGAD may lead to their misdiagnosis as MS. Thus, clinically and radiologically, MOGAD can mimic MS and clinical vigilance is required for accurate diagnostic workup.Case presentationWe present three cases initially diagnosed as MS and then treated with alemtuzumab. Unexpectedly, all three patients did quite poorly on this medication, with a decline in their clinical status with worsening of expanded disability status scale (EDSS) and an increasing lesion load on magnetic resonance imaging of the brain. Subsequently, all three cases were found to have anti-MOG antibody in their serum.ConclusionsThese cases highlight that if a patient suspected to have MS does not respond to conventional treatments such as alemtuzumab, a search for alternative diagnoses such as MOG antibody disease may be warranted.

Inebilizumab for treatment of neuromyelitis optica spectrum disorder.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease characterized by recurrent optic neuritis and transverse myelitis often resulting in severe disability. Anti-AQP4-immunoglobulin G (IgG) is a pathogenic product of CD19-positive plasma cells found in most, but not all, individuals with NMOSD and is associated with immune-mediated neurologic injury. Inebilizumab, an afucosylated humanized IgG1κ, anti-CD19 monoclonal antibody, may target pathogenic CD19-expressing B cells. In a Phase II/III trial, inebilizumab significantly reduced the proportion of participants experiencing an NMOSD attack and was well tolerated versus placebo. Fewer treated participants had worsening disability than those receiving placebo. Inebilizumab was approved in 2020 by the US FDA for treatment of anti-AQP4 antibody positive NMOSD.

Application of deep-learning to the seronegative side of the NMO spectrum.

To apply a deep-learning algorithm to brain MRIs of seronegative patients with neuromyelitis optica spectrum disorders (NMOSD) and NMOSD-like manifestations and assess whether their structural features are similar to aquaporin-4-seropositive NMOSD or multiple sclerosis (MS) patients. We analyzed 228 T2- and T1-weighted brain MRIs acquired from aquaporin-4-seropositive NMOSD (n = 85), MS (n = 95), aquaporin-4-seronegative NMOSD [n = 11, three with anti-myelin oligodendrocyte glycoprotein antibodies (MOG)], and aquaporin-4-seronegative patients with NMOSD-like manifestations (idiopathic recurrent optic neuritis and myelitis, n = 37), who were recruited from February 2010 to December 2019. Seventy-three percent of aquaporin-4-seronegative patients with NMOSD-like manifestations also had a clinical follow-up (median duration of 4years). The deep-learning neural network architecture was based on four 3D convolutional layers. It was trained and validated on MRI scans of aquaporin-4-seropositive NMOSD and MS patients and was then applied to aquaporin-4-seronegative NMOSD and NMOSD-like manifestations. Assignment of unclassified aquaporin-4-seronegative patients was compared with their clinical follow-up. The final algorithm differentiated aquaporin-4-seropositive NMOSD and MS patients with an accuracy of 0.95. All aquaporin-4-seronegative NMOSD and 36/37 aquaporin-4-seronegative patients with NMOSD-like manifestations were classified as NMOSD. Anti-MOG patients had a similar probability of being NMOSD or MS. At clinical follow-up, one unclassified aquaporin-4-seronegative patient evolved to MS, three developed NMOSD, and the others did not change phenotype. Our findings support the inclusion of aquaporin4-seronegative patients into NMOSD and suggest a possible expansion to aquaporin-4-seronegative unclassified patients with NMOSD-like manifestations. Anti-MOG patients are likely to have intermediate brain features between NMOSD and MS.

Reader response: Hashimoto encephalopathy in the 21st century.

I read the interesting study on correlation of thyroid antibodies and neurologic manifestations specially the encephalopathy, psychosis, refractory seizures, etc.1 The simultaneous editorial on the same issue is also enlightening.2 The authors concluded that Hashimoto encephalopathy requires redefinition. Here, we would like to share our small but important experience. We found in a cohort of approximately 73 patients of noncompressive myelopathy and neuromyelitis optica spectrum disorder (NMOSD) and antibodies to thyroid peroxidase (TPOAb) positivity in 2 patients.3 The other antibodies relevant to NMOSD or myelitis and etiologic workup was noncontributory; hence, we connected it to the thyroid immune disorder or TPOAb. These patients had recurrent myelitis and required disease-modifying therapies besides steroids, and we concluded that this entity may be an independent marker of recurrence of the disease—i.e., myelitis. Similar to those patients implicated in earlier studies,4 they require disease-modifying therapy besides steroids because steroids alone are not sufficient.

Editors' note: Hashimoto encephalopathy in the 21st century

In “Hashimoto encephalopathy in the 21st century,” Mattozzi et al. reported that patients who meet the present criteria for Hashimoto encephalopathy (1) have a diverse range of presenting symptoms, (2) respond variably to steroids, and (3) are just as likely as controls to have NH2-α-enolaseAb detected. Furthermore, they noted the frequency of serum thyroid peroxidase antibodies (TPOAbs) is similar among patients with autoimmune encephalitis and controls. The authors concluded that it is time to establish a new definition of Hashimoto encephalopathy. Shubharkaran noted that in a series of 73 patients with noncompressive myelopathy and neuromyelitis optica spectrum disorder, 2 had positive TPOAb and developed recurrent myelitis that required treatment with disease-modifying therapies prompting conclusion that TPOAb may be a marker of disease recurrence. However, Graus and Dalmau—on behalf of the authors—responded that the frequency of positive TPOAb in this series was similar to that in the general population and suggested the presence of TPOAb neither explains the etiology for myelitis in these patients nor necessitates treatment with disease-modifying therapies. Additional work is needed to understand the clinical significance of a positive TPOAb and the circumstances in which this finding should impact management. Hashimoto encephalopathy may not represent a single entity and it is important to consider the possibility of coexisting autoimmune disorders. In “Hashimoto encephalopathy in the 21st century,” Mattozzi et al. reported that patients who meet the present criteria for Hashimoto encephalopathy (1) have a diverse range of presenting symptoms, (2) respond variably to steroids, and (3) are just as likely as controls to have NH2-α-enolaseAb detected. Furthermore, they noted the frequency of serum thyroid peroxidase antibodies (TPOAbs) is similar among patients with autoimmune encephalitis and controls. The authors concluded that it is time to establish a new definition of Hashimoto encephalopathy. Shubharkaran noted that in a series of 73 patients with noncompressive myelopathy and neuromyelitis optica spectrum disorder, 2 had positive TPOAb and developed recurrent myelitis that required treatment with disease-modifying therapies prompting conclusion that TPOAb may be a marker of disease recurrence. However, Graus and Dalmau—on behalf of the authors—responded that the frequency of positive TPOAb in this series was similar to that in the general population and suggested the presence of TPOAb neither explains the etiology for myelitis in these patients nor necessitates treatment with disease-modifying therapies. Additional work is needed to understand the clinical significance of a positive TPOAb and the circumstances in which this finding should impact management. Hashimoto encephalopathy may not represent a single entity and it is important to consider the possibility of coexisting autoimmune disorders.

Atypical MOG antibody disease presenting with typical multiple sclerosis lesions

Myelin oligodendrocyte glycoprotein (MOG) antibody disease is an autoimmune disease of the central nervous system associated with a serological antibody against MOG, a glycoprotein expressed on the outer membrane of myelin. It is solely found within the central nervous system in the brain, optic nerves and spinal cord. MOG antibody disease falls within the neuromyelitis optica spectrum disorders (NMOSD), however clinical characteristics appear distinct from aquaporin-4 antibody related disease and multiple sclerosis. It has predilection for causing recurrent optic neuritis and transverse myelitis. Accurate diagnosis is important to determine long term prognosis and suitable treatment. We describe the case of a 42 year old woman previously labelled as MS who demonstrated a variable presentation of MOG antibody disease.

Clinical and radiological profile of neuromyelitis optica spectrum disorders in an Ecuadorian cohort

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a complex disease characterized by a severe inflammation of the central nervous system (CNS). This disease typically manifests with recurrent optic neuritis (ON) and acute transverse myelitis (ATM). The clinical and radiological spectrum of NMOSD is little known in Latin America (LATAM) and few reports have been published in the literature so far. In Ecuador, no reports on NMOSD have been published. For this reason we aimed to assess the demographic, clinical and imaging characteristics of patients with NMOSD from third level hospitals from Ecuador. MethodsThis is a descriptive study in which we assessed medical reports of patients with inflammatory demyelinating diseases who were attended in third level hospitals from Ecuador in 2017. Then we applied the 2015 diagnostic criteria, those patients who met the new NMOSD diagnostic criteria were selected and analyzed. Additionally, exploratory sub-analyses were subsequently carried out. ResultsWe identified 59 patients with NMOSD, the relative frequency of NMOSD was 15.9%. The multiple sclerosis (MS) /NMOSD ratio was 5.2:1. Twenty four percent of patients were newly defined as having NMOSD when 2015 criteria was applied. The median time to diagnoses was shorter by the 2015 criteria than 2006 criteria (p<0.001). NMOSD was more prevalent in women (female/male ratio 4.4:1). The disease onset was more frequent at the fourth decade of life. The most common symptoms at the disease onset were ON and the association of ON with ATM. The mean of expanded disability status scale (EDSS) was 4.8 (SD±1.8). Concomitant autoimmune diseases were infrequent in this population (11.9%). The brain magnetic resonance imaging (MRI) abnormalities were present in 25.7% of patients at disease onset. Spinal cord MRI showed longitudinally extensive transverse myelitis (LETM) in 91.5% of cases. Recurrent NMOSD was frequent in this cohort (88%). Positivity for antibodies against aquaporin-4 (AQP4-IgG) which was measured through indirect immunofluorescence assay (IIF) was identified in 81% of the patients tested. Patients with seronegative AQP4-IgG had higher grade of disability than seropositive patients (p<0.05). Ninety eight percent of patients received treatment with immunosuppressive drugs. Three patients died due to gastric cancer (1 patient) and infectious diseases (2 patients). ConclusionsThis is the first descriptive study in an Ecuadorian cohort of patients with NMOSD. We show a wide epidemiological, clinical and radiological spectrum of NMOSD.

Anti-myelin oligodendrocyte glycoprotein antibody associated disease spectrum – A north Indian tertiary care centre experience and review of literature

IntroductionMOG antibody associated disease is a relatively new disorder for which the full clinical spectrum is being described and the literature is evolving. The current study outlines the observations on a cohort of patients diagnosed with this clinical entity. MethodsThis is a retrospective review of prospectively followed up patients with MOG antibody positive neurological illness. Case records of patients following up in neuroimmunology clinic of All India Institute of Medical Sciences(AIIMS), New Delhi from January 2007 to July 2019 were reviewed for MOG antibody positivity and those patients with positive antibody result were included in this study. FindingsA total of 20 patients were tested positive for MOG-IgG antibody. 75% were females. Median (Range) age was 30.5 years (8-58). Median disease duration was 22 months (1–139). Most common symptom at presentation was decrease in vision (unilateral or bilateral) (80%). Most common syndrome at onset was unilateral optic neuritis (ON) (40%) followed by bilateral ON (35%), transverse myelitis (TM)(15%), ON plus TM (5%) and cerebral syndrome (5%). Median number of demyelinating episodes per person was 2.5. Out of 29 affected eyes, 26 had good outcome. Out of 7 patients with motor disability, 5 patients had good outcome. ConclusionMOG antibody associated disease presents predominantly as recurrent ON, but may also present as an opticospinal, cerebral or brainstem syndrome and recurrent myelitis. Many of the patients had relapses, but had good outcomes with treatment.

Steroid resistant recurrent transverse myelitis in an elderly female with good response to plasma pheresis: A case report

Transverse myelitis is a rare disease involving inflammation of the spinal cord. It is estimated to have an incidence of 1.34 to 4.6 per million. It is more common in females and has a bimodal peak at 10–19 years old and 30–39 years old. It is monophasic but may become recurrent in some. Diagnostic criteria for the spectrum of diseases involving transverse myelitis is still evolving. Studies have shown an association between recurrent transverse myelitis, neuromyelitis optica spectrum and autoimmune antibodies associated with systemic lupus erythematosus (SLE) and other systemic autoimmune conditions. Management options for recurrent transverse myelitis include steroids, plasmapheresis, immunosuppressive antimetabolites and monoclonal antibody. We are presented now with an interesting case of recurrent transverse myelitis in an elderly female presenting with progressive weakness and numbness of the bilateral lower extremities. She tested positive for autoimmune antibodies anti-ssA and anti-dsDNA. She had disease progression despite management with intravenous steroids, hence was considered steroid-resistant. The patient responded well with six sessions of plasmapheresis.

Brain volume data in Brazilian patients with opticspinal and conventional multiple sclerosis

Opticspinal Multiple Sclerosis (OSMS) is a MS phenotype described in Asian population characterized nowdays by recurrent optic neuritis and transverse myelitis small spinal cord lesions and AQP4 – Ab negative. The objective of the study was to analyze and compare Brain MRI by MSmetrix reports in OSMS and Conventional MS patients (CMS) from Rio de Janeiro where the majority of the population is Afro descendent. 58 MS patients were scanned on HDxt GE 1,5 T. For each scanner a 3D T1 and 3D FLAIR were acquired and analysed blinded in icometrix platform. Data on whole brain volume (WBV), gray matter volume (GMV), total load volume 3DT1, 3DFLAIR image and white matter lesions segmentation were analyzed and compared blinded between OSMS and RRMS groups. OSMS and CMS groups had similar demographic and long term disability (Median EDSS <1.5). OSMS had a longer time of disease (19 versus 13 years) . As shown at Table 1, the total load volume 3DFLAIR and periventricular and deep white matter load lesions were significantly higher in CMS than OSMS. Periventricular lesions were identified in 100% of the participants but infratentorial lesions ocurred in 50% of OSMS and 27,9 of CMS and deep WM lesions in 100% of CMS and 30% of OSMS. Cerebral atrophy measured by the WBV and GMV not differed between the groups, however, the 3DT1 volume was significantly higher in CMS. MSmetrix records showed different T2 and T1 patterns of Brain lesions between OSMS and CMS.

Very late-onset recurrent myelitis in a patient diagnosed with antiphospholipid syndrome: A puzzle of autoimmunity

We describe the case of a man with a very-late onset neuromyelitis optica spectrum disorder syndrome (NMOSD) who was initially diagnosed as recurrent antiphospholipid syndrome-associated myelitis. This case illustrates that a puzzle of autoreactive antibodies can be detected in patients having neurological syndromes belonging to the NMOSD. Prompt identification and timely immunosuppression prevent relapses and the accumulation of irreversible disability.

Relapsing myelitis in patients with anti thyroid antibodies –Steroids may not be enough

Relapsing myelitis in patients with anti thyroid antibodies –Steroids may not be enough - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2019.012, IP Indian Journal of Neurosciences-IP Indian J Neurosci