Neuromyelitis optica

Case contributed by Dr Bruno Di Muzio


Acute onset of right lower limb hemiparesis and right upper limb hemiparesthesia. Known from the clinics due to long-term treatment.

Patient Data

Age: 56 years
Gender: Female

MRI Cervical Spine and Brain (selected images)

There are multiple foci of an increased T2/STIR signal along the cord, in particular, a long segment one from C5 to C7, which has a central medullary distribution and a central bright spot. These lesions do not demonstrate enhancement (post-contrast sequences not shown). The selected images of the brain (FLAIR) show multiple scattered subcortical and deep white matter foci of increased signal, which predominantly involve the frontal lobes. 

Case Discussion

This patient has a known history of neuromyelitis optica and has presented with a new acute onset of neurological symptoms related to the cord involvement. 

Note that, differently from multiple sclerosis, the cord involvement occurs with long segments (about three spinal levels) and a central modular distribution. Also, this case demonstrates central bright spotty, which has been inferred to be a discriminative finding of NMO over MS 1

Regarding the brain findings, this patient has deep and subcortical punctate white matter lesions, which do not exhibit the classic distribution usually seen on MS.

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Case information

rID: 55598
Published: 16th Sep 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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