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Author:Nasrin Asgari, Eoin P. Flanagan, Kazuo Fujihara, Ho Jin Kim, Hanne P. Skejoe, Jens Wuerfel, Hiroshi Kuroda, Su Hyun Kim, Elisabeth Maillart, Romain Marignier, Sean J. Pittock, Friedemann Paul, and Brian G. Weinshenker,From the Department of Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (E.P.F., S.J.P., B.G.W.), Mayo Clinic, Rochester, MN; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University School of Medicine; Multiple Sclerosis and Neuromyelitis Optica Center (K.F.), Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan; Department of Neurology (H.J.K., S.H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; Department of Radiology (H.P.S.), Aleris-Hamlet Hospital, Copenhagen, Denmark; Medical Image Analysis Center Basel (J.W.); Department of Biomedical Engineering (J.W.), University Basel, Switzerland; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (J.W., F.P.), Department of Neurology, Charité Universitätsmedizin Berlin; Experimental and Clinical Research Center (J.W., F.P.), Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (H.K.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology (E.M.), Hôpital Pitié-Salpêtrière, APHP, Paris, France; Service de Neurologie A and Eugène Devic EDMUS Foundation against Multiple Sclerosis (R.M.), Observatoire Français de la Sclérose en Plaques (OFSEP), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; and Lyon Neurosciences Research Center (R.M.), FLUID team (Openi/National Library of medicine) Source:https://openi.nlm.nih.gov/detailedresult?img=PMC5400808_NEURIMMINFL2016011692FF3&query=Neuromyelitis%20optica%20spectrum%20disorder&it=xg&req=4&npos=10 Description:F3: An area postrema lesion in association with leptomeningeal enhancement and intraparenchymal BBB breakdownSpinal 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.
