Unclear

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.

Select Relevant Investigations
CSF Analysis

Performed

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
Full Blood Count

Performed

All indices are within normal parameters.
MRI Brain & Spine

Performed

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.
Serum NMO-IgG Abs

Performed

Positive for NMO-IgG Antibodies.

Select Relevant Management
Methylprednisolone
Catheterization
Aspirin
Rehabilitation