Table 2 Clinical demographics, characteristics and serum, CSF, MRI findings and outcomes of patients with NMO
From: Relevance of bright spotty lesions in neuromyelitis optica spectrum disorders (NMOSD): a case series
Case | Age/gender | Year of diagnosis | Onset/presentation | Serum NMO | MRI results | Treatment | Outcomes |
|---|---|---|---|---|---|---|---|
Case 1 | 75/F | 2017 | Progressive lower extremity weakness | Seropositive | MRI C Spine: intramedullary hyperintensity with corresponding enhancement posteriorly at the T3 and T5/T6 level. MRI thoracic spine: evidence of transverse myelitis extending from the mid body of T4 down to about the T5–6 level MRI Brain: mild-to-moderate cortical and subcortical atrophy MRI orbit: NA | Eculizumab | Improved |
Case 2 | 71/F | 2016 | Progressive lower extremity weakness, numbness below T1 dermatome | Seropositive | MRI C-spine: intramedullary hyperintensity with enhancing demyelinating plaque extending from the C7–T1 level. MRI T-spine: hyperintense cord lesion with enhancing demyelination plaques involving the upper thoracic spinal cord at the C7–T1 level and at the T6–T7 and T9–T10 levels, MRI brain: periventricular white matter hyperintensities MRI orbit: NA | Rituximab | Partially improved |
Case 3 | 74/F | 2011 | numbness waist down | Seropositive | MRI C spine: intramedullary hyperintensity beginning at the level of C4 to T1, MRI T spine: hyperintensity and abnormal enhancement of the thoracic cord noted from the T1 through T6 level, MRI brain: subtle, nonspecific signal changes identified in the periventricular white matter, bilateral thalami, left cerebral peduncle and medulla MRI orbit: NA | Azathioprine and oral prednisone | Partially improved |
Case 4 | 69/F | 2008 | Progressive lower Extremity weakness and band-like sensation in chest | Seropositive | MRI C spine: intramedullary hyperintensity beginning at the level of C4–C6, with diffuse cervical and cervico-thoracic cord atrophy noted MRI T spine: the mid-to-upper thoracic cord atrophy appears more severe with subtle cord signal changes T3–T5 MRI brain: abnormal hyperintense signal in the cervicomedullary junction with no mass effect or abnormal contrast enhancement MRI orbit: NA | Rituximab | Partially improved |
Case 5 | 64/F | 2015 | lower extremity weaknesses well as hypoxic respiratory failure requiring mechanical ventilation | Seropositive | MRI c spine: intramedullary hyperintensity beginning at the level of C2 to C7, no abnormal enhancement seen, MRI T spine: increased signal intensity in the mid to lower thoracic cord, MRI brain: no abnormal T2/FLAIR abnormality, MRI orbit: NA | Pulse oral steroids, plasmapheresis and rituximab | Partially improved |
Case 6 | 35/F | 2019 | bilateral loss of vision left more than right | Seropositive | MRI C spine: multiple confluent T2 hyperintense cord lesions throughout the upper to mid cervical spine, some with patchy enhancement. MRI T spine: nonenhancing T2 hyperintense cord lesions, most prominently at T7 and T8 MRI brain and orbit: findings of bilateral optic neuritis and nonspecific periventricular white matter T2 hyperintensity along left lateral ventricle | Satralizumab | Partially improved |
Case 7 | 69/F | 1997 | Progressive lower extremity weakness and right loss of vision | Seropositive | MRI c spine: intramedullary hyperintensity with corresponding enhancement at the level of C2–C3 to T4, MRI T spine: increased signal intensity in the mid to lower thoracic cord with enhancement at T5–T6 MRI brain with nonspecific white matter changes in frontal deep white matter, MRI orbit bilateral hyperintensity of optic nerve post chiasmatic segment and right optic nerve atrophy | Rituximab and IVIG | Partially improved |
Case 8 | 26/F | 2006 | Bilateral loss of vision rt > lt. F/B bilateral arm and leg weakness | Seropositive | MRI C spine: intramedullary hyperintensity cord signal at C3 to C7 level, MRI T spine: cord signal again demonstrates abnormal T2 signal within the cord seems at the C7 level and extending inferiorly to the T7 level, MRI brain: bilateral optic nerve atrophy, otherwise, no acute intracranial process | Satralizumab | Partially improved |
Case 9 | 36/F | 2012 | Progressive lower extremity weakness and paresthesia | Seropositive | MRI C spine: intramedullary hyperintensity cord signal at C2 to C6 level, MRI T spine: cord signal again demonstrates abnormal T2 signal within the cord seems at T6 level, MRI brain: unremarkable, MRI orbit: left optic nerve hyperintensity | PLEX, Pulse oral steroid and CellCept | Partially improved |
Case 10 | 69/F | 2005 | Progressive lower extremity weakness and paresthesia | Seropositive | MRI C spine: unremarkable MRI T spine: cord signal again demonstrates abnormal T2 signal within the cord extending at T4 to T9 level MRI brain and orbit: hyperintensity along left optic nerve | Rituximab | Partially improved |
Case 11 | 67/F | 2008 | Left blurry vision and left hemiparesis | Seropositive | MRI C spine: intramedullary longitudinal expansile T2 hyperintense cord lesion is currently noted from the C2 to C5 with abnormal enhancement MRI orbit: left optic nerve demonstrates abnormal signal changes MRI T spine: no cord lesion | Pulse oral steroid and PLEX | Partially improved |