AKA Devic’s Disease, Devic’s Syndrome, Devic’s Neuromyelitis Optica, Neuromyelitis Optica and its Spectrum Disorder (NMOSD)
- Brain/Brain stem: Less commonly involved but when present lesions center around AQP4 rich areas including periependymal region surrounding third ventricle (thalamus, hypothalamus), around 4th ventricle near area postrema, periventricular white matter, and non-specific subcortical white matter.
- Spinal Cord:
- Cervical > thoracic cord
- Extensive (> 3 vertebral body segments in length)
- Nerves: Optic nerves long segment +/- chiasm involvement, can be bilateral.
- General Appearance:
- Length: Typically, > 3 vertebral bodies in length
- Width: Typically involves entire cross section of cord.
- Acute lesions: +/- mild cord swelling/edema which can mimic intramedullary neoplasm.
- Modality-Specific (Spinal Cord Only):
- CT Myelography:
- Spinal cord not well evaluated. May see spinal cord swelling in acute phase (mimics intramedullary tumor).
- T1: Isointense or hypointense.
- T1 + Contrast: +/- Enhancement. Patchy enhancement in the subacute/acute phase.
- T2: Long segment hyperintense lesions.
- STIR: Long segment hyperintense lesions. Increased sensitivity for detection of lesions.
- DWI: Typically, increased diffusivity.
Contributor: Jacob A. Eitel, MD
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