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Ohara S, Miyahira TA, Oguchi K, Takei YI, Yanagimura F, Kawachi I, Oyanagi K, Kakita A. Neuromyelitis optica spectrum disorder with massive basal ganglia involvement: a case report. BMC Neurol 2019; 19:351. [PMID: 31888527 PMCID: PMC6937957 DOI: 10.1186/s12883-019-1580-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occurrence of basal ganglia involvement in neuromyelitis optica spectrum disorders (NMOSD) has rarely been reported and none documented pathologically. CASE PRESENTATION A 73-year-old female was clinically diagnosed with a NMOSD based on the clinical and radiological features and positive serum autoantibodies to AQP4. One month before her death, she became acutely ill with disturbed consciousness and right hemiparesis, and was diagnosed and treated as having basal ganglia infarction based on the brain CT. She made a partial recovery but later died from heart failure. At autopsy, the corresponding basal ganglia process revealed a large fresh area of necrosis. Histologically, several pathological signatures of NMOSD could be recognized in the lesion, including inflammatory cell infiltrations by B and T lymphocytes, perivascular complement and fibrinogen deposition, and the appearance of numerous phagocytosed corpora amylacea within the infiltrating macrophages. CONCLUSIONS The present case illustrates that basal ganglia may be directly involved in the pathological processes of NMOSD, although the possibility of modification of the lesions by superimposed regional ischemia could not be excluded.
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Affiliation(s)
- Shinji Ohara
- Department of Neurology, Matsumoto Medical Center, Minami 2-20-30, Matsumoto, 399-8701, Japan. .,Department of Neurology, Iida Hospital, 1-15 Ohdori, Iida, 395-8505, Japan.
| | - Taka-Aki Miyahira
- Department of Neurology, Matsumoto Medical Center, Minami 2-20-30, Matsumoto, 399-8701, Japan
| | - Kenya Oguchi
- Department of Neurology, Matsumoto Medical Center, Minami 2-20-30, Matsumoto, 399-8701, Japan
| | - Yo-Ichi Takei
- Department of Neurology, Matsumoto Medical Center, Minami 2-20-30, Matsumoto, 399-8701, Japan
| | - Fumihiro Yanagimura
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Kiyomitsu Oyanagi
- Division of Neuropathology, Brain Research Center, Shinshu University School of Medicine, Matsumoto, Japan.,Brain Research Laboratory, Hatsuishi Hospital, Chiba, Japan
| | - Akiyoshi Kakita
- Department of Neuropathology, Brain Research Institute, Niigata University, Niigata, Japan
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