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. 2017 Apr 21;4(4):e343. doi: 10.1212/NXI.0000000000000343

Figure 3. An area postrema lesion in association with leptomeningeal enhancement and intraparenchymal BBB breakdown.

Figure 3

Spinal cord MRI (A–C) and brain MRI (D–G) from an AQP4-IgG–positive patient with NMOSD who presented with recurrent myelopathy of 1 month duration and area postrema lesion, which progressed into LETM. Images were obtained during acute attacks. An area postrema lesion (A) in association with subacute progression to LETM with leptomeningeal and intraparenchymal T1W contrast enhancement (arrows, B). The spinal cord lesions were also demonstrated on T2W and STIR images (C). Cerebral MRI during another attack with periependymal enhancement on T1W images at the lateral (D) and third ventricles (F). FLAIR images showing lesions along lateral ventricle (E), thalamus, and hypothalamus (G). (B) Used with permission of the publisher from Flanagan EP, Weinshenker BG. Neuromyelitis optica spectrum disorders. Curr Neurol Neurosci Rep 2014;14:483. Copyright © 2014, Springer Science+Business Media New York. AQP4-IgG = aquaporin-4 immunoglobulin G; BBB = blood-brain barrier; FLAIR = fluid-attenuated inversion recovery; LETM = longitudinally extensive transverse myelitis; NMOSD = neuromyelitis optica spectrum disorder; T1W = T1 weighted; T2W = T2 weighted.