case_images: PMC7605028_01
case_images: Brain MRI performed during acute attack. Axial FLAIR (a-j) and T2-weighted (k-t) images show multifocal round or oval hyperintense lesions in the left cerebellar peduncles (a, k), the temporal horn of the left lateral ventricle (b, c, l, m), brainstem (b-e, l-o), the left occipital lobe (d, n), the right thalamus (e, f, o, p), the right insular subcortical and the left insular juxtacortical regions (f, p), bilateral frontal and parietal lobes (i, j, s, t), periventricular white matter (f-h, p-r), and the body and splenium of the corpus callosum (g, h, q, r).. MRI, magnetic resonance imaging.
case_images: 10.1177_1756286420969462-fig1.jpg
case_images: PMC7605028_01_10.1177_1756286420969462-fig1.jpg
case_images: fig1-1756286420969462
case_images: Magnetic resonance imaging (MRI) revealed multifocal round or oval lesions scattered in bilateral frontal and parietal lobes, the left occipital lobe, the right insular subcortical and the left insular juxtacortical regions, as well as periventricular white matter, the body and splenium of the corpus callosum, thalamus, periaqueductal gray matter, brainstem, the left cerebellar peduncles, and cervical and thoracic spinal cord, as manifested with hypointensity on T1-weighted images, and hyperintensity on both T2-weighted and fluid attenuated inversion recovery (FLAIR) images (Figures 1 and 2). Gadolinium (Gd)-enhanced MRI showed heterogenous patchy or ring-like enhancement in the majority of lesions (Supplemental Figure S1).
case_images: Spinal cord MRI performed during acute attack. T2-weighted sagittal cervical (a) and thoracic (b) spinal cord images show short-segment hyperintense lesions with well-defined borders (arrows). Axial cervical spinal cord image shows one lesion involving the anterior white matter and the lateral column (a', arrow), and thoracic spinal cord image shows one lesion involving the central gray matter (b', arrow). No lesions are seen in lumbar spinal cord images (c, c').. MRI, magnetic resonance imaging.
case_images: 10.1177_1756286420969462-fig2.jpg
case_images: PMC7605028_01_10.1177_1756286420969462-fig2.jpg
case_images: fig2-1756286420969462
case_images: Magnetic resonance imaging (MRI) revealed multifocal round or oval lesions scattered in bilateral frontal and parietal lobes, the left occipital lobe, the right insular subcortical and the left insular juxtacortical regions, as well as periventricular white matter, the body and splenium of the corpus callosum, thalamus, periaqueductal gray matter, brainstem, the left cerebellar peduncles, and cervical and thoracic spinal cord, as manifested with hypointensity on T1-weighted images, and hyperintensity on both T2-weighted and fluid attenuated inversion recovery (FLAIR) images (Figures 1 and 2).
case_images: Detection of MOG-IgG and Caspr2-IgG by transfected CBA. Representative photographs (x400) show positive MOG-IgG in CSF (a; titer, 1:1) as well as positive Caspr2-IgG in both serum (b; titer, 1:100) and CSF (c; titer, 1:1).. Caspr2-IgG, antibodies against contactin-associated protein-like 2; CBA, cell-based assay; MOG-IgG, antibodies against myelin oligodendrocyte glycoprotein.
case_images: 10.1177_1756286420969462-fig3.jpg
case_images: PMC7605028_01_10.1177_1756286420969462-fig3.jpg
case_images: fig3-1756286420969462
case_images: CSF. Cell-based assays (CBA) revealed that serum MOG-IgG was negative while CSF MOG-IgG was positive with a low titer of 1:1 (Figure 3a). Unexpectedly, but interestingly, Caspr2-IgG was positive both in serum and CSF with titers of 1:100 and 1:1, respectively (Figure 3b and c).