A 34 year old woman presents with sudden onset painless blurring of vision in her right eye, and urinary incontinence and progressive weakness of both lower limbs for 2 days. Her medical history is unremarkable except for an episode of bilateral lower limb weakness 3 months ago, which was of sudden onset and lasted for less than a day. Her neurological examination was normal, and she was diagnosed with a transient ischemic attack, and started on long-term aspirin. There is no history of recent vaccination or ingestion of tinned food.
Appearance: clear Cell count: 60 cells/mm3 (<5 cells/mm3) 60% polymorphs Protein: 45 mg/dl (15-40 mg/dL) Glucose: 56 mg/dL (½ to ⅔ of blood glucose) Gram stain and Ziehl-Neelsen stain: no organisms VDRL on CSF: non reactive CSF oligoclonal bands: positive Random Plasma Glucose: 80 mg/dL
All indices are within normal parameters.
MRI Brain: there is strong enhancement of the right optic nerve in T1-weighted images suggestive of optic neuritis. No other abnormalities are noted. MRI Spine: T2-weighted images reveal hyperintense ill-defined lesions from T4 – T8. There is no evidence of cord compression.
Positive for NMO-IgG Antibodies.