Neurológia pre prax 4/2018

Advances in imaging and diagnosing autoimmune and inflammatory diseases

The paper introduces the reader to advances in diagnosing multiple sclerosis (MS) and neuromyelitis optica (NMO) as well as presents a not very well known entity referred to as CLIPPERS – chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids as seen on magnetic resonance imaging (MRI). In the recent two years, the support of MS diagnosis using MRI has been discussed in order for the criteria to be as simple as possible while being highly sensitive with a sustained specificity. In December 2017, the latest revision to the McDonald criteria was published. The article coherently presents the latest revision to the McDonald criteria and discusses the areas where changes have been made. In the case of NMO with anti-aquaporin-4 antibody positivity (AQP4-IgG), brain MRI findings have been revised. The original concept of normal brain MRI has long been surpassed. In terms of pathogenesis, this disease is considered to be primary astrocytopathy with secondary demyelination. In a proportion of patients in whom AQP4-IgG is not detected, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) may be present in the serum, and the whole spectrum of diseases associated with these antibodies is discussed. Also presented are the latest criteria for NMO and its spectrum disorder (NMOSD) and typical findings on MRI that aid in distinguishing it from MS and that are defined in the 2015 diagnostic criteria.

Keywords: multiple sclerosis, neuromyelitis optica, CLIPPERS, magnetic resonance imaging, diagnostic criteria