1. GENE 2015 Apresentador: Érica Cardoso Orientador : Dr. James Yared
Departamento de Radiologia do HCor
Data: 11/06/2015

2. Apresentação Clínica Feminino, 17 anos Soluços e vômitos há 1 mês
Piora com vômitos incoercíveis
Estado de mal epiléptico – IOT
AP: hipotireoidismo

3. Setembro / 2014

4. Axial unenhanced CT image of the brain at the level of basal ganglia shows marked hypoattenuation in the basal ganglia that is indicative of cystic changes.

5. Susceptibility-weighted axial MR images show (a) a markedly hypointense rim around the cystic changes in the basal ganglia and hypointensity in the thalami and (b) striking hypointensity in the red nuclei of the midbrain.

7. T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

9. Evolução Iniciada corticoterapia, melhora clínica e alta hospitalar
Manteve soluços e vômitos em menor intensidade.
Submetida a nova RM após 8 meses:
Nova queixa – tonturas há 01 semana.

10. Maio / 2015

11. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

12. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

13. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

14. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

15. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

16. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

17. Axial T2-weighted (repetition time msec/echo time msec, 3440/90) MR images show high-signal-intensity areas lined by hypointense margins in the (a) basal ganglia, (b) substantia nigra, and (c) cerebellar nuclei that are indicative of cystic changes. (d) T2*-weighted (560/20) MR image at same level as a shows markedly hypointense lining around the cystic changes in the basal ganglia and subtle hypointensity in the thalami that is indicative of iron deposition, which was not identifiable on a. (e) T2*-weighted (560/20) MR image at the level of the central sulcus shows evidence of signal loss in the pre- and postcentral gyri.

20. Diagnóstico
Neuromielite Óptica
Edema vasogênico transitório pós-ictal

21. Diagnóstico da NMO
AQP4-IgG é específico para o diagnóstico e se reduz com o tratamento.
Serologic diagnosis of NMO. Neurology Feb 28; 78(9): 665–671.
Neurite óptica, mielite aguda, síndrome da área postrema, outras síndromes do tronco, narcolepsia sintomática ou Sd. diencefálica aguda ou Sd cerebral sintomática, ambas com achados de RM.
AQP4-IgG (+) + 1
AQP4-IgG (-) + 2. A característica deve ter disseminação espacial, MR negativa para EM ou outra doença desmielinizante.