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Case Reports
. 2022 Oct 19;9(6):e200020.
doi: 10.1212/NXI.0000000000200020. Print 2022 Nov.

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Intracranial Hypertension: A Case Report

Jaydip Ray Chaudhuri  1 , Jui Jade Bagul  2 , Alluri Swathi  2 , Bhim Sen Singhal  2 , N Chakradhar Reddy  2 , Kiran Kumar Vallam  2
Affiliations
Case Reports

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Intracranial Hypertension: A Case Report

Jaydip Ray Chaudhuri et al. Neurol Neuroimmunol Neuroinflamm. .

Abstract

The production of autoantibodies against myelin oligodendrocyte glycoprotein (MOG) can cause a spectrum of autoimmune disorders, including optic neuritis, transverse myelitis, brainstem encephalitis, and acute disseminated encephalomyelitis. In this study, we present the case of a 19-year-old woman with an unusual clinical presentation of intracranial hypertension (IH) and bilateral papilledema. The patient presented with symptoms of increased intracranial pressure, which followed a relapsing, remitting course over several months. Serial CSF studies showed an increased opening pressure during clinical relapses. The CSF and serum tested positive for MOG immunoglobulin G antibodies. Contrast-enhanced MRI of the brain showed mild meningeal enhancement in the left parietal region with subtle underlying cortical hyperintensities, indicating possible fluid-attenuated inversion recovery variable unilateral enhancement of the leptomeninges. The patient responded well to immunosuppressive therapy using rituximab. The presentation of MOG antibody-associated disease (MOGAD) as IH without optic neuritis is rare. This report presents the first description of a relapsing remitting course presenting each time with only symptoms of raised intracranial pressure, without developing any typical clinical manifestations of MOGAD.

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Figures

Figure 1
Figure 1. MRI Brain FLAIR and Contrast
(A) Abnormal leptomeningeal enhancement along the left temporoparietal cortical sulci. (B) Fluid-attenuated inversion recovery (FLAIR) image showing minimal hyperintensity of the adjoining cortex.
Figure 2
Figure 2. Flowchart of the Clinical Course of Patient Treatment
MMF = mycophenolate mofetil; MOG = myelin oligodendrocyte glycoprotein.
See this image and copyright information in PMC

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