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A 21-year-old right-handed woman suffered cervical myelitis in 1971, followed by two episodes of bilateral optic neuritis and four relapses of thoracic or lumbar myelitis through 1998. Her initial brain MRI in 1989 revealed no abnormality, which met the MRI criteria for multiple sclerosis. In 2009, her serum anti-aquaporin-4 antibody was found to be positive, and a diagnosis of relapsing neuromyelitis optica (NMO) was made on the basis of current diagnostic criteria. Although she was treated with oral prednisone at each attack, she had residual sensory impairment below the C3 spinal segment. Then, she experienced no relapse until 2010 without any immunotherapy.
In April 2010 (at age 60 years), she was admitted to our hospital for unsteady gait and clumsiness in her left …