Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 51-year-old woman with triplegia and blindness.

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Figure 4 Neuromyelitis optica spectrum disorder brain lesions

Figure 2 Orbital MRI findings One-third of myelin oligodendrocyte glycoprotein antibody–positive patients revealed extensive enhancement patterns that.

Figure 1 Percent positivity by clinical feature Overall, 6

Figure 2 Concordance of results for commercial cell-based assay (CBA) and fluorescence-activated cell sorting (FACS) assays, FACS titers, and disease activity.

Figure 2 Representative brain MRIs from patients with neuromyelitis optica Lesions are localized at sites of high aquaporin-4 expression (white dots).

Figure 4 Confirmatory cohorts to assess MOG-IgG1 assay(A) All 81 aquaporin-4 (AQP4)- seropositive patients (blue) from the Oxford National neuromyelitis.

Figure 1 Kaplan-Meier estimation of time to neuromyelitis optica (NMO) conversion and development of motor disability Kaplan-Meier estimation of time to.

Figure 1 Examples illustrating gating strategy for fluorescence-activated cell sorting (FACS)‏ Examples illustrating gating strategy for fluorescence-activated.

Figure 3 Multiple sclerosis (MS) immunomodulatory treatments interferon-β (IFNB) and fingolimod (FTY720) result in global perturbation of the immune system.

Figure 1 Relapse and rituximab historyThe figure shows rituximab (RTX) treatment history as well as relapse history for 100 days prior to the first RTX.

Figure 1 Representative spinal cord MRIs from patients with neuromyelitis optica Longitudinally extensive transverse myelitis of the cervical (A) and cervicothoracic.

Figure 2. Detection of KIR4.1 autoantibodies using LIPS

Figure 1 Full-length MOG cell-based assay using a serum dilution of 1:160 as a cutoff for positivity (red line in both plots)(A) Myelin olidgodendrocyte.

Presentation transcript:

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 51-year-old woman with triplegia and blindness

51-year-old woman was treated with interferons and glatiramer for relapsing- remitting multiple sclerosis over 20 years Continued to have recurrent attacks of optic neuritis (ON) and transverse myelitis (TM) leading to bilateral blindness and triplegia despite treatment Vignette Braksick et al. © 2013 American Academy of Neurology

A CB Braksick et al. Imaging A © 2013 American Academy of Neurology

Neuromyelitis optica was ultimately suspected and confirmed by detection of aquaporin-4 autoantibodies Even in the presence of MS-type lesions on MRI, NMO should be considered in patients with recurrent ON and TM MS-directed immunomodulatory medications are not effective and may be harmful when aimed at NMO Braksick et al. Advanced Neuromyelitis Optica © 2013 American Academy of Neurology