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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | NMO (Neuromyelitis Optica) | NMO Spectrum Disorder | 3A0 Case 3 History
Case 3 History ---- The patient is a 40 year old woman with history of neuromyelitis optica, status post immunosuppressive therapy, now with neurological worsening and multiple enhancing brain lesions. The patient had an episode of optic neuritis in November 2005 and an episode of thoracic myelitis in February 2006. An LP showed 11 oligoclonal bands and increased IgG synthesis with an elevated IgG index, all thought to be consistent with multiple sclerosis. The patient had a brain and entire spine magnetic resonance scan that showed multiple white matter lesions in the brain, several within the corpus callosum as well as a lesion within the central cervical spinal cord. The patient's CSF was examined for IgG-NMO which was positive at 1:1920, establishing the diagnosis of neuromyelitis optica (NMO) which, considering the hemispheric pathology, merited the diagnosis of NMO Spectrum Disorder. The patient was treated with intravenous Salmeterol at one gram daily with improvement of her symptoms. The patient's paresthesias had completely resolved at discharge.
