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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | NMO (Neuromyelitis Optica) | NMO | 1A0 Case 1 History
Case 1 History ---- The patient was a 58-year-old woman with hypertension and a history of mandibular ameloblastoma resected 5 years prior. Her present illness began with ascending numbness from her toes to her hips and two days later she experienced increasing bilateral leg weakness and was wheel chair bound 3 days later. An MRI at this time revealed a T2 hyperintensity at C7 extending to T6. She was paraplegic with 0/5 strength bilateral proximal lower extremities. She had a sensory level at T4, and bilateral upgoing toes on Babinski testing. CSF revealed elevated protein of 98 with normal cell count and glucose. A repeat CSF 3 days later showed pleocytosis of 37 cells and lymphocytic predominance (93% lymphocytes and 7% monocytes). The patient had increased IgG in the CSF. An extensive work-up for vasculitis, infection, neoplastic and paraneoplastic causes were negative; however, she was positive for an NMO-IgG autoantibody. The patient was treated with steroids and plasmapheresis for her rapid course of idiopathic transverse myelitis and was discharged to inpatient rehabilitation. She returned to the hospital from home in a wheelchair and with indwelling catheter on 6/17 for a UTI. She received IV fluids without improvement of her tachycardia, however, and was treated with ciprofloxacin for her UTI. She had a rapid decline after admission in which she remained hypoxemic even on oxygen along with progressive severe hypotension with increasing tachycardia. She had eye deviation to one side and mouth twitching, and was treated for a possible seizure. After treatment in the ICU, she continued to be hypotensive, became acutely bradycardic approximately 2.5 hours after admission and went into pulseless electrical arrest. Extended resuscitation measures were unsuccessful.
