Clinical imaging correlations in Neuromyelitis Optica Spectrum Disorders

Abstract

Background. Neuromyelitis Optica Spectrum Disorders (NMOSD) are antibody-mediated diseases against aquaporin-4 (AQP-4) that result in autoimmune disorders of the central nervous system. The main clinical findings in NMSOD+AQP-4 include optic neuritis and myelitis. To support these clinical presentations, we look for MRI findings of lesions, inflammations, and edema in the optic nerve, spinal cord, brainstem, etc. Purpose of study. To understand the correlations between clinical manifestations in patients with NMSOD and cerebral and spinal cord MRI. Material and methods. This literature review uses relevant articles from the National Library of Medicine, PubMed, and Neural Regeneration Research. Results. The most frequent symptom, optic neuritis, involves different severity levels of loss of vision, pain due to eye movement, dyschromatopsia that can be explained by the bilateral lesion, and atrophy of the optic nerve along with the optic chiasm. Acute myelitis is identified by the presence of motor and sensory es like numbness, spasms in the limbs, loss of bladder control, sexual dysfunctions, etc. This is influenced by lesions that descend from the corticospinal tract in the white matter towards the midbrain and damage the pyramidal tracts. Area postrema near the 4th ventricle is believed to be the crucial point of attack in NMOSD and a portal for entry for the circulation of the antibodies, which manifest clinically as persistent hiccups, nausea, and vomiting. The presence of a brain stem lesion seen in the MRI causes damage to the cranial nerve plexuses, leading to muscle numbness and ataxia. Conclusion. The crucial factor in identifying NMOSD clinically is to understand the symptoms, signs, and MRI that frequently show bilateral and longitudinal injury of the optic nerve, optic chiasm, area postrema, and injury of the spinal cord, with the lesions involving multiple vertebral segments.