Disclosures: Jason R. Lou, MD: Nothing to disclose

Case Description: A patient presented to the ED with new-onset left hemiparesis, right-sided neuropathic pain and sudden right-eye blindness. MRI showed multiple new active lesions in the bilateral cerebral hemispheres and C-spine. She completed five sessions of plasmapheresis with minimal to no improvement in her weakness, vision, or pain. She required maximum assistance for dressing and transfers and was transferred to acute rehabilitation.

Setting: Tertiary Hospital/Acute Inpatient Rehabilitation Hospital

Patient: 32-year-old graduate student with a history of Aquaporin-4 Positive Neuromyelitis Optica Spectrum Disorder (NMOSD), SLE, and Sjogren’s syndrome.

Assessment/Results: Patient was discharged home after 2 weeks of rehab, functioning at a supervision level for walking/transfers and a modified independent level for her ADLs. She completed a 15-page paper due during her stay through treatments focused on fine motor control using a computer. Her neuropathic pain improved after desensitization therapy. She had significant improvement in ambulation and was able to walk 150 feet with a rolling walker and left AFO. Her visual acuity in her right eye improved to 20/70.

Discussion: This is an atypical case of NMOSD presenting with left hemiparesis and right-sided neuropathic pain due to a combination of brain and cervical spinal cord injury. Paraplegia and symmetric sensory disturbances due to transverse myelitis are the most common presenting symptoms.

Conclusion: NMOSD is a rare (~1/100,000) cause of spinal cord and brain injury. Typical signs include unilateral blindness, paraplegia, and symmetric sensory loss. The prevalence of brain injury in NMOSD has only recently been studied after the discovery of Aquaporin-4 antibody as a diagnostic tool. Rehabilitation should aim to restore function with individualized goals. As NMO has a relapsing course in greater than 90 percent of cases ultimately resulting in permanent disability, rehabilitation goals and patient expectations should be established early in the disease course.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neuromyelitis-optica-spectrum-disorder-presenting-with-hemiparesis-due-to-non-traumatic-brain-and-spinal-cord-injury-a-case-report/