Abstract
Introduction: MOG antibody-associated disease (MOGAD) comprises a broad spectrum of clinical manifestations and imaging findings. Recent evidence indicates that brainstem encephalitis is a possible manifestation of MOGAD.
Case presentation: We present the case of a 32-year-old female patient with a 9-year history of a fluctuating disease course and good response to steroids, with almost exclusive brainstem involvement and subsequent optic nerve involvement. The patient did not meet the criteria for multiple sclerosis or neuromyelitis optica, and other differentials were excluded. The diagnosis of MOGAD was confirmed by IgG antibodies against the MOG protein.
Discussion: Brainstem lesions in MOGAD have been described in 30% of a Spanish cohort of MOG-IgG positive patients. The lesions tend to be bilateral, poorly defined, and large. Although low titers on the assay may raise doubts about the diagnosis, Banwell et al recently proposed new diagnostic criteria that include low MOG-IgG titers. In the face of low titers, the supporting clinical criteria support the diagnosis.
Conclusions: Patients with signs of brainstem encephalitis without a clear etiology should be evaluated for MOG-associated antibodies to confirm or rule out the diagnosis.
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