Abstract
We report the diagnostic process of a rare patient with a combined central and peripheral demyelinating disease with antibodies against paranodal protein neurofascin 186 (anti– NF186)—the patient presented with weakness in both lower limbs. The clinical process and evidence are similar to subacute combined degeneration. However, thoracic spinal MRI shows T1 equal signal, and T2 high signal lesions in thoracic vertebrae 5-7 mainly involve white matter. The Aquaporin 4 antibody of the central nervous system indicates the disease is of an optic neuromyelitis pedigree. The antibodies against paranodal protein neurofascin 186 indicate demyelinating peripheral nerve pathogenesis. The final diagnosis was a combined central and peripheral demyelinating disease based on the results of various examinations. The patient's condition improved after methylprednisolone therapy and intravenous immunoglobulin.
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