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Neurological picture
Unusual radiological features on diffusion-weighted imaging in myelin oligodendrocyte glycoprotein-associated disease
  1. Eoin O'Sullivan1,
  2. Jonathan Hart2,
  3. Adam Bates3,
  4. Jacqueline Palace4
  1. 1 Eye Unit, King's College Hospital, London, London, UK
  2. 2 Department of Neuroradiology, King's College Hospital, London, UK
  3. 3 Eye Department, Maidstone Hospital, Maidstone, Kent, UK
  4. 4 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, Oxfordshire, UK
  1. Correspondence to Mr Eoin O'Sullivan, Eye Unit, King's College Hospital, London, London, UK; eoin.o'sullivan{at}nhs.net

https://doi.org/10.1136/jnnp-2020-325151

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    We report an unusual radiological appearance in a patient with myelin oligodendrocyte glycoprotein-associated disease (MOGAD).1 A 53-year-old Caucasian man presented with a 2-week history of pain on eye movements and a 1-week history of reduced vision. The patient had a history of tuberculosis as a child and hypertension. Optic nerve function was markedly reduced with acuities of counting fingers in the right eye and only perception of light in the left. His optic discs were swollen with some right peripapillary haemorrhage. There were no other neurological features of note.

    Investigations including full blood picture, renal and liver profiles, B12, folate and serum ACE were normal. His CRP was less than 2.0 mg/L. Tests for HIV, Varicella Zoster Virus, Cat scratch disease, Lyme disease and syphilis were negative. His initial MRI scan was performed without dedicated orbital images or Gadolinium-based contrast. As such the views of the optic nerves on …

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    Footnotes

    • Contributors All authors met the criteria outlined below.Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JP is partly funded by highly specialised services to run a national congenital myasthenia service and a neuromyelitis service. She has received support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Chugai Pharma and Bayer Schering, Alexion, Roche, Genzyme, MedImmune, EuroImmun, MedDay, Abide ARGENX, UCB and Viela Bio and grants from Merck Serono, Novartis, Biogen Idec, Teva, Abide, MedImmune, Bayer Schering, Genzyme, Chugai and Alexion. She has received grants from the MS society, Guthrie Jackson Foundation, NIHR, Oxford Health Services Research Committee, EDEN, MRC, GMSI, John Fell, Myaware and AMPLO for research studies. EO has received an honorarium from Roche.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.