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.