A 46-year-old woman with a 1-year history of anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) presented with severe hiccups. The patient was treated with prednisolone and azathioprine. Lumbar puncture (LP) revealed pleocytosis, and brain magnetic resonance imaging (MRI) revealed NMOSD recurrence in the area postrema. No LP-related headache occurred. Intravenous methylprednisolone (IVMP) relieved her symptoms. However, six days after starting IVMP, she developed tonic-clonic seizures. Brain MRI revealed a new unilateral lesion (Picture A). T2*-weighted imaging showed hypointense signals in veins around the new lesion, consistent with cerebral venous thrombosis (CVT) rather than NMOSD (Picture B) (1). MR-venography confirmed the diagnosis (Picture C). Thrombophilia evaluations were normal, and anticardiolipin antibodies were negative. Anticoagulation therapy improved the patient's condition. IVMP after LP may increase the risk of CVT in NMOSD patients, as in multiple sclerosis patients (2). It should be noted that hypointense signals in cerebral veins on T2*-weighted imaging sensitively differentiate CVT from NMOSD lesions.
Picture.
The authors state that they have no Conflict of Interest (COI).
References
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