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Neuromyelitis Optica Spectrum Disorder: A Case Report Tetsuryu MITSUYAMA 1 , Taku YONEYAMA 2 , Sakiko SUZUKI 1 , Mizuo KAGAWA 3 , Takakazu KAWAMATA 1 1Department of Neurosurgery,Tokyo Women's Medical University Yachiyo Medical Center 2Department of Neurosurgery,Tokyo Women's Medical University 3Department of Neurosurgery,Koyama Memorial Hospital Keyword: aquaporin-4 antibody , astrocyte disorder , longitudinally extensive spinal cord lesion , low-dose steroid , neuromyelitis optica pp.337-342
Published Date 2012/4/10
DOI https://doi.org/10.11477/mf.1436101699
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 Neuromyelitis optica (NMO) is a relapsing inflammatory disease of the central nervous system,usually affecting the optic nerves and the spinal cord. It is presumed to be an antibody-mediated disorder and the target antigen is the water channel aquaporin-4 (AQP4) on astrocyte cell membranes. NMO is a disease caused by astrocyte disorder and is distinct from multiple sclerosis (MS),which is a primarily demyelinating disease caused by oligodendrocyte disorder. In NMO,spinal MRI shows a T2-hyperintense,longitudinally extensive (≧3 vertebral segments) spinal cord lesion. The case,which has optic neuritis or transverse myelitis with the presence of AQP4 antibody,is called as NMO spectrum disorder.

 A 68 year-old woman with a history of hypertension and diabetes mellitus was brought to the former hospital by ambulance with acute onset of tetraparesis. She denied visual acuity disturbance. MRI revealed a T2-hyperintense lesion from C5 to T2 level. Laboratory examination showed the presence of AQP4 antibody and the absence of oligoclonal bands. Low-dose steroid treatment was started after establishing a diagnosis of NMO. She incompletely recovered from disability, although the T2-hyperintense lesion on MRI had almost disappeared six months after the onset.

 It is important to maintain a high index of suspicion for NMO in cases with a longitudinally extensive spinal cord lesion,because untreated NMO leads to severe disability.


Copyright © 2012, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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