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Case No. 725
2025-07-01~2025-07-31
출제자 : 서배선
Hit : 483
| Period | 2025-07-01~2025-07-31 |
|---|---|
| Diagnosis | Myelin oligodendrocyte glycoprotein antibody–associated transverse myelitis |
| Gender |
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| Age | 13 |
| Clinical information | M/13 Lower limb weakness, urinary retention, ataxia, positive romberg test What is your diagnosis? |
| Discussion | Sagittal T2WI demonstrated a longitudinally extensive hyperintense lesion involving nearly the entire spinal cord. No contrast enhancement was observed. On axial T2WI, the hyperintensity was more prominent in the gray matter. Diffusion-weighted imaging (DWI) showed no evidence of diffusion restriction. The patient tested positive for serum myelin oligodendrocyte glycoprotein (MOG) antibodies and was diagnosed with MOG-associated disease (MOGAD). MOGAD represents a group of inflammatory demyelinating disorders characterized by the presence of IgG antibodies to MOG. Transverse myelitis is the second most common clinical manifestation in MOGAD. Characteristic spinal MRI findings include: Pseudodilatation of the central canal: sagittal T2-hyperintense linear signal surrounded by more hazy T2 hyperintensity in the anterior and posterior gray matter horns H-sign: central T2 hyperintensity on axial imaging, confined to the gray matter, often lacking gadolinium enhancement. Two different patterns depending on the length of involvement: longitudinally extensive transverse myelitis (LETM) or short segment involvement. Contrast enhancement can be observed in some cases Reference) 1. Shahriari M, Sotirchos ES, Newsome SD, Yousem DM. MOGAD: How It Differs From and Resembles Other Neuroinflammatory Disorders. AJR Am J Roentgenol. 2021 Apr;216(4):1031-1039. 2. Zhang L, Feng C, He L, Huang SY, Liu XY, Fan X. MOG-antibody-associated transverse myelitis with the H-sign and unusual MRI enhancement: a case report and literature review. Front Pediatr. 2024 Sep 10;12:1451688. |
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