Journal of Medicine and Life Science

Institute for Medical Science (제주대학교 의과학연구소)
권호 표지
DOI QR코드

DOI QR Code

Neuromyelitis optica spectrum disorders with an inverted V sign on spinal cord magnetic resonance imaging: anti-aquaporin-4 antibody and functional vitamin B12 deficiency

척수에 뒤집힌 V징후를 가진 시신경척수염: 항아쿠아포린-4항체와 비타민 B12 기능적 결핍

  • Sung Jo Bang (Department of Neurology, Keimyung University School of Medicine) ;
  • Sohyeon Kim (Department of Neurology, Keimyung University School of Medicine) ;
  • Young Seok Jeong (Department of Neurology, Keimyung University School of Medicine) ;
  • Seo Hyeon Lee (Department of Neurology, Keimyung University School of Medicine) ;
  • Hung Youl Seok (Department of Neurology, Keimyung University School of Medicine)
  • 방성조 (계명대학교 의과대학 신경과학교실) ;
  • 김소현 (계명대학교 의과대학 신경과학교실) ;
  • 정영석 (계명대학교 의과대학 신경과학교실) ;
  • 이서현 (계명대학교 의과대학 신경과학교실) ;
  • 석흥열 (계명대학교 의과대학 신경과학교실)
  • Received : 2022.09.07
  • Accepted : 2022.11.30
  • Published : 2022.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Several studies have reported a possible link between anti-aquaporin-4 antibody and vitamin B12 deficiency in neuromyelitis optica spectrum disorder (NMOSD). Bilaterally symmetric hyperintense signals on magnetic resonance imaging (MRI) of the posterior columns, called the inverted V sign, are a characteristic feature of subacute combined degeneration associated with vitamin B12 deficiency. We report a patient with anti-aquaporin-4 antibody-positive NMOSD and an inverted V sign on MRI of the spinal cord and address the association between anti-aquaporin-4 antibody and functional vitamin B12 deficiency.

Keywords

References

  1. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015;85:177-89. 
  2. Ishii N, Mochizuki H, Takahashi T, Shiomi K, Nakazato M. A case of simultaneous neuromyelitis optica spectrum disorder and subacute combined degeneration. Neurol Sci;34:1819-21. 
  3. Seok HY, Jang SH, You S. Neuromyelitis optica spectrum disorder presenting with pseudoathetosis. J Clin Neurol 2018;14:123-5. 
  4. Jarius S, Paul F, Ruprecht K, Wildemann B. Low vitamin B12 levels and gastric parietal cell antibodies in patients with aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders. J Neurol 2012;259:2743-5. 
  5. Kim NH. Differential diagnosis between multiple sclerosis and neuromyelitis optica spectrum disorder. J Korean Neurol Assoc 2016;34:290-6. 
  6. Seok HY, Eun MY. Radiological evidence of myelitis in neuromyelitis optica spectrum disorder: bright spotty lesions. Neurol India 2021;69:1623. 
  7. Stabler SP. Clinical practice. vitamin B12 deficiency. N Engl J Med 2013;368:149-60. 
  8. Abe Y, Yasui M. Aquaporin-4 in neuromyelitis optica spectrum disorders: a target of autoimmunity in the central nervous system. Biomolecules 2022;12:591. 
  9. Lennon VA, Kryzer TJ, Pittock SJ, Verkman AS, Hinson SR. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med 2005;202:473-7. 
  10. Pandit L. Neuromyelitis optica spectrum disorders: an update. Ann Indian Acad Neurol 2015;18(Suppl 1):S11-5. 
  11. Han J, Yang MG, Zhu J, Jin T. Complexity and wide range of neuromyelitis optica spectrum disorders: more than typical manifestations. Neuropsychiatr Dis Treat 2017;13:2653-60. 
  12. Cao J, Xu S, Liu C. Is serum vitamin B12 decrease a necessity for the diagnosis of subacute combined degeneration?: a meta-analysis. Medicine (Baltimore) 2020;99:e19700.