We discussed a case of a young female who had prodromal viral illness with subsequent acute onset right internuclear ophthalmoplegia, R optic neuritis, facial numbness, left UE/LE weakness and loss of sensation that quickly progressed to her right UE/LE involvement with urinary and bowel retention. Brain MRI showed hyperintensity on T2/FLAIR in the pons without restricted diffusion; Spine MRI w wo con showed diffuse cord signal abnormality with enhancement and cord expansion throughout the cervical/thoracic/lumbar spine. LP showed lymphocytic pleocytosis. Her “MOG” Antibodies returned >1:2560 with negative oligoclonal bands and negative paraneoplastic workup.
Ddx for acute myelopathy from immune-mediated neuroinflammatory causing demyelination
- AQP4-NMOSD (Neuromyelitis optica spectrum disorder)
- Multiple Sclerosis
Sx of MOGAD
- MOGAD often presents w/ optic neuritis. So consult ophtho!
Treatment of MOGAD
- She received high dose steroids and plasma exchange with full recovery of motor and sensory function