Abstract
Objective: Lumbosacral Radiculomyelopathy is an uncommon presentation of Neuromyelitis Optica (NMO). It has been reported in 2 patients with NMO Spectrum Disorders (NMOSD). We present a patient with diagnosed NMOSD and lumbosacral radiculomyelopathy.
Background: Classically NMO tends to spare the conus. One report suggests that lesions in the conus medullaris were seen in 1.58% in NMOSD, and 9.6% in anti-AQP4 antibody positive cases. In myelin oligodendrocyte glycoprotein antibody-positive NMO/NMOSD, conus involvement on spinal magnetic resonance imaging is 75%, whereas in AQP4-Ab-positive cases it is only seen in 17%.
Design/Methods: Case: A 21-year-old female presented with Area Postrema syndrome. Following imaging and a positive serum anti-aquaporin 4 antibody, she was diagnosed with NMOSD. She was started on disease modifying agent Rituxan which was administered at 6 monthly intervals or if her CD19 counts increased whichever came earlier. She later presented to clinic with urinary incontinence and saddle anesthesia. The MRI spine demonstrated a lesion in the conus medullaris and contrast enhancement of the nerve roots in the cauda equina. Work up for other etiologies was negative.
Results: The patient had an NMO flare constituting Myeloradiculopathy, a rare presentation of NMOSD. She received Plasmapharesis with near complete resolution of her symptoms.
Conclusions: Myeloradiculopathy is an uncommon presentation of NMO. If it is the initial presentation, it is imperative to check the antiaquaporin-4 antibody. In patients with diagnosed NMO/NMOSD, it is important to suspect conus lesions especially if presentation includes bowel, bladder, or sexual dysfunction. Conus lesions are overlooked as neuroimaging obtained typically in suspected NMO includes only the cervical and thoracic spinal cord looking for LETMs. In addition, lower motor neuron lesions are typically not suspected in NMOSD.
Disclosure: Dr. Sapnar has nothing to disclose. Dr. Prabhu has nothing to disclose.
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