陆军军医大学学报 (Jun 2024)
Myelin oligodendrocyte glycoprotein antibody-associated disease: a clinical analysis of 14 cases
Abstract
Objective To investigate the clinical and imaging characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Methods The clinical symptoms, MRI features, results of laboratory tests and clinical prognosis of 14 MOGAD patients who were hospitalized in our hospital from June 2016 to June 2022 were collected and retrospectively analyzed. Their clinical and imaging characteristics were summarized and discussed. Results Among the 14 enrolled patients, there were 10 males and 4 females, with a male to female ratio of 2.5∶1. Their age of first onset was 45 years in 3 cases. Optic neuritis (10/14, 71.43%) was the most common clinical type, followed by encephalitis or meningoencephalitis (9/14, 64.29%), brainstem encephalitis (5/14, 35.71%) and myelitis (5/14, 35.71%). Visual impairment (10/14, 71.43%) was the most common clinical symptom, followed by headache in 8 cases (8/14, 57.14%), fever in 6 cases (6/14, 42.86%), dizziness in 6 cases (6/14, 42.86%), parethesia in 5 cases (5/14, 35.71%), and seizures, limb paralysis, sphincter dysfunction, ataxia, and vomit were all in 4 cases (4/14, 28.57%). Four patients (4/14, 28.57%) had a history of upper respiratory tract infection before MOGAD onset. There were 10 patients undergoing cerebrospinal fluid (CSF) test, and 8 of them had abnormal results, including 2 patients (2/10, 20%) of increased pressure, 8 patients (8/10, 80%) of larger WBC count in CSF, and 5 patients (5/10, 50%) of elevated total protein in CSF. MRI displayed multiple lesion involvement, and there were 7 cases (7/14, 50.00%) in cortical/subcortical white matter, 6 cases in brainstem (6/14, 42.86%), 5 cases in optic nerve (5/14, 35.71%), 4 cases in spinal cord (4/14, 28.57%). The hippocampus, thalamus, basal ganglia, and paraventricular white matter were involved in 3 cases (3/14, 21.43%), respectively, and the cerebellum and corpus callosum were in 2 cases (2/14, 14.29%), respectively. MRI lesions demonstrated patchy hyperintensity on T2 WI and T2 FLAIR, with patchy, nodular and linear enhancement. Among the 10 patients undergoing visual evoked potential (VEP) test, abnormalities were detected in 9 cases (9/10, 90%), and 8 (8/10, 80%) had bilateral visual pathway abnormalities. Eight patients (8/14, 57.14%) experienced relapse and remission course. Both methylprednisolone pulse therapy and immunoglobulin modulation therapy were effective in the acute phase. Five patients with relapsed remission presented a significant reduction in recurrence after immunosuppressants. Conclusion MOGAD is manifested with various clinical features, with vision loss, headache, fever and dizziness more common. MRI lesions of MOGAD involve cerebral cortex, subcortical white matter, brainstem, and optic nerve, etc. Patchy hyperintesive signals are observed on T2WI and T2 FLAIR, and some lesions can be enhanced. Corticosteroid pulse therapy and immunoglobulin therapy show effective treatment in the acute phase, and immunosuppressants in the remission phase can reduce relapse.
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