Brain MRI Study in Thai Patient with Neuromyelitis Optica
Pattaranun Sangwirotekun MD1, Oranan Tritanon MD2, Panitha Jindahra MD, PhD, MRCP1, Teeratorn Pulkes MD, PhD1,
Disya Ratanakorn MD1, Pairoj Boonkongchuen MD1, Charungthai Dejthevaporn MD, PhD1,
Jesada Keandoungchun MD1, Pisit Preechawat MD3, Anuchit Poonyathalung MD3,
Metha Apiwattanakul MD4, Jiraporn Laothamatas MD5, Supoch Tunlayadechanont MD1
Affiliation :
1 Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2 Division of Diagnostic Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
3 Department of Ophthamology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
4 Neuroimmunology Department, Prasat Neurological Institute, Bangkok, Thailand
5 Advanced Diagnostic Imaging Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Neuromyelitis optica spectrum disease [NMOSD] is an in(cid:976)lammatory disease of the central nervous system involving
optic nerve, spinal cord, and brain. Asymptomatic brain abnormalities were recorded in some countries but the data in Thailand
were limited.
Objective : To evaluate asymptomatic NMOSD brain abnormalities and their relation to clinical relapses in Thai patients.
Materials and Methods : This was a retrospective study, recruiting 27 NMOSD patients in a tertiary care center in Thailand. All
patients were seropositive for aquaporin-4 IgG. Magnetic resonance imaging [MRI] of the brain was performed in every case.
Results : Twenty-four cases (88.89%) had asymptomatic hyperintensities on (cid:976)luid-attenuated inversion recovery images [FLAIR].
These lesions were widespread across the brain even in areas with low density of aquaporin-4. To our knowledge, a fornix lesion
was reported for the (cid:976)irst time in a patient with acute optic neuritis. By using linear regression analysis, no signi(cid:976)icant correlation
between annual relapse rate [ARR] and the number of asymptomatic FLAIR hyperintensities was established (coef(cid:976)icient 0.02, 95%
con(cid:976)idence interval -0.0009 to 0.04, p = 0.06).
Conclusion : Asymptomatic FLAIR hyperintensities on brain MRIs are frequently found in NMOSD. They may not correlate with
clinical relapses. Further cohort studies are required. To our knowledge, this is the (cid:976)irst report of a fornix lesion in a NMOSD patient
presented with acute optic neuritis.
Keywords : Neuromyelitis optica spectrum disease, Optic neuritis, Transverse myelitis, Aquaporin-4 IgG, Asymptomatic brain
abnormalities, Fornix lesion
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