Neuroimmunological disorders without signs of abnormalities in magnetic resonance imaging (MRI)

Abstract

It is obvious that current medical practice, particularly in neurology, greatly depends on MRI. However, despite showing serious clinical manifestations, MRI findings in some patients are virtually absent. Such a discrepancy between clinical phenotype and MRI may makes it difficult to make proper diagnosis and choose appropriate treatment. Here I discuss on two disorders ; Normal brain imaging accompanies neuroimmunologically justified, autoimmune encephalomyelitis (NINJA) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), in which routine laboratory tests and MRI examination are not useful, but advanced technique in radiology and immunology would open the key to reaching correct diagnosis. NINJA was isolated from patients who received clinical diagnosis of multiple sclerosis (MS) but did not have any findings in MRI. Diffusion tensor image, however, reveals brain lesions and flow cytometer analysis shows an increase of plasmablasts, consistent with the autoimmune pathogenesis of NINJA.