DOI QR코드

DOI QR Code

Neuromyelitis Optica Mimicking Intramedullary Tumor

  • Oh, Si-Hyuck (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Yoon, Kyeong-Wook (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Kim, Young-Jin (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Lee, Sang-Koo (Department of Neurosurgery, Dankook University College of Medicine)
  • Received : 2012.11.08
  • Accepted : 2013.05.13
  • Published : 2013.05.28

Abstract

Neuromyelitis optica (NMO) is considered to be a rarer autoimmune disease than multiple sclerosis. It is very difficult to make a diagnosis of MNO for doctors who are not familiar with its clinical features and diagnostic criteria. We report a case of a young female patient who had been suffering motor weakness and radiating pain in both upper extremities. Cervical MRI showed tumorous lesion in spinal cord and performed surgery to remove lesion. We could not find a tumor mass in operation field and final diagnosis was NMO. NMO must be included in the differential diagnosis of lesions to rescue the patient from invasive surgical interventions. More specific diagnostic tools may be necessary for early diagnosis and proper treatment.

Keywords

References

  1. Das A, Puvanendran K : A retrospective review of patients with clinically definite multiple sclerosis. Ann Acad Med Singapore 27 : 204-209, 1998
  2. de Seze J, Blanc F, Jeanjean L, Zephir H, Labauge P, Bouyon M, et al. : Optical coherence tomography in neuromyelitis optica. Arch Neurol 65 : 920-923, 2008
  3. Downer JJ, Leite MI, Carter R, Palace J, Kuker W, Quaghebeur G : Diagnosis of neuromyelitis optica (NMO) spectrum disorders : is MRI obsolete? Neuroradiology 54 : 279-285, 2012 https://doi.org/10.1007/s00234-011-0875-x
  4. Ghezzi A, Bergamaschi R, Martinelli V, Trojano M, Tola MR, Merelli E, et al. : Clinical characteristics, course and prognosis of relapsing Devic's Neuromyelitis Optica. J Neurol 251 : 47-52, 2004 https://doi.org/10.1007/s00415-004-0271-0
  5. Hui AC, Wong RS, Ma R, Kay R : Recurrent optic neuromyelitis with multiple endocrinopathies and autoimmune disorders. J Neurol 249 : 784-785, 2002 https://doi.org/10.1007/s00415-002-0709-1
  6. Jarius S, Aboul-Enein F, Waters P, Kuenz B, Hauser A, Berger T, et al. : Antibody to aquaporin-4 in the long-term course of neuromyelitis optica. Brain 131 (Pt 11) : 3072-3080, 2008 https://doi.org/10.1093/brain/awn240
  7. Kira J : Multiple sclerosis in the Japanese population. Lancet Neurol 2 : 117-127, 2003 https://doi.org/10.1016/S1474-4422(03)00308-9
  8. Krampla W, Aboul-Enein F, Jecel J, Lang W, Fertl E, Hruby W, et al. : Spinal cord lesions in patients with neuromyelitis optica : a retrospective long-term MRI follow-up study. Eur Radiol 19 : 2535-2543, 2009 https://doi.org/10.1007/s00330-009-1425-3
  9. Kuroiwa Y, Igata A, Itahara K, Koshijima S, Tsubaki T : Nationwide survey of multiple sclerosis in Japan. Clinical analysis of 1,084 cases. Neurology 25 : 845-851, 1975 https://doi.org/10.1212/WNL.25.9.845
  10. Lee M, Epstein FJ, Rezai AR, Zagzag D : Nonneoplastic intramedullary spinal cord lesions mimicking tumors. Neurosurgery 43 : 788-794; discussion 794-795, 1998 https://doi.org/10.1097/00006123-199810000-00034
  11. Lennon VA, Wingerchuk DM, Kryzer TJ, Pittock SJ, Lucchinetti CF, Fujihara K, et al. : A serum autoantibody marker of neuromyelitis optica : distinction from multiple sclerosis. Lancet 364 : 2106-2112, 2004 https://doi.org/10.1016/S0140-6736(04)17551-X
  12. Mandler RN, Ahmed W, Dencoff JE : Devic's neuromyelitis optica : a prospective study of seven patients treated with prednisone and azathioprine. Neurology 51 : 1219-1220, 1998 https://doi.org/10.1212/WNL.51.4.1219
  13. Matiello M, Lennon VA, Jacob A, Pittock SJ, Lucchinetti CF, Wingerchuk DM, et al. : NMO-IgG predicts the outcome of recurrent optic neuritis. Neurology 70 : 2197-2200, 2008 https://doi.org/10.1212/01.wnl.0000303817.82134.da
  14. Naismith RT, Tutlam NT, Xu J, Klawiter EC, Shepherd J, Trinkaus K, et al. : Optical coherence tomography differs in neuromyelitis optica compared with multiple sclerosis. Neurology 72 : 1077-1082, 2009 https://doi.org/10.1212/01.wnl.0000345042.53843.d5
  15. Nakamura M, Miyazawa I, Fujihara K, Nakashima I, Misu T, Watanabe S, et al. : Preferential spinal central gray matter involvement in neuromyelitis optica. An MRI study. J Neurol 255 : 163-170, 2008 https://doi.org/10.1007/s00415-008-0545-z
  16. Nishiyama S, Ito T, Misu T, Takahashi T, Kikuchi A, Suzuki N, et al. : A case of NMO seropositive for aquaporin-4 antibody more than 10 years before onset. Neurology 72 : 1960-1961, 2009 https://doi.org/10.1212/WNL.0b013e3181a82621
  17. O'Riordan JI, Gallagher HL, Thompson AJ, Howard RS, Kingsley DP, Thompson EJ, et al. : Clinical, CSF, and MRI findings in Devic's neuromyelitis optica. J Neurol Neurosurg Psychiatry 60 : 382-387, 1996 https://doi.org/10.1136/jnnp.60.4.382
  18. Pittock SJ, Weinshenker BG, Lucchinetti CF, Wingerchuk DM, Corboy JR, Lennon VA : Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol 63 : 964-968, 2006 https://doi.org/10.1001/archneur.63.7.964
  19. Saiz A, Zuliani L, Blanco Y, Tavolato B, Giometto B, Graus F, et al. : Revised diagnostic criteria for neuromyelitis optica (NMO). Application in a series of suspected patients. J Neurol 254 : 1233-1237, 2007 https://doi.org/10.1007/s00415-007-0509-8
  20. Schwartz TH, McCormick PC : Non-neoplastic intramedullary pathology. Diagnostic dilemma : to Bx or not to Bx. J Neurooncol 47 : 283-292, 2000 https://doi.org/10.1023/A:1006495212574
  21. Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X, et al. : EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol 17 : 1019-3102, 2010 https://doi.org/10.1111/j.1468-1331.2010.03066.x
  22. Sellner J, Lüthi N, Bühler R, Gebhardt A, Findling O, Greeve I, et al. : Acute partial transverse myelitis : risk factors for conversion to multiple sclerosis. Eur J Neurol 15 : 398-405, 2008 https://doi.org/10.1111/j.1468-1331.2008.02088.x
  23. Vernant JC, Cabre P, Smadja D, Merle H, Caubarrere I, Mikol J, et al. : Recurrent optic neuromyelitis with endocrinopathies : a new syndrome. Neurology 48 : 58-64, 1997 https://doi.org/10.1212/WNL.48.1.58
  24. Watanabe S, Misu T, Miyazawa I, Nakashima I, Shiga Y, Fujihara K, et al. : Low-dose corticosteroids reduce relapses in neuromyelitis optica : a retrospective analysis. Mult Scler 13 : 968-974, 2007 https://doi.org/10.1177/1352458507077189
  25. Watanabe S, Nakashima I, Misu T, Miyazawa I, Shiga Y, Fujihara K, et al. : Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica. Mult Scler 13 : 128-132, 2007 https://doi.org/10.1177/1352458506071174
  26. Wingerchuk DM, Hogancamp WF, O'Brien PC, Weinshenker BG : The clinical course of neuromyelitis optica (Devic's syndrome). Neurology 53 : 1107-1114, 1999 https://doi.org/10.1212/WNL.53.5.1107
  27. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG : Revised diagnostic criteria for neuromyelitis optica. Neurology 66 : 1485-1489, 2006 https://doi.org/10.1212/01.wnl.0000216139.44259.74
  28. Wingerchuk DM, Weinshenker BG : Neuromyelitis optica : clinical predictors of a relapsing course and survival. Neurology 60 : 848-853, 2003 https://doi.org/10.1212/01.WNL.0000049912.02954.2C

Cited by

  1. Neuromyelitis Optica: Atypical Clinical and Neuroradiological Presentation vol.28, pp.1, 2015, https://doi.org/10.15274/nrj-2014-10118
  2. A practical approach to the diagnosis of spinal cord lesions vol.18, pp.3, 2013, https://doi.org/10.1136/practneurol-2017-001845
  3. Cervical neuromyelitis optica with thoracic ependymoma vol.12, pp.None, 2013, https://doi.org/10.25259/sni_677_2021
  4. Unravelling diagnostic dilemma: AQP4-positive transverse myelitis mimics spinal intramedullary tumor vol.24, pp.3, 2013, https://doi.org/10.4103/aian.aian_424_20