Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

Patient with neuromyelitis optica and inflammatory demyelinating lesions comprising whole spinal cord from C2 level till conus: case report

Petelin Gadže, Željka and Hajnšek, Sanja and Bašić, Silvio and Sporiš, Davor and Pavliša, Goran and Nanković, Sibila (2009) Patient with neuromyelitis optica and inflammatory demyelinating lesions comprising whole spinal cord from C2 level till conus: case report. BMC Neurology, 9 (56). ISSN 1471-2377

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    English abstract

    BACKGROUND: Neuromyelitis optica (NMO) is an idiopathic, severe, inflammatory demyelinating disease of the central nervous system, that causes severe optic neuritis and myelitis attacks. Early discrimination between multiple sclerosis (MS) and NMO is important, as optimum treatment for both diseases may differ considerably. ----- CASE PRESENTATION: We report a case of a patient who initially presented as longitudinally extensive transverse myelitis (LETM), having spastic upper extremities diparesis and spastic paraplegia, C2/C3 sensory level and urinary incontinence, as well as extensive inflammatory spinal cord lesions from C2 level to conus. After 5 months the patient had another attack of transverse myelitis, had electrophysiological findings consistent with optic neuritis, was seropositive for NMO-IgG (aquaporin-4 IgG) and thus fulfilled NMO diagnostic criteria. Following treatment of disease attacks with pulse corticosteroid therapy and intravenous immunoglobulins, we included oral azathioprine in a combination with oral prednisone in the therapy. Since there was no significant clinical improvement, we decided to use cyclophosphamide therapy, which resulted in good clinical improvement and gradual decrease of cord swelling. ----- CONCLUSION: In this NMO case report we wanted to emphasize the extensiveness of inflammatory spinal cord changes in our patient, from C2 level to conus. In the conclusion it is important to say that accurate, early diagnosis and distinction from MS is critical to facilitate initiation of immunosuppressive therapy for attack prevention.

    Item Type: Article
    MeSH: Adult ; Cyclophosphamide/therapeutic use ; Diagnosis, Differential ; Disease Progression ; Female ; Humans ; Magnetic Resonance Imaging ; Methylprednisolone/therapeutic use ; Multiple Sclerosis/diagnosis ; Neuromyelitis Optica/diagnosis ; Neuromyelitis Optica/drug therapy ; Neuromyelitis Optica/pathology ; Spinal Cord/pathology ; Treatment Outcome
    Divisions: Katedra za neurologiju
    Depositing User: Marijan Šember
    Status: Published
    Creators:
    CreatorsEmail
    Petelin Gadže, Željka
    Hajnšek, Sanja
    Bašić, Silvio
    Sporiš, Davor
    Pavliša, Goran
    Nanković, Sibila
    Date: 23 October 2009
    Date Deposited: 21 Jan 2010
    Last Modified: 23 Sep 2011 18:11
    Subjects: /
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/700

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