Disclosures: Naveen Singh Khokhar, DO: Nothing to disclose

Case Description: The patient presented with progressive gait instability, low back paresthesias, right lower extremity weakness, left lower extremity numbness, and decreased vision in her right eye. MRI brain and cervical spine demonstrated T2 enhancement in the right optic nerve and findings consistent with demyelination in the cervical spine. She was treated with Prednisolone for 5 days.

Setting: Inpatient Rehabilitation Center.

Patient: A 39-year-old female with Neuromyelitis Optica.

Assessment/Results: The patient was noted to have monoparesis in her right lower extremity and diminished sensation in her left lower extremity consistent with Brown Sequard’s Syndrome. She did have improvement in right lower extremity function with steroids and therapies but required a double metal ankle foot orthotic to improve ambulation. Further, the patient benefitted from increased therapies to improve functional mobility and ADLs in the setting of lower extremity weakness and new vision deficits. A positive Anti-aquaporin4 antibody resulted and confirmed the diagnosis of Neuromyelitis Optica.

Discussion: Neuromyelitis Optica is an immune mediated process involving demyelination and axonal damage that targets both the spinal cord and optic nerve. Interestingly, this patient developed lower extremity weakness and sensory changes in a pattern consistent with Brown Sequard’s Syndrome leading to ipsilateral loss of motor function, vibration, and proprioception and contralateral loss of pain and temperature.

Conclusion: It is important to consider central demyelinating processes when considering spinal cord injury including nontraumatic presentations of Brown Sequard’s Syndrome. Clinical presentation with vision deficits can key practitioners to consider Neuromyelitis Optica as a likely etiology. Prompt diagnosis can lead to early intervention and initiation of therapy to reduce acute injury and improve functional ability.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-case-of-brown-sequards-syndrome-secondary-to-neuromyelitis-optica-a-case-report/