Chronic progressive behavioral changes associated with headache: An atypical presentation of myelin oligodendrocyte glycoprotein (MOG)-associated disease

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease does not have clinical features that are disease-specific, and its clinical spectrum has yet to be defined. Herein, we described an atypical presentation of MOG-related disease. A 26-year-old female presented with behavioral changes in the past seven months in the form of agitation, anger, anxiety, fear of death, panic attacks, and an obsession to repeatedly perform daily activities. The patient also had headache for six months. The patient had a similar history of behavioral abnormality and four episodes of painful visual blurring. Neurological examination was unremarkable except for truncal and gait ataxia. Magnetic resonance imaging of the brain showed hyperintense signals in bilateral subcortical white matter, middle cerebral peduncles, cerebellum, thalamus, and pons with contrast enhancement. Myelin oligodendrocyte glycoprotein antibody was found to be positive by cell-based indirect immunofluorescence assay. The patient was managed with an intravenous methylprednisolone pulse. The patient had complete resolution of symptoms and magnetic resonance imaging brain abnormalities at the one-month control.