Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
Presentation
Ongoing varicella zoster infection with encephalopathy, suspected vasculitis.
Patient Data
T2/T2 FLAIR hyperintensities in bilateral centrum semiovale and corona radiata with involvement of overlying cortex at places.
Hyperintensities are also seen involving bilateral parieto-occipital cortex / subcortical white matter, bilateral basal ganglia, mesial temporal lobes, left lateral aspect of the midbrain and left cerebellar hemisphere.
The above areas do not show any obvious diffusion restriction.
On post-contrast scans, no abnormal parenchymal/leptomeningeal enhancement is seen.
No significant mass effect is seen on the ventricular system. No obvious midline shift.
Case Discussion
Encephalitis, vasculitis, and acute disseminated encephalomyelitis are all known CNS manifestations of varicella zoster infection. In the absence of any diffusion restriction, enhancement, or mass effect, and with the involvement of the midbrain, basal ganglia, and left cerebellar hemisphere, a probability of acute disseminated encephalomyelitis (ADEM) was raised.
However, further pathological investigations turned out to be positive for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). This case again highlights that imaging findings between ADEM and MOGAD overlap and are often indistinguishable.
The patient was started on antiviral drugs and steroids and improved significantly.
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