E1918. Shedding the Fog on ‘MOG’: Review of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disorders (MOGAD)
Authors
Shreyas Reddy K;
St John's Medical College Hospital
Sunitha Palasamudram;
St John's Medical College Hospital
Anna Menezes;
St. Ann’s Hospital
Background
Myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) are a relatively new group of autoimmune neuroinflammatory demyelinating disorders. They are characterized by the presence of serum antibodies to MOG, which is an extracellular myelin protein. Though there is significant overlap with other demyelinating diseases, the present immunological, histopathological, paraclinical and imaging evidence demonstrated MOGAD as a distinct disease entity.
Educational Goals / Teaching Points
We aim to present both common and uncommon clinical and imaging presentations in MOGAD with a brief overview of aetiopathogenesis. Key features that help in raising the suspicion of this rare, complex entity and the varying patterns of its CNS involvement will be highlighted.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We intend to showcase 12 cases of serum MOG antibody confirmed MOGAD cases, after excluding its mimics including multiple sclerosis (MS), neuromyelitis optica (NMO), ADEM and infective encephalitis. Among these cases, few had atypical clinical and imaging findings which include leptomeningeal enhancement, limbic encephalitis, basal ganglia in the pediatric age group, optic pathway, hypothalamic, brainstem, and cerebellar involvement. Several further instances of well-known patterns are emphasized. The diagnosis was hard to establish in a few of the cases, as there was overlap with other demyelinating disorders, thus potentially causing a delay in treatment initiation. No group of imaging findings have been deemed completely diagnostic of MOGAD up to this point, thereby providing value in being knowledgeable about the different presentations.
Conclusion
Understanding of MOGAD is still in its infancy, considering the extensive and complex clinical-radiological presentations. Being familiar with its atypical presentations, can help in early recognition and planning for appropriate management. In certain clinical scenarios, a high degree of clinical suspicion and low threshold for testing is the key to diagnosis.
