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Neurol Sci (2009) 30:5154 DOI 10.1007/s10072-008-0002-x
CASE REPORT
Neuromyelitis optica with CSF examination mimicking bacterial meningomyelitis
Dragan Lepur Vjerislav Peterkovi Nevija Kalabri-Lepur
Received: 24 April 2008 / Accepted: 13 October 2008 / Published online: 15 January 2009 Springer-Verlag 2009
Abstract Neuromyelitis optica (NMO) is a rare inammatory demyelinating disease of the central nervous system that causes severe attacks of optic neuritis and myelitis. Abnormal CSF ndings are one of the characteristics of NMO that help to distinguish it from classical multiple sclerosis. Here we describe two cases of Devics syndrome with CSF ndings suggestive of bacterial meningomyelitis.
Keywords Neuromyelitis optica Optic neuritis
Meningomyelitis
Introduction
Neuromyelitis optica (NMO) or Devics syndrome is a rare inammatory disorder consisting of one or more episodes of optic neuritis (ON) in combination with acute transverse myelitis (ATM). In contrast to typical multiple sclerosis (MS), these clinical events in NMO are usually more acute or even fulminant and severe [1]. Devics syndrome may follow either a monophasic or relapsing course with several important differences regarding the onset, severity and
long-term prognosis of disease [2]. The diagnosis of neuromyelitis optica, despite well-dened criteria and the possibility of serological conrmation (NMO-IgG), could be very challenging, particularly in cases with a long time interval between the optic neuritis and the myelitis attack [3, 4]. In addition, NMO has been associated with numerous systemic autoimmune and infectious diseases [5].
One of the characteristics that distinguishes it from classical MS is the cerebrospinal uid (CSF) nding. In patients with NMO, CSF examination during an active phase of the disease often reveals at least one abnormality (up to 65.9%) [6]. The most common is pleocytosis that can be dominated by polymorphonuclear cells followed by an increased total protein concentration level [7, 8].
The authors present two cases of NMO with CSF ndings mimicking bacterial meningomyelitis.
Case 1
A 47-year-old white female was admitted to the neurology ward of another hospital in October 2007 because of sudden and severe pain in the neck, back and lumbar region spreading to the groins and both legs. During the next 2 days she reported weakness, which evolved into accid paraplegia accompanied with complete sensory loss caudal to her breast and loss of bladder and bowel control. In addition, decreased visual accuracy...