Purpose or Case Report: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a condition in which serum antibodies are targeted against central nervous system (CNS) myelin-forming oligodendrocytes, resulting in an acquired monophasic or relapsing-remitting CNS demyelination. The histopathology and imaging manifestations of MOGAD differ from that of other demyelinating disorders, such as Multiple Sclerosis or Neuromyelitis Optica Spectrum Disorders. Age dependent MOGAD presentations have also been reported, in which pediatric patients often present with acute disseminated encephalitis (ADEM) or brain lesions, followed by optic neuritis, among others. This contrasts with that of the typical adult presentation of optic neuritis, followed by transverse myelitis and a smaller proportion presenting with ADEM. Our educational exhibit will showcase the CT and MR imaging spectrum of pediatric MOGAD in patients at our institution, including: 1) ADEM, 2) transverse myelitis, 3) optic neuritis, and 4) other atypical manifestations, including ophthalmologic findings of papilledema.

We also discuss the concurrent finding of elevated intracranial pressure (ICP) in our cases, its presumed pathophysiology in the setting of MOGAD, and brief discussion of the current literature in which little is known about how elevated ICP affects MOGAD disease presentation, prognosis, and management. Interestingly, despite markedly elevated lumbar puncture opening pressures in our pediatric MOG patients, our patients did not demonstrate classic imaging findings of intracranial hypertension, such as those seen in idiopathic intracranial hypertension. This finding is both clinically and radiologically significant, as clinicians aim to better understand the purported disease course, manage MOG-associated intracranial hypertension, and stratify risk in patients demonstrating elevated lumbar puncture opening pressures on admission. Our exhibit will add a neuroradiology imaging component to the literature as we strive to comprehensively understand pediatric MOGAD in the subset of patients who demonstrate associated elevated intracranial pressures.
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