[A case of paroxysmal dysarthria and ataxia appeared late after treatment of myelin oligodendrocyte glycoprotein (MOG) antibody-related isolated rhombencephalitis].

Abstract

A 49-year-old female was admitted to our hospital due to acute-onset dysarthria and unstable gait. Brain MR diffusion weighted imaging revealed high signal intensities in the midbrain. Brain tumors, abscess and demyelinating lesions was suspected firstly as etiology of the lesion and antibiotics and antiviral drug were started under consulting with the neurosurgeon about brain biopsy. However, despite these treatment her symptoms were deteriorated gradually and intravenous high dose methylprednisolone was added. Since starting this treatment, her symptoms had been improving and the same treatment was repeated once and oral administration of prednisolone (0.5 ‍mg/kg/day) was started. Based on the positive for anti myelin oligodendrocyte glycoprotein (MOG) antibody in the serum, she was ultimately diagnosed with MOG related rhombencephalitis and discharged to her home on the 45th day. After discharge, new paroxysmal symptoms such as paroxysmal dysarthria and ataxia (PDA) had appeared whose symptoms occurred several times a day and lasted for a few seconds to several tens of seconds. These symptoms were regarded as PDA secondary to sequelae of MOG related rhombencephalitis and oral administration of Carbamazepine was started. After the treatment, the symptoms completely disappeared. The differential diagnosis of midbrain tegmental lesions should consider MOG antibody-associated disease, and in cases where delayed-onset PDA occurs, carbamazepine may be effective.