Disclosures: Andrew C. Wondra, MD: No financial relationships or conflicts of interest

Case Diagnosis: Brown-Séquard phenomenon secondary to Myelin Oligodendrocyte Glycoprotein Antibody Disease

Case Description: We report on an 11-year-old healthy female who presented emergently with acute onset severe left-sided flaccid hemiplegia. MRI demonstrated an enhancing lesion in the upper cervical spinal cord, consistent with Acute Flaccid Myelitis (AFM). She received one dose of intravenous immunoglobulin (IVIG) before transfer to Acute Rehabilitation. On admission, she had flaccid hemiplegia on the left with impaired sensation for pain and temperature in the right hemibody. During her stay, she was found to be anti-MOG Ab positive, changing her diagnosis to MOG Antibody Disease (MOGAD), which can mimic AFM.

Setting: Pediatric Acute Rehabilitation HospitalAssessment/

Results: Left-sided strength improved during her rehab course. By discharge, she ambulated independently without assistive devices or lower extremity orthoses. Her left hand dexterity improved, however limited proximal strength returned and loss of pain and temperature in the right hemibody persisted. She will continue to receive monthly IVIG treatment and participate in outpatient physical and occupational therapy.

Discussion: MOG is a protein expressed on the surface of myelin and oligodendrocyte membranes (1), making it a target for an autoimmune response. Typical age of onset for MOGAD is 20-30s, but can occur in children (2). MOGAD has several clinical presentations, most commonly with recurrent optic neuritis, transverse myelitis, or both. In children, MOGAD is often associated with an ADEM presentation preceded by infection (3), but not always, as seen in this patient. While there are case reports of MOGAD “mimicking” AFM (4), to the best of our knowledge, this may be one of the first documented cases with a Brown-Séquard clinical presentation.

Conclusion: MOGAD should be considered in children with Brown-Séquard without a trauma history, and closely monitored for disease recurrence (5). Treatment is time-sensitive and early initiation of rehabilitation is critical in minimizing long term functional impairments.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-presentation-of-brown-sequard-phenomenon-as-a-result-of-myelin-oligodendrocyte-glycoprotein-antibody-disease-case-report/