The Spectrum of Brain MRI Abnormalities in Neuromyelitis Optica Spectrum Disorders (P4.009)

OBJECTIVE: To investigate brain MRI abnormalities in patients with Neuromyelitis Optica spectrum disorders (NMOSD). BACKGROUND: Although brain involvement of NMOSD has been increasingly recognized, the spectrum and frequency of brain MRI abnormalities have not been well characterized. METHODS: We retrospectively reviewed clinical records and MRI brain imaging data of 35 patients diagnosed as Neuromyelitis optica (NMO) or NMOSD with positive AQP4-IgG at University of Mississippi Medical Center from 2004 to 2013. The spectrum and frequency of brain MRI abnormalities were analyzed. Brain lesions were classified as “NMO-distinctive” lesions, multiple sclerosis (MS)-like lesions or non-specific white matter lesions. RESULTS: Of the 35 AQP4-IgG positive patients, 31 (88.6 %) were female and 32 (91.4%) were African-American. Mean age of onset was 31.9 (12-78) years old. Brain MRI abnormalities were detected in 30 (85.7 %) of the 35 patients. Of the 30 patients with brain MRI abnormalities, 19 (63%) had “NMO-distinctive” lesions, including: periependymal lesions in area postrema, periaqueductal area, hypothalamus, around lateral ventricles, and undersurface of corpus callosum (12/30, 40%); medullary-cervical junction lesions (10/30, 30%); lesions Involving the corticospinal tracts (7/30, 23.3%); large, edematous lesions (6/30, 20%); as well as lesions involving the optic tracts (4/30, 13.3%). 11 (36.7%) of the 30 patients with brain MRI abnormalities had white matter lesions compatible with the 2010 McDonald MRI criteria for demonstration of dissemination in space. 10 (33.3%) of the 30 patients had non-specific white matter lesions. Coexisting of two lesion types at the same time or at different time points was detected in 30% of the patients with brain MRI abnormalities. CONCLUSIONS: Brain MRI abnormalities are very common in patients with NMOSD. It is important to recognize the NMO “distinctive” lesions to ensure early diagnosis and treatment. MS-like lesions in patients with NMOSD are much more common than expected. Study Supported by:none Disclosure: Dr. Huang has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. McDonald has nothing to disclose. Dr. Vedanarayanan has nothing to disclose. Dr. Parker has nothing to disclose. Dr. Corbett has received personal compensation in an editorial capacity for The Neurologist. Dr. Herndon has received personal compensation for activities with Biogen Idec, and Bayer Pharmaceuticals Corp. Dr. Herndon holds stock and/or stock options in Novartis.