Neuromyelitis optica: a challenging diagnosis at secondary hospital
| Autor: | Lívia Grigoriitchuk Herbst, André Kazuyoshi Kirihara, Marcio Ricardo Taveira Garcia, Maira Leticia Veras, André Macedo Serafim da Silva, Patricia Taranto, Anna Paula Romero de Oliveira, Angelina Maria Martins Lino |
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| Rok vydání: | 2013 |
| Předmět: |
lcsh:Internal medicine
medicine.medical_specialty Pediatrics Cord Central nervous system lcsh:Medicine Neurological examination Pathology and Forensic Medicine Internal Medicine medicine lcsh:RC31-1245 Diplopia Neuromyelitis optica medicine.diagnostic_test business.industry Neuromyelitis Optica lcsh:R Magnetic resonance imaging medicine.disease Spinal cord Magnetic Resonance Imaging Surgery medicine.anatomical_structure Vomiting Drug medicine.symptom Respiratory Insufficiency business Article / Clinical Case Reports Pulse Therapy Demyelinating Diseases |
| Zdroj: | Autopsy and Case Reports, Vol 3, Iss 1 (2013) Autopsy & Case Reports |
| ISSN: | 2236-1960 |
| DOI: | 10.4322/acr.2013.008 |
| Popis: | Known since the 19th century, neuromyelitis optica (NMO), or Devic’s disease, is an idiopathic immune-mediated inflammatory demyelinating disease of the central nervous system selectively affecting the optic nerve and spinal cord. Commonly diagnosed in demyelinating diseases reference centers, we report an 18-year-old female patient who sought medical attention with a 3-month history of weight loss, headache, and vomiting, followed by diplopia, a burning sensation over the lower limbs, and difficulty walking. A few days prior to hospital admission, the muscle strength in her lower limbs became worse and ascended to the upper limbs associated with sensory changes in the trunk and voiding dysfunction. At admission, the neurological examination was consistent with a spinal cord syndrome. After few days of hospitalization, she was tetraplegic with severe signs of brainstem involvement requiring mechanical ventilatory support. Intravenous methylprednisolone and cyclophosphamide were promptly started after ruling out the diagnosis of infectious disease and cord compression. Due to no substantial early improvement, intravenous immunoglobulin was also used. From then on, the neurological status gradually improved. Magnetic resonance imaging showed extensive demyelinating features in the spinal cord, and the serum IgG autoantibody was negative. The patient was referred to a tertiary neurological reference center where she remains under treatment. |
| Databáze: | OpenAIRE |
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