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Case Reports
. 2022 Dec 1;61(23):3585-3588.
doi: 10.2169/internalmedicine.9439-22. Epub 2022 May 7.

FLAMES with Elevated Myelin Basic Protein Followed by Myelitis

Hiroyuki Hokama  1 , Yuki Sakamoto  1 , Toshiyuki Hayashi  1 , Seira Hatake  1 , Mizuho Takahashi  1 , Hiroto Kodera  1 , Akihito Kutsuna  1 , Chikako Nito  1 , Shunya Nakane  1 , Hiroshi Nagayama  1 , Toshiyuki Takahashi  2   3 , Kazumi Kimura  1
Affiliations
Case Reports

FLAMES with Elevated Myelin Basic Protein Followed by Myelitis

Hiroyuki Hokama et al. Intern Med. .

Abstract

The pathophysiology of unilateral cortical fluid-attenuated inversion recovery (FLAIR)-hyperintense lesions in anti-myelin oligodendrocyte glycoprotein (MOG)-associated encephalitis with seizures (FLAMES) is unclear. A 26-year-old man was referred because of a seizure. FLAIR showed an increased signal intensity and swelling of the right frontal cortex. His symptoms and imaging abnormalities were improved after intravenous methylprednisolone therapy. MOG antibody was detected both in serum and cerebrospinal fluid (CSF). Therefore, the patient was diagnosed with FLAMES. Myelin basic protein (MBP) was elevated in CSF. The high MBP value in the CSF in the present case suggested that demyelination as well as inflammation can occur in some FLAMES patients.

Keywords: encephalitis; myelin basic protein; myelin oligodendrocyte glycoprotein antibody; myelitis; seizure.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure.
Figure.
Serial brain and cervical magnetic resonance imaging (MRI) findings. (A) Brain MRI at a local hospital; diffusion-weighted imaging (DWI, left panel), fluid-attenuated inversion recovery (FLAIR, center panel), and T1-weighted imaging (T1-WI) with gadolinium injection (right panel). MRI shows increased signal intensity and swelling in the right frontal cortex on FLAIR with enhancement on T1-WI with gadolinium injection (arrows). (B) Brain MRI on Day 16. After high-dose methylprednisolone therapy, the hyperintense signal and swelling on FLAIR are ameliorated, and no gadolinium-enhanced lesion is seen on T1-WI. (C) About 2.5 months later, cervical MRI shows a hyperintense lesion of the cervical cord (arrowheads).
See this image and copyright information in PMC

References

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