Neuromyelitis optica

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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