Disclosures: Corey Spector, DO: No financial relationships or conflicts of interest

Case Diagnosis: Newly diagnosed neuromyelitis optica

Case Description or Program Description: A 48-year-old female presented to the hospital with new onset generalized weakness, pain, and difficulty ambulating. She endorsed blurry vision and skin darkening of her posterior forearms bilaterally. MRI of the cervical, thoracic, and lumbar spine demonstrated demyelination of the mid-lower cervical and thoracic spine with the lumbar cord spared. Aquaporin-4, Sjoegren, anti-dsDNA antibodies were elevated, with CSF demonstrating lymphocytosis, RBCs and increased nucleated cell count.

Setting: Tertiary-care teaching hospital

Assessment/Results: She was diagnosed with neuromyelitis optica with cutaneous lupus by Neurology, and received IV solumedrol followed by IVIG with oral steroid taper, with improved bilateral upper extremity movement, but continued cutaneous burning sensation. She was admitted to acute inpatient rehabilitation, at which time she ambulated twenty five feet with a walker and moderate assistance. Two weeks later, she ambulated one hundred fifty feet independently with a walker and climbed twelve steps, with improvement in activities of daily living.

Discussion (relevance): Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder characterized by demyelination and axonal damage targeting the optic nerves and spinal cord. It can be distinguished from multiple sclerosis by the presence of aquaporin-4 (AQP4) antibodies. Presentation includes acute attacks with optic neuritis causing visual loss, with acute transverse myelitis causing limb weakness. Diagnostic criteria includes the presence of at least one core clinical characteristic (optic neuritis, acute myelitis, area postrema syndrome), presence of APQ4 antibodies, and exclusion of alternative diagnoses. MRI may demonstrate longitudinal spinal cord lesions extending over three or more segments. NMOSD often correlates with other auto-immune diseases including lupus, Sjoegren syndrome, and sarcoidosis.Treatment includes corticosteroids followed by chronic immunosuppressants.

Conclusions: Early diagnosis of NMOSD in our patient allowed for prompt treatment, with improvement in symptoms and function. NMOSD should be considered in patients with new onset weakness with ocular symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-newly-diagnosed-neuromyelitis-optica/