Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report
Authors: Wei Kok Poh, Zaidatul Wahida Abd Wahab, Yong Chin Kok
Background: Cortical involvement and leptomeningeal enhancement are rare in neuromyelitis optica spectrum disorder (NMOSD). Cerebrospinal fluid (CSF) total protein is usually raised typically ranged between 0.5 and 1.5 g/l. Case Presentation: A 22-year old lady who was previously well presented with a subacute onset of bilateral lower limb weakness for 1 week, which progressed in an ascending pattern involving the upper limbs. Magnetic resonance imaging spine showed longitudinally extensive transverse myelitis as well as leptomeningeal enhancement of the entire spine. CSF protein was high with 3.33 g/l. Serum Aquaporin-4 IgG was positive. After failed steroid therapy, she responded dramatically with plasma exchange. Conclusion: The presence of very high CSF protein and the presence of extensive leptomeningeal enhancement should not dissuade clinicians from considering the diagnosis of NMOSD, but merely reflects its severity and may need aggressive immunotherapy such as combination of steroids and plasma exchange.
Keywords: Neuromyelitis optica spectrum disorders, spinal leptomeningeal enhancement, aquaporin-4 IgG, longitudinally extensive transverse myelitis.
Authors
Correspondence to:
Poh Kok Wei, Internal Medicine, Hospital Tuanku Jaafar Seremban, Malaysia dr.teddypoh@gmail.com
Publication history:
Received 29 Jun 2019
Revised 24 Jul 2019
Accepted 05 Aug 2019
Published online 12 Sep 2019
Published in print 15 Dec 2019
Poh WK, Wahab ZWA, Kok YC. Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. EJMCR. 2019; 3(3): 119-122. doi:
10.24911/ejmcr/173-1561798736
Poh WK, Wahab ZWA, Kok YC. Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. https://www.ejmcr.com/?mno=54686 [Access: March 28, 2024]. doi:
10.24911/ejmcr/173-1561798736
Poh WK, Wahab ZWA, Kok YC. Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. EJMCR. 2019; 3(3): 119-122. doi:
10.24911/ejmcr/173-1561798736
Poh WK, Wahab ZWA, Kok YC. Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. EJMCR. (2019), [cited March 28, 2024]; 3(3): 119-122. doi:
10.24911/ejmcr/173-1561798736
Poh, W. K., Wahab, . Z. W. A. & Kok, . Y. C. (2019) Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. EJMCR, 3 (3), 119-122. doi:
10.24911/ejmcr/173-1561798736
Poh, Wei Kok, Zaidatul Wahida Abd Wahab, and Yong Chin Kok. 2019. Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. European Journal of Medical Case Reports, 3 (3), 119-122. doi:
10.24911/ejmcr/173-1561798736
Poh, Wei Kok, Zaidatul Wahida Abd Wahab, and Yong Chin Kok. "Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report." European Journal of Medical Case Reports 3 (2019), 119-122. doi:
10.24911/ejmcr/173-1561798736
Poh, Wei Kok, Zaidatul Wahida Abd Wahab, and Yong Chin Kok. "Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report." European Journal of Medical Case Reports 3.3 (2019), 119-122. Print. doi:
10.24911/ejmcr/173-1561798736
Poh, W. K., Wahab, . Z. W. A. & Kok, . Y. C. (2019) Extensive spinal leptomeningeal enhancement in neuromyelitis optica spectrum disorders: a case report. European Journal of Medical Case Reports, 3 (3), 119-122. doi:
10.24911/ejmcr/173-1561798736