Neuromyelitis Optica (MR).

MRI  BRAIN & ORBITS& CERVICAL CORD

PROTOCOL:

T1W – Sagittal & axial scans
T2W – Axial & coronal scans
FLAIR – Axial scans 

FINDINGS:

-Revealed:
• Abnormal signal intensity in the form of mirror distribution peri ventricular hemispheric confluent white matter lesions giving characteristic appearance of spilled ink pattern.
• Other lesions in the dorsum of pons and medulla oblongata.
• Aqueductal distribution.
• Multiple variables sized tiny corpus callosal lesions with heterogeneous signal leading to a marble pattern.
• Increased signal intensity of right optic nerve on T2 and Flair images.
• Abnormal faint increased T2 hyper intense signal over long distance of cervical cord (more than 3 segments giving what is known as extensive spinal cord lesion) and reaching the central part of the cord (MS tends to involve peripheral white matter tracts).
• Patchy cloud like enhancement after contrast administration in the spinal cord.

-Lateral and third ventricles are normal in size and position. Septum is in midline.  There is no midline shift.
-Basal cisterns, cortical sulci and gyri are normal in appearance.
-Fourth ventricle is normal in size and is midline in position.


OPINION:

-Extensive spinal cord lesion is characteristic of Neuromyelitis optica.
-Features helpful favoring NMO over Multiple sclerosis in this case are as mentioned below:
• Presence of peri ventricular / Aqueductal distribution of lesions.
• Absent Dawson’s fingers.
• More extensive involvement of corpus callosum giving marble appearance.
• Larger more confluent lesions.
• Lack of open ring enhancement.
• Lack of cortical grey white matter involvement.
     -Picture is suggestive of Neuromyelitis optica causing right optic nerve neuritis and cervical meylitis for     clinical correlation.


Reported By : DR.MOHAMMED MOHYELDIN
 Consultant-Radiologist
Report Status : Validated / Validated By :  Dr.Mohammed Mohyeldin 


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