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- W2884311688 abstract "Objective: To present diffusion weighted imaging (DWI) findings in a patient with longitudinally extensive transverse myelitis (LETM). Background: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease due to antibodies against aquaporin-4 (AQP4) channels. NMO characteristically affects the optic nerve and spinal cord. LETM is the imaging hallmark of NMO. Acutely, lesions are hypointense on T1 and contrast enhance in 33–71% of patients. DWI patterns of LETM in NMO have not been well described. Literature review suggests optic neuritis in NMO can demonstrate restricted diffusion, whereas optic neuritis from other causes does not. Limited data on DWI patterns in spinal cord lesions suggest that apparent diffusion coefficient (ADC) values are significantly higher in inflammatory lesions than in infarcts and in health controls. Design/Methods: Case report. Results: A 56 year old woman with systemic lupus erythematosus, end-stage renal disease on hemodialysis, a mechanical mitral valve on warfarin, and a prior cardioembolic stroke presented with four days of progressive neurologic symptoms. Examination revealed bilateral lower extremity spastic paraplegia, mild right arm weakness sparing wrist extension, and a sensory level to T4 on the right and T6 on the left. Pulse steroids were started empirically without improvement. Lumbar puncture could not be performed acutely due to INR >2.0. Non-contrast MRI of the cervical and thoracic spine revealed centrally located T2W hyperintense signal with high DWI and low ADC signal from C1-T9. Although DWI findings suggested spinal cord infarction, plasmapheresis was initiated, despite the risk of worsening symptoms if caused by infarction. Seven days later, anti-AQP4 antibody returned positive (titer >40; positive >3.0, Quest). Conclusions: Limited data exist on DWI and ADC patterns in demyelinating disease, particularly for NMO and LETM. Understanding these neuroimaging patterns in patients who cannot receive gadolinium is important in diagnosing NMO and providing prompt treatment. Disclosure: Dr. Gluck has nothing to disclose. Dr. Vollbracht has received personal compensation for activities with Teva as a speaker." @default.
- W2884311688 created "2018-08-03" @default.
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- W2884311688 date "2017-04-18" @default.
- W2884311688 modified "2023-09-28" @default.
- W2884311688 title "Diffusion Weighted Imaging in a Case of Longitudinally Extensive Transverse Myelitis in Neuromyelitis Optica (P6.395)" @default.
- W2884311688 hasPublicationYear "2017" @default.
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