Neuromyelitis optica

Case contributed by Dr Ammar Haouimi

Presentation

Bilateral visual loss with paraplegia mainly on the right.

Patient Data

Age: 55 years
Gender: Female
MRI

Swollen optic chiasma of low signal intensity on T1WI, high signal intensity on T2WI, extending to the optic tracts mainly on the left side (well-visualized on T2WI fat sat). On postcontrast sequences, there is a ring-enhancement of the left portion of the optic chiasma.

MRI

Swollen dorsal spinal cord from T5 to T8 (four vertebral segments) of high signal intensity on T2WI and STIR involving both halves of the cord well-visualized on axial T2WI sequence. On postcontrast, there is an eccentric ring-enhancement on axial sequence and lens-shaped enhancement on the sagittal sequence.

Case Discussion

In neuromyelitis optica (NMO) the spinal cord lesions are more frequently present in the cervical and the upper thoracic spinal cord than the lower thoracic and lumbar regions.

The main differential diagnosis of NMO is multiple sclerosis (MS), especially if the disease is limited to the optic nerves and spinal cord. It is very important to differentiate these two conditions because their prognosis and therapy are different, as some MS therapies can exacerbate NMO

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Case information

rID: 65415
Published: 21st Jan 2019
Last edited: 23rd Jan 2019
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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