PSY5 Neuromyelitis optica. (Psychiatry and Neurology).

PSY5 NEUROMYELITIS OPTICA. Imran P. Haque. MD. University of Virginia School of Medicine, Roanoke-Salem Internal Medicine Program, Roanoke.

Neuromyelitis optica or Devic's syndrome is an uncommon neurological illness characterized by optic neuropathy and myelopathy. This case presents a 39-year-old African-American female with new onset of visual changes, periocular pain, headache, malaise, lower extremity weakness, and back pain. The patient's symptoms began one week prior to admission. She presented with lower extremity pain and weakness six months earlier and was suspected clinically to have multiple sclerosis and had resolution of her symptoms with corticosteroids. She had no changes on magnetic resonance imaging of brain and cerebral spinal fluid findings were nonspecific at the time. Her symptoms of visual changes and loss with periocular pain were not present upon this prior admission. On physical exam, she had papillitis, severe visual field defect, profoundly decreased lower extremity weakness and sensation, and Lhermitte's sign. On laboratory exam, cerebral spinal fluid showed increased protein and she had an elevated ESR. Magnetic reso nance imaging of spine showed diffuse cervical cord swelling and cervical signal changes. This patient presented with bilateral optic neuritis and myelitis, known as Devic's syndrome or neuromyelitis optica. She was treated with intravenous methyiprednisolone and had gradual improvement of her symptoms. Devic's syndrome generally has a rapid onset of optic neuritis and myelitis. Patients with acute or subacute Devic's syndrome often respond to corticosteroids as this patient did. In Devic's syndrome, acute spinal cord lesions can demonstrate diffuse swelling extending over several levels of the entire cord in either a continuous or patchy distribution. The optic nerve and chiasm can show either demyelinating lesions and/or necrotizing lesions. Approximately 35% of patients have a monophasic illness and 55% develop relapses, and rarely patients have a fulminantly progressive course without relapses or a course typical of multiple sclerosis.