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Devic type multiple sclerosis in an 81 year old woman
  1. S M STAUGAITIS
  1. Department of Pathology, Division of Neuropathology, College of Physicians and Surgeons of Columbia University, New York, USA
  2. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  3. Departments of Neurology and Public Health (Epidemiology), College of Physicians and Surgeons of Columbia University, New York, USA
  4. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  5. Departments of Pathology (Division of Neuropathology) and Psychiatry, College of Physicians and Surgeons of Columbia University, and Department of Neuroscience (Division of Neuropathology), New York State Psychiatric Institute, New York, USA
  1. Dr Andrew J Dwork, Department of Neuroscience, New York State Psychiatric Institute, Unit 62, 722 West 168th Street, New York, NY 10032, USA. Telephone 001 212 543 5563; fax 001 212 543 5769; email: ajd6{at}columbia.edu
  1. J K ROBERTS
  1. Department of Pathology, Division of Neuropathology, College of Physicians and Surgeons of Columbia University, New York, USA
  2. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  3. Departments of Neurology and Public Health (Epidemiology), College of Physicians and Surgeons of Columbia University, New York, USA
  4. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  5. Departments of Pathology (Division of Neuropathology) and Psychiatry, College of Physicians and Surgeons of Columbia University, and Department of Neuroscience (Division of Neuropathology), New York State Psychiatric Institute, New York, USA
  1. Dr Andrew J Dwork, Department of Neuroscience, New York State Psychiatric Institute, Unit 62, 722 West 168th Street, New York, NY 10032, USA. Telephone 001 212 543 5563; fax 001 212 543 5769; email: ajd6{at}columbia.edu
  1. R L SACCO
  1. Department of Pathology, Division of Neuropathology, College of Physicians and Surgeons of Columbia University, New York, USA
  2. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  3. Departments of Neurology and Public Health (Epidemiology), College of Physicians and Surgeons of Columbia University, New York, USA
  4. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  5. Departments of Pathology (Division of Neuropathology) and Psychiatry, College of Physicians and Surgeons of Columbia University, and Department of Neuroscience (Division of Neuropathology), New York State Psychiatric Institute, New York, USA
  1. Dr Andrew J Dwork, Department of Neuroscience, New York State Psychiatric Institute, Unit 62, 722 West 168th Street, New York, NY 10032, USA. Telephone 001 212 543 5563; fax 001 212 543 5769; email: ajd6{at}columbia.edu
  1. J R MILLER
  1. Department of Pathology, Division of Neuropathology, College of Physicians and Surgeons of Columbia University, New York, USA
  2. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  3. Departments of Neurology and Public Health (Epidemiology), College of Physicians and Surgeons of Columbia University, New York, USA
  4. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  5. Departments of Pathology (Division of Neuropathology) and Psychiatry, College of Physicians and Surgeons of Columbia University, and Department of Neuroscience (Division of Neuropathology), New York State Psychiatric Institute, New York, USA
  1. Dr Andrew J Dwork, Department of Neuroscience, New York State Psychiatric Institute, Unit 62, 722 West 168th Street, New York, NY 10032, USA. Telephone 001 212 543 5563; fax 001 212 543 5769; email: ajd6{at}columbia.edu
  1. A J DWORK
  1. Department of Pathology, Division of Neuropathology, College of Physicians and Surgeons of Columbia University, New York, USA
  2. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  3. Departments of Neurology and Public Health (Epidemiology), College of Physicians and Surgeons of Columbia University, New York, USA
  4. Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, USA
  5. Departments of Pathology (Division of Neuropathology) and Psychiatry, College of Physicians and Surgeons of Columbia University, and Department of Neuroscience (Division of Neuropathology), New York State Psychiatric Institute, New York, USA
  1. Dr Andrew J Dwork, Department of Neuroscience, New York State Psychiatric Institute, Unit 62, 722 West 168th Street, New York, NY 10032, USA. Telephone 001 212 543 5563; fax 001 212 543 5769; email: ajd6{at}columbia.edu

https://doi.org/10.1136/jnnp.64.3.417

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    An 81 year old woman presented after several transient episodes of dizziness and nausea. One episode was associated with right arm dysmetria. She denied previous neurological symptoms. Her medical history was relevant for myocardial infarction, two coronary artery bypass grafts, and Hashimoto’s thyroiditis. Brain MRI showed abnormal signal intensities which were attributed to cerebrovascular disease and she was treated with ticlopidine. Several months later, she had an influenza vaccination and one month afterwards she developed bilateral foot weakness and numbness. These symptoms progressed over three days to complete paraplegia, a thoracic sensory level, and urinary incontinence. No abnormalities were seen in the spinal cord on MRI. Over the next two months, sensation and bladder control improved and she could walk with a frame. Six months later, her spinal cord symptoms recurred; MRI at this time showed a cavitary lesion that extended from T2 to T10 with peripheral enhancement. Brain MRI showed multiple abnormal white matter signal intensities.

    Cerebrospinal fluid contained 10 leucocytes/mm3 (70% lymphocytes, 20% monocytes, 10% polymorphonuclear leucocytes), total protein was 100 mg/dl, IgG/total protein was 16%, and oligoclonal bands were more intense in CSF than in serum. Complete blood count, chemistry profile, thyroid function tests, erythrocyte …

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