Rare demyelinating diseases of the central nervous system: A diagnostic and therapeutic challenge – based on the case of a young woman with MOGAD

Demyelinating diseases of the central nervous system constitute a heterogeneous group of diseases. The best known is multiple sclerosis, while neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare diseases. A 19-year-old female patient was admitted to the neurology department due to rapidly progressing memory and speech disorders. Mild mixed aphasia and right-sided pyramidal syndrome were diagnosed. Magnetic resonance imaging (MRI) of the brain revealed acute nodular demyelination in the left hemisphere. Intravenous methylprednisolone was administered. After approximately 2 months, the patient was readmitted due to several generalized epileptic seizures. At that time, the patient was transferred to a clinical center, where extensive diagnostics was performed. Among others, acute disseminated encephalitis, autoimmune encephalitis, tumefactive multiple sclerosis, and tumor were taken into consideration. MRI with spectroscopy and angiography revealed degenerative changes following acute demyelination. General examination of the cerebrospinal fluid was normal. No anti-neuronal antibodies were detected. However, positive anti-MOG antibodies were detected (and antibodies against aquaporin 4 were negative), which led to a suspicion of MOGAD. The patient was discharged home with a recommendation to use antiepileptic drugs and oral steroids. It is important to remember about rare demyelinating diseases, such as MOGAD, which require differentiation from multiple sclerosis. The prognosis for this condition is generally better, but the disease can lead to permanent neurological damage.