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Extensive vasogenic edema of anti-aquaporin-4 antibody-related brain lesions

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

N Isobe

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

T Matsuoka

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

T Ishizu

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Y Kawano

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

T Yoshiura

Division of Neuroradiology, Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Y Ohyagi

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

J Kira

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japankira{at}neuro.med.kyushu-u.ac.jp

Objective

Using neuroimaging, we analyzed the nature of extensive brain lesions in five anti-aquaporin-4 (AQP4) antibody-positive patients with neuromyelitis optica spectrum disorders.

Results

Extensive brain lesions involved white matter in three, and basal ganglia and corpus callosum in one each. Four patients showed high diffusivity on apparent diffusion coefficient maps and three demonstrated increased choline/creatine ratios and decreased N-acetyl-aspartate/creatine ratios on ¹H-magnetic resonance spectroscopy. These findings suggested that the lesions were vasogenic edema associated with inflammation. Unusual brain symptoms associated with such lesions included recurrent limbic encephalitis, parkinsonism, and coma.

Conclusion

Anti-AQP4 antibody is considered to be associated with the neuroimaging appearances of vasogenic edema.

Key Words: aquaporin-4 • diffusion-weighted image • MRI • MRS • neuromyelitis optica • vasogenic edema

This version was published on September 1, 2009

Multiple Sclerosis, Vol. 15, No. 9, 1113-1117 (2009)
DOI: 10.1177/1352458509106613


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