Authors: Dr Deepinder Kaur Maini , Dr Rajiv Anand , Dr Shashank Raj , Dr Varun Rehani

Abstract

Background: Brain and spine MRI in NMOSD is well described in the diagnostic criteria of Wingherchuk 2015 criteria. However, despite this the pattern of lesion remains incomprehensive.
Case presentation: We report the case of a 65-year-old female with acute onset of drowsiness, dysphagia, aphasia and respiratory distress. Brain and spine MRI showed extensive white matter lesions in subcortical area and cystic lytic patchy lesions in spine. Extensive blood work up was conclusive of anti AQP4 IgG positive suggestive of NMOSD.
Conclusion: The bilateral extensive white matter lesions (EWML) are rare presentation in NMO disorders which may mimic adult leukodystrophy. This feature can be considered as a radiological marker for future references.  

Keywords: NMOSD, CNS demyelinating disease, AQ4 positive,