Neuromyelitis Optica in a Nepalese Man.

Yogesh Subedi,Ashbina Pokharel,Utsav Joshi,Ashbita Pokharel,Sanjeeb Sudarshan Bhandari

doi:10.1155/2017/8596781

Abstract

Background Neuromyelitis optica is a severely disabling inflammatory disorder of the central nervous system of autoimmune etiology that mainly affects the optic nerves and spinal cord. Here, we present a case report detailing a patient with tingling and weakness of right upper and lower limbs who was neuromyelitis optica immunoglobulin G-positive. Case Presentation A 46-year-old Nepalese man presented to the hospital with a history of tingling and weakness of right upper and lower limbs that developed over a period of two months. Clinical evaluation showed diminished power across all major muscle groups in the right upper and lower limbs. Magnetic resonance imaging of his cervical spine showed T1 iso- to hypointense signal and T2 hyperintense signal in central cervical spinal cord from first to sixth cervical level, probably suggestive of myelitis or demyelination. The patient was immediately started on intravenous methylprednisolone. The diagnosis of neuromyelitis optica was later confirmed with strongly positive neuromyelitis optica immunoglobulin G. Conclusion In resource limited setting, in the absence of tests for neuromyelitis optica immunoglobulin G, treatment was started and the patient's condition started to get better. Hence, early initiation of aggressive immunosuppressive treatment is essential in such cases.

Highlights

Neuromyelitis optica (NMO) is a severe inflammatory disorder of the central nervous system (CNS) of autoimmune etiology that mainly affects the optic nerves and spinal cord [1]
Diagnosis of NMO is made based on the presence of core clinical characteristics like optic neuritis, acute myelitis, area postrema syndrome, acute brainstem syndrome, symptomatic narcolepsy, or acute diencephalic clinical syndrome with neuromyelitis optica spectrum disorder- (NMOSD-) typical diencephalic magnetic resonance imaging (MRI) lesions and symptomatic cerebral syndrome with NMOSDtypical brain lesions with or without NMO Immunoglobulin G (NMO-immunoglobulin G (IgG)) [4]
In case of an acute initial presentation or exacerbation of NMO, the typical treatment is the administration of intravenous methylprednisolone therapy (IVMP; 1,000 mg daily for 3–5 days) and if there is no significant clinical improvement on steroids, plasma exchange (PLEX) has been shown to be effective for both optic neuritis and myelitis associated with NMO [14]

Summary

Background

Neuromyelitis optica is a severely disabling inflammatory disorder of the central nervous system of autoimmune etiology that mainly affects the optic nerves and spinal cord. We present a case report detailing a patient with tingling and weakness of right upper and lower limbs who was neuromyelitis optica immunoglobulin G-positive. A 46-yearold Nepalese man presented to the hospital with a history of tingling and weakness of right upper and lower limbs that developed over a period of two months. Clinical evaluation showed diminished power across all major muscle groups in the right upper and lower limbs. In the absence of tests for neuromyelitis optica immunoglobulin G, treatment was started and the patient’s condition started to get better. Early initiation of aggressive immunosuppressive treatment is essential in such cases

Introduction

Case Presentation

Discussion

Conclusion