• Long segment hyperintense signal in the cervical cord predominantly affecting central cord and associated with cord expansion
• Post contrast cigar shaped enhancement in the expanded cord

• Persistent hyperintense signal in the cervical cord
• Predominant affection of central gray matter
• No enhancement on post contrast study

• Focal hyperintense lesions in the ventral Pons; one in the midline at brain–CSF interface and other in the left paramedian region

• Long segment hyperintense signal in the upper dorsal cord predominantly affecting central cord and associated with mild cord expansion
• Predominant affection of central gray matter
• No significant post-contrast enhancement

• MRI DIAGNOSIS

Imaging findings suggest neuromyelitis optica spectrum disorder

• Severe inflammatory demyelinating disorder distinct from multiple sclerosis
• Once it was known as monophasic disease with co-occurance of optic neuritis and extensive myelitis but now is recognized as relapsing disorder in which these events can be separated by years or decades. Now a days it is known as NMO spectrum disorder
• Pathogenesis-Autoimmune astrocytopathy with development of antibodies to aquaporin 4 (cell membrane water channel concentrated on glial foot processes at glial limiting membrane surrounding blood vessels and in association with pia mater)
• Conventional MR imaging SPINE
• Presence of longitudinally extensive (>/= 3 vertebrae) spinal cord lesion (LESCL) with predominant involvement of central gray matter
• May acutely expand the cord and show patchy enhancement in their entire extent

• Autoimmune myelitidis associated with conditions like Sjogren’s/SLE
• Neurosarcoidosis and postinfectitious myelitidis-surface enhancement due to meningeal involvement is more common in these conditions. They may be indistinguishable from spinal NMO on radiological grounds
• Paraneoplastic myelitis
• Spinal dural AV fistula

• Long segment involvement the optic nerve associated with acute swelling and enhancement, particularly when bilateral and extending up to the optic chiasm, possibility of NMO should be considered in appropriate clinical settings

• Typical of NMO brain lesions reflect AQP4 distribution. Nonspecific punctate or small lesions (< 3mms) in periependymal distribution surrounding third ventricle, cerebral aqueduct and forth ventricle and dorsal brainstem. Periventricular NMO lesions surrounding lateral ventricles tend to extend along the wall rather than perpendicular to it
• Large confluent heterogenoushemispheric lesions are also known