Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan; Department of Neurology, Saiseikai Matsuyama Hospital, Ehime, Japan.
Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan.
Mult Scler Relat Disord. 2019 Jun;31:62-64. doi: 10.1016/j.msard.2019.03.018. Epub 2019 Mar 26.
A 20-year-old woman suffered right facial paralysis. The patient showed an abnormality in the perception of speech at an age of 25 years. At an age of 32 years, she developed acute headache and fever. Brain magnetic resonance imaging (MRI) showed an expanded high signal intensity lesion with gadolinium enhancement in the white matter of the left frontal lobe, which was suggestive of tumefactive demyelinating lesion (TDL). A brain tumor was suspected because TDL is a large demyelinating brain lesion mimicking a primary brain tumor. After initiation of steroid therapy, the symptoms and MRI abnormalities improved. At an age of 34 years, she was referred to our hospital with the main complaint of weakness of lips on the left side. Brain MRI showed hyperintense lesions involving the left frontal and the right parietal white matter lobes, and the left ventrolateral pons, which was suggestive of acute disseminated encephalomyelitis (ADEM). Analysis of anti-MOG antibodies identified anti-MOG antibodies both in the serum and in the CSF. Steroid therapy led to complete clinical recovery. MOG antibodies in both serum and CSF were negative six months after the previous measurement. The patient fulfilled the diagnostic criteria for multiple sclerosis (MS) and TDL is one of the rare variants of MS. This study suggests that anti-MOG antibodies can be associated with repetitive encephalitis including TDL and ADEM-like presentation.
一位 20 岁女性出现右侧面瘫。患者在 25 岁时出现言语感知异常。32 岁时，她出现急性头痛和发热。脑磁共振成像（MRI）显示左额叶白质内扩展的高信号强度病变，伴钆增强，提示肿块样脱髓鞘病变（TDL）。由于 TDL 是一种类似于原发性脑肿瘤的大脱髓鞘脑病变，因此怀疑为脑肿瘤。开始类固醇治疗后，症状和 MRI 异常改善。34 岁时，她因左侧嘴唇无力为主诉就诊于我院。脑 MRI 显示累及左侧额叶和右侧顶叶白质以及左侧桥外侧面的高信号病变，提示急性播散性脑脊髓炎（ADEM）。抗 MO G 抗体分析发现血清和脑脊液中均存在抗 MO G 抗体。类固醇治疗导致完全临床康复。上次测量后 6 个月，血清和脑脊液中的 MOG 抗体均为阴性。该患者符合多发性硬化症（MS）的诊断标准，TDL 是 MS 的罕见变异之一。本研究表明，抗 MO G 抗体可能与包括 TDL 和 ADEM 样表现在内的复发性脑炎有关。
