EURORAD ESR

Case 15896

Neuromyelitis optica

Author(s)
C. Brito, P. Vilela

Hospital Beatriz Ângelo, Serviço de Imagiologia, Neurorradiologia; Av. Carlos Teixeira 514, Loures, Portugal; Email:ferrovilela@sapo.pt
 
Patient
female, 35 year(s)
 
 
  • Figure 1
    Head CT

    The initial head CT scan shows a hypodense diencephalic lesion

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 2
    MRI

    The initial MRI scan demonstrates a T2 hyperintense diencephalic lesion, surrounding the third ventricle and involving hypothalamus

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 3
    MRI

    Axial FLAIR: Note the diencephalic lesion, surrounding the third ventricle and involving hypothalamus

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 4
    MRI

    Post contrast T1WI: The lesion had no contrast enhancement.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 5
    MRI

    Sagital T2WI shows a posterior medulla lesion and LETM extending from C4 to Th3. Note also the bright spotty lesion at C7 level, which helps to differentiate patients with NMOSD from those with MS. [5]

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 6
    MRI

    Axial T2WI demonstrates a T2 hyperintense lesion involving the posterior medulla.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 7
    MRI

    Axial T2WI at the C4–C5 level shows a bright spotty spinal cord lesion.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 8
    MRI

    Axial post contrast T1WI at the C4–C5 level shows the spinal cord lesion had no contrast enhancement.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 9
    MRI before and after treatment
     

    MRI before (A and B) and after 1 month (C and D) of treatment. The patient was treated with high-dose steroid therapy and started long-term immunosuppression treatment with azathioprine, with significant clinical...

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    MRI before (A and B) and after 1 month (C and D) of high-dose steroid treatment documented favourable evolution with significant decrease of the lesions sizes.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    MRI before (A and B) and after 1 month (C and D) of high-dose steroid treatment documented favourable evolution with significant decrease of the lesions sizes.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    MRI before (A and B) and after 1 month (C and D) of high-dose steroid treatment documented favourable evolution with significant decrease of the lesions sizes.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
The initial head CT scan shows a hypodense diencephalic lesion
 
The initial MRI scan demonstrates a T2 hyperintense diencephalic lesion, surrounding the third ventricle and involving hypothalamus
 
Axial FLAIR: Note the diencephalic lesion, surrounding the third ventricle and involving hypothalamus
 
Post contrast T1WI: The lesion had no contrast enhancement.
 
Sagital T2WI shows a posterior medulla lesion and LETM extending from C4 to Th3. Note also the bright spotty lesion at C7 level, which helps to differentiate patients with NMOSD from those with MS. [5]
 
Axial T2WI demonstrates a T2 hyperintense lesion involving the posterior medulla.
 
Axial T2WI at the C4–C5 level shows a bright spotty spinal cord lesion.
 
Axial post contrast T1WI at the C4–C5 level shows the spinal cord lesion had no contrast enhancement.
 
MRI before (A and B) and after 1 month (C and D) of treatment. The patient was treated with high-dose steroid therapy and started long-term immunosuppression treatment with azathioprine, with significant clinical and radiological improvement.
 
MRI before (A and B) and after 1 month (C and D) of high-dose steroid treatment documented favourable evolution with significant decrease of the lesions sizes.
 
MRI before (A and B) and after 1 month (C and D) of high-dose steroid treatment documented favourable evolution with significant decrease of the lesions sizes.
 
MRI before (A and B) and after 1 month (C and D) of high-dose steroid treatment documented favourable evolution with significant decrease of the lesions sizes.
 
 
 
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