We present the case of a 53-year-old male, an
independent public accountant, who bravely faced the challenges of NMO. His
journey began with left optic neuritis and vision loss in 2017, which was
treated with methylprednisolone. A year later, he experienced a relapse with
right optic neuritis, again treated with methylprednisolone. In 2024, the
patient developed transverse myelitis syndrome, leading to lower extremity
weakness and urinary retention. He sought our clinic's help in March 2024 due
to gait disturbances, recurrent falls, and numbness, predominantly affecting
the right pelvic limb. Neurological examination revealed loss of strength in
the right forearm and hand, accompanied by diminished sensitivity to coarse and
fine touch. The patient also reported persistent holocranial headache (4/10
intensity), tremors, and a single episode of sphincter incontinence.
MRI findings indicated:
- An affection bilateral of
optic manifested nerve signal alterations, with gadolinium enhancement
suggesting active bilateral optic neuritis, predominantly affecting the left
optic nerve.
- Besides, we find
subcortical white matter hyperintensities in the frontal regions without
diffusion restriction, consistent with chronic non-specific changes.
- Spinal cord lesions
spanning C2-C7 and T2-T7, with gadolinium enhancement indicative of disease
activity (Figure 1).
Serology confirmed IgG AQP4 positivity and IgM
anti-MOG negativity (<1:1600). These findings, which are consistent with a
diagnosis of NMO, established the diagnosis of neuromyelitis optica spectrum
disorder (NMOSD).
The patient's IgG AQP4 positivity indicates a high
likelihood of NMO, while the absence of IgM anti-MOG antibodies suggests a
lower risk of certain complications and a more favourable prognosis.
