Testing for Neuromyelitis Optica (NMO)
Though brain symptoms are unusual in adult patients with neuromyelitis optica, they do occur more frequently in children with neuromyelitis optica. In a recent study that we did at the Mayo Clinic, you can see that in children with neuromyelitis optica spectrum disorders, the vast majority of the children have optic neuritis, either unilateral or bilateral, or transverse myelitis, or both as the presenting clinical syndrome. However, 16% of children presented with brain symptomatology, vomiting in 7%, nausea and Syndrome of Inappropriate ADH production in 2%, encephalopathy in 5%, and double vision in 2%.
On the right hand side of this figure you can see some of the brain MRI abnormalities that were seen in these children. The children that presented with brain symptomatology and were found to have NMO-IgG, subsequently went on to develop either optic neuritis or transverse myelitis.
On the lower figure you can see a diffuse, white matter signal abnormality in both of the hemispheres. This patient presented with an encephalopathy. All 3 patients that presented with encephalopathy as the presenting symptom of an NMO spectrum disorder were initially diagnosed as having acute disseminated encephalomyelitis. The identification of NMO-IgG allowed the patient to be clinically classified as neuromyelitis optica spectrum disorder. The presence of the antibody predicted the development of further attacks of optic neuritis or transverse myelitis.
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