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Marc Gotkine, MBBS

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Gilmore and colleagues report the case of a 37-year-old woman with NMO-associated Parinaud syndrome. They compared this woman's case with that of the 13-year-old boy my colleagues and I described previously who presented with severe encephalopathy and confluent nonenhancing white matter lesions.¹ They note that this woman's brain lesions showed gadolinium enhancement on magnetic resonance imaging and conclude that "gadolinium-enhancing brain lesions . . . may not be a reliable way of distinguishing NMO from ADEM."

My colleagues and I agree with this statement as gadolinium enhancement does not exclude the possibility of NMO as has been previously noted,^1-2 and we would like to clarify our assertion that the lack of gadolinium enhancement in the appropriate context may be a specific (although insensitive) indicator of NMO. We were impressed by the similarity of our case with a previous report,² namely childhood onset of an ADEM-like encephalopathy with bilateral confluent . . . [Full Text of this Article]

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