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Abstract Details

Frequency of Increased Intracranial Pressure in MOGAD
Autoimmune Neurology
S32 - Autoimmune Neurology: NMOSD/MOGAD (2:48 PM-3:00 PM)
010

To evaluate the frequency of increased intracranial pressure (ICP) in a large cohort of MOGAD.
There are a few case reports of bilateral optic disc edema and raised opening pressure (OP) on lumbar puncture (LP) in myelin-oligodendrocyte-glycoprotein-antibody-associated-disease (MOGAD), which could cause diagnostic confusion between MOGAD with bilateral optic neuritis (ON) and pseudotumor cerebri.

Cross-sectional study of MOGAD patients at a tertiary institution with LP OP within 30 days of attack onset.

From 321 MOGAD patients, 109 LPs were included from 104 patients. The frequency of increased ICP (OP >250 mmH2O in adults or >280 mmH2O in children) was 26% (28/109) in MOGAD attacks (25% [26/104] in MOGAD patients). Patients with increased ICP were slightly younger (median age at LP 23 [IQR 11-40] vs. 35 [IQR 17-49], p=0.050), more often male (58% vs. 35%, p=0.038) and obese (54% vs. 32%, p=0.043). The median OP was 350 [IQR 296-400] mmH2O during increased-ICP attacks and 172 [IQR 140-210] during normal-ICP attacks (p<0.001). The median CSF white cell count was 33 (IQR 5-134) cells/mm3 in increased-ICP attacks vs. 8 (IQR 2-43) in normal-ICP attacks (p=0.022), with CSF pleocytosis (>5 cells/mm3) in 75% vs. 54% (p=0.063). CSF protein was comparable. Increased ICP was most commonly observed during acute disseminated encephalomyelitis (ADEM: 44%; 10/23), cerebral cortical encephalitis (67%; 2/3), and ON with myelitis attacks (33%; 3/9). Among the 28 increased-ICP attacks, 32% (9/21) had bilateral disc edema (2 papilledema from increased ICP alone; 7 bilateral ON), while 33% (7/21) had no disc edema, and 64% (18/27) had headache. Three (11%) attacks initially treated as pseudotumor cerebri had bilateral ON and CSF pleocytosis.
Increased ICP can be observed in a quarter of MOGAD attacks, particularly ADEM and cerebral cortical encephalitis. The cause is uncertain but potential etiologies include MOGAD inflammation, coinciding pseudotumor cerebri, and spuriously elevated OP.
Authors/Disclosures
Nanthaya Tisavipat, MD (Mayo Clinic)
PRESENTER 		Miss Tisavipat has nothing to disclose.
Natthapon Rattanathamsakul, MD (Mayo Clinic) Dr. Rattanathamsakul has nothing to disclose.
Abdul-Rahman Salman No disclosure on file
Vyanka Redenbaugh, MB BCh BAO (Mayo Clinic) Dr. Redenbaugh has nothing to disclose.
Laura Cacciaguerra, MD, PhD (Mayo Clinic) Dr. Cacciaguerra has nothing to disclose.
Deena Tajfirouz, MD Dr. Tajfirouz has nothing to disclose.
Kevin Chodnicki (Mayo Clinic) Kevin Chodnicki has nothing to disclose.
Jan-Mendelt Tillema, MD (Mayo Clinic) Dr. Tillema has nothing to disclose.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. The institution of Dr. Pittock has received research support from Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from F. Hoffman/LaRoche/Genentech. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from Viela Bio. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities.
John Chen John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen.