Maitha M. Alhajeri

Astrocytes, microglia, and oligodendrocytes, key neuroglial cell types, are essential for central nervous system (CNS) homeostasis, immune regulation, and neuronal support. In neurodegenerative diseases such as Alzheimer’s disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD), and amyotrophic lateral sclerosis (ALS), glial dysfunction contributes to pathogenesis via chronic inflammation, synaptic disruption, oxidative stress, and impaired myelination. Growing evidence highlights the regulatory influence of sex hormones on glial function. These hormones modulate inflammatory tone, synaptic remodeling, and remyelination, potentially contributing to sex-based differences in disease incidence, progression, and treatment response. This review synthesizes current understanding of glial involvement in neurodegeneration and examines how gonadal hormones interact with astrocytes, microglia, and oligodendrocytes. By integrating glial biology with neuroendocrinology, we propose that hormone-glia interactions represent promising, personalized targets for sex-informed therapies in CNS disorders.

Neuropathic pain is a common, well-known and often difficult-to-treat symptom in neuromyelitis optica spectrum disorder (NMOSD) and is usually related to spinal cord lesions. However, non-neurological pain can coexist, posing diagnostic difficulties and delaying treatments. We describe the clinical course and diagnostic workup of a young woman with relapsing myelitis related to Aquaporin-4 (AQP4) IgG positive NMOSD who presented repeatedly to the neurology clinic with persistent pain affecting initially lower limbs and then upper limbs despite apparently stable neurological disease. Joint MRI demonstrated multifocal avascular osteonecrosis involving both femoral and humeral heads, distal humerus and knees. She underwent bilateral total hip replacement; other joints were managed conservatively. Avascular necrosis due to corticosteroid use can cause unexplained persistent pain and should be considered as a differential diagnosis not only in NMOSD but any condition requiring corticosteroids. Early diagnosis can ensure timely and appropriate management, relieving pain and minimising complications.