Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings

Authors

Carolyn Goldschmidt
Steven L. Galetta
Robert P. Lisak
Laura J. Balcer
Andrew Hellman
Michael K. Racke
Amy E. Lovett-Racke
Roberto A. Cruz, The University of Texas Rio Grande ValleyFollow

Document Type

Article

Publication Date

1-2023

Abstract

A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.

Comments

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Recommended Citation

Carolyn Goldschmidt, Steven L. Galetta, Robert P. Lisak, Laura J. Balcer, Andrew Hellman, Michael K. Racke, Amy E. Lovett-Racke, Roberto Cruz, Matthew S. Parsons, Neda Sattarnezhad, Lawrence Steinman, Scott S. Zamvil, Elliot M. Frohman, Teresa C. Frohman Neurol Neuroimmunol Neuroinflamm Jan 2023, 10 (1) e200037; DOI: 10.1212/NXI.0000000000200037

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Publication Title

Neurology(R) neuroimmunology & neuroinflammation

DOI

10.1212/NXI.0000000000200037

Academic Level

faculty

Mentor/PI Department

Neurology