15B. Neuromyelitis optica (Devic-disease)

Definition and epidemiology

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system characterised mainly by optic neuritis and acute longitudinally extensive (> 3 vertebral segments) transverse myelitis. It’s associated with anti-aquaporin 4 antibodies (anti-AQP4 antibodies).

It mostly occurs in 40 – 60 year olds. The clinical features may be similar to MS so it’s important to distinguish them.

Clinical features

The patient has recurring attacks of severe symptoms which become progressively worse and worse.

The symptoms of optic neuritis may be unilateral or bilateral and can be impaired vision with or without retrobulbar pain. The symptoms of transverse myelitis are bilateral and may be symmetric paraplaegia, sensory loss, and bladder dysfunction.

The patient may also have area postrema syndrome, where they experience severe nausea and vomiting.

Diagnosis and evaluation

Serology shows the anti-AQP4 antibodies. MRi shows transverse inflammation and demyelination of the spinal cord which spans 3 or more segments. CSF should also be performed to rule out MS. The CSF in NMO is unremarkable.

Unlike in MS, the MRi shows no lesions in the brain itself.

Treatment

In acute relapses we use plasma exchange. The chronic treatment is usually steroids + azathioprine.


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15A. Trigeminal neuralgia

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16A. Clinical symptoms of insufficient blood supply in territory of carotid and vertebral artery

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