Abstract
Dear Sirs,Inflammatory demyelinating diseases of the central ner-vous system (CNS) represent a broad spectrum of disor-ders, sometimes with overlapping features [1], that make itdifficult to make an exact diagnosis.A 34-year-old male showed, in November 2008, opticneuritis, encephalopathy, trunk and gait ataxia thatimproved after high dose corticosteroid treatment. Thebrain and spinal cord magnetic resonance imaging (MRI)showed multiple T2-weighted (T2-w) hyperintense lesionsin the white matter of cerebral hemispheres and in thebrainstem. In December 2008 brain MRI evidenced a newT2-w hyperintense lesion in the pons. In the followingmonths he showed mood and behavioural disturbances. InApril 2009 he developed encephalopathy, paraplegia andsensory loss with an upper thoracic level in a few days thatdid not improved after high dose corticosteroid, plasmaexchange and IVIg treatment. Brain and spinal cord MRIrevealed multiple T2-w hyperintense lesions, someresembling Balo`-like lesions, and two lesions extendedfrom C7 to D2 and from D9 to D11, with contrastenhancement. A cerebrospinal fluid (CSF) sample did notshow any cells or oligoclonal bands. CSF and serum testsfor infectious diseases and autoimmune disorders werenegative. Serum anti-neuromyelitis optica (NMO)-IgGwere negative. The patient was then treated six times withcyclophosphamide 1 g/m
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