Meningitis

Surgery

Pseudotumor cerebri

Acute disseminated encephalomyelitis

Intracranial pressure

CSF pleocytosis

Papilledema

Aseptic meningitis

Immunology

Optic neuritis

Meningoencephalitis

Multiple sclerosis

Medicine

Pleocytosis

Blurred vision

Pathology

Multiple Sclerosis and Related Disorders

Objective To describe 2 atypical cases with Anti-MOG antibody related demyelinating syndrome. Methodology Case series. Results We present two cases. Case 1 is an 18-year-old woman who presented with headache, blurred vision, and papilledema and was initially diagnosed with pseudotumor cerebri syndrome. CSF showed mildly elevated opening pressure and lymphocytic pleocytosis and a diagnosis of aseptic meningitis was considered. MRI brain and spinal cord revealed longitudinally extensive bilateral simultaneous optic neuritis and multiple spinal cord lesions. Case 2 is a 28-year old man who presented initially with unilateral optic neuritis followed by aseptic meningitis three weeks later and subsequently acute disseminated encephalomyelitis (ADEM). Serology was positive for Anti-MOG antibody on a cell-based assay in both these cases. Discussion Although bilateral optic neuritis has been well described in MOG related disorders, aseptic meningitis and pseudotumor cerebri-like syndromes are notable alternate presentations. The presence of eosinophils in the CSF (in the first patient) is a unique finding in our case series. Conclusion In a patient with an aseptic meningitis like presentation, the presence of optic neuritis, brain and/or spinal cord lesions should raise suspicion for an MOG-Ab related syndrome.

Atypical Anti-MOG syndrome with aseptic meningoencephalitis and pseudotumor cerebri-like presentations