Investigation into the casual or causal association of cerebral venous thrombosis and myelin oligodendrocyte glycoprotein antibody‑associated disease: A case report and literature review

Abstract

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a central nervous system demyelinating syndrome (DS) typically presenting with optic neuritis or myelitis. The association between cerebral venous thrombosis (CVT) and demyelinating diseases, including multiple sclerosis (MS), is rare. In the present study, a 37-year-old man presented with sensory disturbances in the lower limbs and urinary incontinence, consistent with myelitis. The diagnosis of MOGAD was confirmed by spinal magnetic resonance imaging findings and serum anti-MOG antibody positivity using a cell-based assay. The patient responded successfully to intravenous corticosteroid therapy. However, shortly after recovery, the patient developed a persistent headache and suffered an epileptic seizure, which was later attributed to CVT. The patient was treated with low molecular weight heparin and lacosamide and subsequently returned to baseline health status without seizure recurrence in the following year. Comprehensive review of the literature on CVT associated with DS, encompassing 15 case reports, two case series and two studies, underscores the rarity of this condition. Most reported cases of CVT have been linked to MS, while only three cases of CVT associated with MOGAD have been documented to date. Additional risk factors, such as lumbar puncture and high-dose corticosteroid treatment, have been implicated in some instances. Given their shared inflammatory basis, a thrombotic-inflammatory pathogenic mechanism acting between DS and CVT in predisposed individuals is plausible. However, the exact pathogenic association between these conditions remains largely unclear, and a coincidental association cannot be ruled out. The role of anti-MOG antibodies in this rare condition also warrants further investigation.

Keywords: MOGAD; MS; cerebral sinus thrombosis; demyelinating disorders.

Figure 1

Spine magnetic resonance imaging. Hyperintense cervical cord lesions (arrows) in short-TI inversion recovery sagittal sequences.

Figure 2

Brain MRI and MR venography findings. MRI (A) axial and (B) coronal sequences showing right parietal fluid-attenuated inversion recovery hyperintensity involving postcentral and precentral gyri (arrowhead). MR venography displaying superior sagittal sinus stenosis (arrows) in (C) axial and (D) coronal views. MR, magnetic resonance; MRI, MR imaging.