NDLI: Gaze palsy, hypogeusia and a probable association with miscarriage of pregnancy - the expanding clinical spectrum of non-opticospinal neuromyelitis optica spectrum disorders: a case report

Content Provider	Springer Nature : BioMed Central
Author	Chang, Thashi Withana, Milinda
Abstract	Background Neuromyelitis optica is characterised by optic neuritis, longitudinally-extensive transverse myelitis and presence of anti-aquaporin-4 antibodies in the serum. However, non-opticospinal central nervous system manifestations have been increasingly recognised. Awareness of the widening clinical spectrum of neuromyelitis optica (unified within the nosology of ‘neuromyelitis optica spectrum disorders’) is key to earlier diagnosis and appropriate therapy. We report 2 patients to illustrate the varied clinical manifestations of neuromyelitis optica spectrum disorders while postulating an effect of anti-aquaporin-4 antibodies on the miscarriage of pregnancy. This is the first report of horizontal gaze palsy as a presenting symptom of neuromyelitis optica spectrum disorders. Case presentation Patient 1 A 17-year-old Sri Lankan female presented with hypersomnolence, lateral gaze palsy and loss of taste of 1 week duration. Two years previously she had presented with intractable hiccups and vomiting followed by a brainstem syndrome. Magnetic resonance imaging showed a lesion in the left cerebellum extending into the pons while lesions in bilateral hypothalami and medulla noted 2 years ago had resolved. Autoimmune, vasculitis and infection screens were negative. Anti-aquaporin-4 antibodies were detected in serum. All her symptoms resolved with immunosuppressive therapy. Patient 2 A 47-Year-old Sri Lankan female presented with persistent vomiting lasting over 3 weeks. Three years previously, at 25-weeks of her 4th pregnancy, she had presented with quadriparesis and was found to have a longitudinally extensive transverse myelitis from C2 to T2 vertebral levels, which gradually improved following intravenous steroid therapy. Magnetic resonance imaging showed a hyper-intense lesion in the area postrema and longitudinally extensive atrophy of the cord corresponding to her previous myelitis. Autoimmune, vasculitis and infection screens were negative. Anti-aquaporin-4 antibodies were detected in serum. Her vomiting subsided with immunosuppressive therapy. Her second pregnancy had resulted in a first-trimester miscarriage. Conclusion The clinical spectrum of neuromyelitis optica spectrum disorders has expanded beyond optic neuritis and myelitis to include non-opticospinal syndromes involving the diencephalon, brainstem and cerebrum. Our report highlights the varied central nervous system manifestations of neuromyelitis optica spectrum disorders and miscarriage of pregnancy possibly related to anti-aquaporin-4 antibodies.
Related Links	https://bmcresnotes.biomedcentral.com/counter/pdf/10.1186/s13104-015-0991-5.pdf
Ending Page	5
Page Count	5
Starting Page	1
File Format	HTM / HTML
ISSN	17560500
DOI	10.1186/s13104-015-0991-5
Journal	BMC Research Notes
Issue Number	1
Volume Number	8
Language	English
Publisher	BioMed Central
Publisher Date	2015-02-10
Access Restriction	Open
Subject Keyword	Biomedicine Medicine Public Health Life Sciences NMOSD Gaze palsy Hypogeusia Area postrema Miscarriage Medicine/Public Health
Content Type	Text
Resource Type	Case study
Subject	Biochemistry, Genetics and Molecular Biology Medicine
Journal Impact Factor	1.6/2023

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Gaze palsy, hypogeusia and a probable association with miscarriage of pregnancy - the expanding clinical spectrum of non-opticospinal neuromyelitis optica spectrum disorders: a case report

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Gaze palsy, hypogeusia and a probable association with miscarriage of pregnancy - the expanding clinical spectrum of non-opticospinal neuromyelitis optica spectrum disorders: a case report

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