Neuro-myelitis Optica (NMO) / Devic Disease

FACTS

Characterized by:
  1. bilateral optic neuritis
  1. longitudinally extensive transverse myelitis
  1. Ab to Aquaporin 4
 
Specific diagnostic criteria:
  • neuritis
  • myelitis
  • two of:
    • longitudinally extensive spinal cord lesion on MRI
    • Brain MRI not initially meeting criteria for MS
    • NMO-IgG seropositivity (NMO Ab is 91% specific)
 
  • more commonly seen in non-White patients (Asian / Indian)
  • poorer prognosis than MS

HPI

universal ROS

PHYSICAL EXAM

universal exam
  • vision testing

IMAGING

  • spinal cord segments will be 3+ segments in length (vs MS 1-2 segments)
  • optic nerve enhancement will be seen on MRI Brain
A/P
  • Neurology to manage high dose IV MDP or rescue plasma exchanges
  • Counsel prognosis
    • only partial recovery occurs after acute attacks
    • 60% relapse after 1 year, 90% after 3 years