Severe Pediatric MOG Antibody–Associated Disease with Diffuse Cerebral Edema, Elevated Intracranial Pressure, and Evolving Contrast-Enhancing Lesions

Presenter: Meghan Louise McCord, MD

Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) in children has a broad neurologic spectrum, including acute disseminated encephalomyelitis (ADEM), but severe encephalopathy with cerebral edema and respiratory failure is less frequently described.

A 16-year-old female initially admitted from an inpatient psychiatric facility for abnormal movements developed altered mental status and rhythmic movements concerning for status epilepticus. Electroencephalography showed right hemispheric epileptiform activity, while inflammatory markers were elevated (erythrocyte sedimentation rate [ESR] 58 mm/hr; C-reactive protein [CRP] 45.1 mg/L). She subsequently developed acute hypoxic respiratory failure requiring intubation and remained unresponsive despite minimal sedation. Magnetic resonance imaging demonstrated diffuse white matter abnormalities involving the cerebrum, cerebellum, and upper cervical spinal cord, with perivascular and meningeal enhancement. A serum MOG antibody titer of 1:100 confirmed MOGAD. Treatment included high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and tocilizumab. Her course was complicated by cerebral edema requiring intracranial pressure monitoring and neuroprotective measures. Neurologic function improved over several weeks, allowing extubation and rehabilitation, with recovery of mobility and communication but persistent deficits in attention, processing speed, and memory.

The case demonstrates a severe MOGAD phenotype with widespread central nervous system involvement and prolonged recovery, supporting early multimodal treatment and multidisciplinary rehabilitation.

The Kids are Not Alright: Missed Opportunities for Inpatient Adolescent Nicotine Screening

Presenter: Ashley M. Ebersole, MD, MS, FAAP

Nicotine use remains common among adolescents in the United States, while lower attendance at routine health supervision visits may limit opportunities for screening. This cross-sectional study assessed documentation of nicotine screening during hospitalization among adolescents admitted between January 2020 and January 2022 and examined whether age, biologic sex, race, and admitting service were associated with screening.

Among 9,611 admissions, 62% had documentation of nicotine or tobacco use screening during the hospital stay. Compared with the hospitalist service, the odds of screening were highest among patients admitted to psychiatry and lowest among those admitted to neurology. Females had greater odds of being screened than males, and the likelihood of screening increased with each additional year of age. Overall, inpatient nicotine screening was inconsistent and varied according to patient and hospitalization characteristics.

The findings indicate that hospitalization may provide opportunities to identify nicotine use and address withdrawal or cessation needs, while standardized screening tools and workflows could improve consistency across inpatient settings.

Moyamoya Disease: As Basal Ganglia Hemorrhage

Presenter: Laxmi aryal, MD

Although pediatric Moyamoya disease (MMD) typically presents with ischemic stroke or transient ischemic attacks, intracranial hemorrhage is an uncommon initial manifestation that may delay recognition of the underlying vasculopathy.

An 11-year-old previously healthy boy developed progressive right-sided weakness, facial droop, and dysarthria after a syncopal episode during gym class. Computed tomography (CT) showed acute hemorrhage in the left basal ganglia and thalamus without midline shift. Subsequent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) demonstrated severe bilateral internal carotid artery stenosis, while digital subtraction angiography confirmed Suzuki stage III MMD, with marked narrowing of the A1 and M1 segments and extensive basal collateral formation. Continuous video electroencephalography showed no epileptiform activity, and genetic evaluation was performed for associated syndromic conditions. The patient remained neurologically stable and was referred for neurosurgical evaluation for cerebral revascularization.

This case emphasizes that spontaneous intracranial hemorrhage, particularly basal ganglia hemorrhage, in a child should prompt evaluation for underlying cerebrovascular disease, including MMD, to facilitate timely definitive management.

American Academy of Pediatrics (AAP) National Conference & Exhibition 2026, October 2–6, San Diego, California