Retrospective Study of Magnetic Resonance Imaging of the Brain and Spine in Neuromyelitis Optica

Objectives: A retrospective MRI study of rare demyelinating disease neuromyelitis optica (NMO). Monitoring differences in multiple sclerosis are addressed as a diagnostic issue. Patients and methods: A cohort of 8 patients with a diagnosis of NMO (7 satisfying the 2006 Wingerchuk criteria, one with lupus erythematodes, high risk, all of them NMO-IgG seropositive) was evaluated by means of MRI. Patients were considered in terms of four groups: MS-like, atypical, nonspecific and with normal brain imaging. MRI findings were evaluated on initial and repeated examinations. Results: 4 patients had a spinal cord lesion extending over more than 3 segments, 3 in the cervical spine, with typical signal intensity. Pathological MRI brain findings were found in 2 patients on initial examination and in 5 patients in the course of repeated examinations (lesion in medulla prevailed). MS-like lesions, however not satisfying the Barkhof criteria, were found in 2 patients. One patient had negative MRI brain and spine findings. Conclusions: Brain MRI findings are not always negative for NMO disease. There are even localizations typical of it (lesion in lower medulla in continuity with the cervical cord). If MRI findings for NMO patients are similar to MS findings, Barkhof criteria are not usually satisfied. MRI findings in the spine depend on correct timing with acute myelitis; this may be a reason for non-satisfaction of the size criterion for intramedullar lesion.