Neuromyelitis optica with brain stem involvement in a middle-aged Ethiopian woman: a case report and review of literature

Journal of Medical Case Reports

Semere Negash¹  Henok Fisseha²  Amir Musema²  Sisay Gizaw²  Ayube Keder²  Hailu Abera Mulatu²  Rodas Asrat Kassu³  Adugna Lissanwerk⁴  Lemlem Tamrat⁴  Fithanegest Tefera⁵ 

[1] Department of Gynecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia;Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia;Department of Neuro-surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia;Department of Ophthalmology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia;Department of Radiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia;

关键词: Ethiopia;    Neuromyelitis optica;    Optic neuritis;    Transverse myelitis;    Oculomotor;    Brainstem;    Case report;   

DOI  :  10.1186/s13256-021-03019-6

来源: Springer

【 摘 要 】

IntroductionNeuromyelitis optica is a demyelinating disease of the central nervous system that predominantly affects the optic nerves and spinal cord. In neuromyelitis optica, white blood cells and antibodies primarily attack the optic nerves and the spinal cord, but may also attack the brain. Brainstem manifestation has been described recently. So far, neuromyelitis optica is very rare in Ethiopia and there were only two case reports, but this is the first case report of neuromyelitis optica with brainstem involvement.Case presentationA 47-year-old Addis Ababa woman presented to Saint Paul’s Hospital Millennium Medical College with a history of visual loss of 7 years and bilateral lower limb weakness of 4 days duration. She had bilateral oculomotor nerve palsy. Her past medical history showed systemic hypertension for 18 years and dyslipidemia for 1 year. The objective evaluation of the patient revealed right optic nerve atrophy suggesting optic neuritis and flaccid paraplegia with sensory level at the fourth thoracic vertebra. Diagnostic work-up using electromyography and spinal magnetic resonance imaging revealed demyelinating anterior visual pathway dysfunction and signs of extensive cervicothoracic transverse myelitis from the third cervical to lower thoracic vertebrae, respectively. Then a diagnosis of neuromyelitis optica was established. After treatment with high-dose systemic steroid followed by azathioprine, the patient was stable for several months with significant improvement of vision and lower-extremity weakness with no relapse of symptoms.ConclusionThe case described here is a rare inflammatory demyelinating disorder of the central nervous system occurring in East Africa. It reminds clinicians to suspect neuromyelitis optica in a patient who presented with unexplained recurrent optic neuritis to make a timely diagnosis and prevention of permanent neuronal damage. Neuromyelitis optica can also be associated with oculomotor nerve involvement.

【 授权许可】

CC BY