Classic presentation of neuromyelitis optica: clinical case and review of the literature
DOI:
https://doi.org/10.5281/zenodo.12668192Keywords:
Enfermedad de Devic, Mielitis, Neuritis Óptica, Neuromielitis Óptica / Devic Disease, Myelitis, Optic Neuritis, Neuromyelitis OpticaAbstract
Background: Neuromyelitis optica (NMO or Devic's syndrome), characterized by acute attacks of optic neuritis and transverse myelitis, is associated with antiaquaporin 4 antibodies (anti-NMO-IgG) and it has a higher prevalence in non-Caucasian populations, where multiple sclerosis is less common.
Clinical case: 41-year-old man, with no significant personal medical history, presented with clinical symptoms including paresthesias in the right hemibody and homonymous hemianopsia in the left eye. Three weeks later, he developed lumbalgia associated with paresthesias in both lower limbs up to the T7 sensory level, as well as acute urinary retention, followed by paraplegia. The magnetic resonance imaging (MRI) displayed multiple hyperintense lesions on T2 and FLAIR sequences and hypointense on T1, located in the periventricular white matter, corpus callosum, bilateral corona radiata, as well as at the spinal level C2-C3, without post-contrast enhancement. The MRI of the spine revealed poorly defined hyperintense areas on T2 sequence, with dilation of the spinal canal from T4 to T11. A qualitative test for anti-NMO-IgG antibodies was positive, confirming the diagnosis of NMO.
Conclusion: NMO presents a diagnostic challenge. Timely diagnosis and management are crucial to prevent disability, future exacerbations, and to improve prognosis.
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