Abstract

A 79-year-old lady was admitted with rapid onset weakness in both legs with a mid-throacic sensory level. She had a preceding history of viral upper respiratory infection. She was recently treated for breast cancer 12 months' previously. Within 24 hours she developed complete paraplegia and the MRI scan revealed extensive T2W high signal changes throughout the spinal cord with discrete contrast enhancement and expansion of the cord. CSF showed 7 mononuclear cells with low CSF glucose (vs serum) and high CSF protein. Investigations revealed positive aquaporin-4 antibodies and she rapidly improved after a course of intravenous steroids followed by oral steroid taper. Extensive screen for an underlying malignancy was negative. Given the temporal relationship with cancer, a diagnosis of possible paraneoplastic syndrome was made as per established criteria (Graus et al. 2004).

We took this opportunity to review the MRI findings in 18 of our recent NMO patient cohort (15 aquaporin-4 antibody positive, 1 anti-MOG positive and 2 seronegative). We compared this against the established radiological criteria (Miller DH et al, 2008) for NMO.

We discuss the possibility of NMO being a rare paraneoplastic phenomenon and review the radiological findings in our cohort of NMO patients against established criteria.