Variability In The Brain Lesion In A Patient With Neuromyelitis Optica Spectrum Disorder

Background: Since the discovery of the antibody Aquaporin water channel 4 (anti AQP4) the definition Neuromyelitis Optica changed to Neuromyelitis Optica Spectrum Disorder. Brain lesions are often described on BMRI with configuration and location characteristics in this pathology. Objective: To show BMRI lesions at different times of disease evolution with different configuration and location for its evolution of 10 years. Clinical case: 55 year old women diagnosed with Multiple Sclerosis. Treated with Interferon Beta 1b then changed to Natalizumab. After 24 months she suffered a relapse with aphasia, unconsciousness, dysarthria, left hemiparesis. JC Virus PCR Negative. Anti AQP4 positive. NMOSD diagnostic and treatment began with plasmapheresis and Azathioprine. A year later she presented a new relapse and started taking Mycophenolate mofetil. BRMI showed at the beginning (2004) focal lesions hyperintense on T2 FLAIR sequences, partially irregular periventricular and juxtacortical margins. November 2011 T2 FLAIR hyperintense wide lesions in the bilateral parietal and occipital region. New deep white matter, bilateral, frontoparietal, juxtacortical lesions. March 2012 resembled significant improvement in January 2014. T2 FLAIR hyperintense pseudotumoral lesions in thalamus, internal capsule and cerebral peduncles. Diffuse recurrence of lesions located in deep white matter in December 2014 FLAIR hyperintense T2 lesions, pseudotumorals and irregular edges in bilateral frontal and parietal region, one in the right cerebellar hemisphere. Conclusion: In this patient diagnosed with NMOSD, we observe change in the configuration and location in BRMI lesions, which changed drastically in the course of the disease.