Abstract

We report a case of a 40 years old male who presented with ascending weakness and sphincter involvement. While in hospital, he became quadriplegic and developed bifacial weakness and frozen eyes. He was fully conscious and was obeying commands by blinking. MR scan showed diffuse hyperintense T2 signal change from the mid brain up to the conus medullaris. Lumbar puncture showed pleocytosis with low glucose ratio. Oligoclonal bands were absent. Infectious screen was negative. Serum aquaporin 4 antibodies were positive. Patient showed a significant response to a course of plasma exchange and steroids. He was subsequently started on mycophenolate as a disease–modifying agent.

This is the first reported case of Neuromyelitis Optica (NMO) with locked–in syndrome.