Abstract
IntroductionNeuromyelitis optica is a demyelinating disease of the central nervous system that predominantly affects the optic nerves and spinal cord. In neuromyelitis optica, white blood cells and antibodies primarily attack the optic nerves and the spinal cord, but may also attack the brain. Brainstem manifestation has been described recently. So far, neuromyelitis optica is very rare in Ethiopia and there were only two case reports, but this is the first case report of neuromyelitis optica with brainstem involvement.Case presentationA 47-year-old Addis Ababa woman presented to Saint Paul’s Hospital Millennium Medical College with a history of visual loss of 7 years and bilateral lower limb weakness of 4 days duration. She had bilateral oculomotor nerve palsy. Her past medical history showed systemic hypertension for 18 years and dyslipidemia for 1 year. The objective evaluation of the patient revealed right optic nerve atrophy suggesting optic neuritis and flaccid paraplegia with sensory level at the fourth thoracic vertebra. Diagnostic work-up using electromyography and spinal magnetic resonance imaging revealed demyelinating anterior visual pathway dysfunction and signs of extensive cervicothoracic transverse myelitis from the third cervical to lower thoracic vertebrae, respectively. Then a diagnosis of neuromyelitis optica was established. After treatment with high-dose systemic steroid followed by azathioprine, the patient was stable for several months with significant improvement of vision and lower-extremity weakness with no relapse of symptoms.ConclusionThe case described here is a rare inflammatory demyelinating disorder of the central nervous system occurring in East Africa. It reminds clinicians to suspect neuromyelitis optica in a patient who presented with unexplained recurrent optic neuritis to make a timely diagnosis and prevention of permanent neuronal damage. Neuromyelitis optica can also be associated with oculomotor nerve involvement.
Highlights
Neuromyelitis optica is a demyelinating disease of the central nervous system that predominantly affects the optic nerves and spinal cord
The case described here is a rare inflammatory demyelinating disorder of the central nervous system occurring in East Africa
It reminds clinicians to suspect neuromyelitis optica in a patient who presented with unexplained recurrent optic neuritis to make a timely diagnosis and prevention of permanent neuronal damage
Summary
It is prudent to suspect NMO in a patient with unexplained recurrent optic neuritis. NMO should be considered as a cause for bilateral oculomotor palsy. Initiation of further diagnostic work-up and aggressive immunosuppressive treatment are essential to prevent recurrences and permanent neurologic disability. It is very important to follow patients with optic neuritis for a longer period. Abbreviations AQP4-Abs: Aquaporin-4 antibodies; AQP-4: Aquaporin-4; CSF: Cerebrospinal fluid; CNS: Central nervous system; FLAIR: Fluid-attenuated inversion recovery; HIV: Human immunodeficiency virus; IgG: Immunoglobulin G; MD: Medical doctor; MRI: Magnetic resonance imaging; MS: Multiple sclerosis; MRC: Medical Research Council; NMO: Neuromyelitis optica; PRVEP: Pattern reversal visual evoked potential; STIR: Short T1 inversion recovery; WBC: White blood cell count
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