Case 1 | Case 2 | Case 3 | Case 4 | |
Age (y) | 42 | 37 | 31 | 29 |
Sex | Male | Male | Female | Female |
Preceding illness | GIT | Nil | Respiratory | Nil |
First attack | Hemiplegia | T4 Level | C2 Myelitis | Optic neuritis |
CSF | ND | Increased protein | Increased protein | Normal protein |
Cells, no OCB | Cells, no OCB | No cells, no OCB | ||
MRI-WML | ND | ND | Lower medulla | ND |
Upper cervical | ||||
Therapy | Nil | Nil | iv Solumedrol | Nil |
Outcome | Full recovery | Poor | Ambulatory | Partial recovery |
Interval | 2 Years | 2 Months | 5 Months | 2 Months |
Second attack | T6 Myelitis | Optic neuritis | Optic neuritis | C4 Myelitis |
CSF | Normal protein | ND | ND | Increased protein |
Cells, no OCB | Cells, no OCB | |||
MRI-WML | Diffuse PV, CC | PV, CS, CR, CC | ND | Lower medulla to |
Pontine, thoracic cord atrophy | Patchy thoracic | T1 elongated lesion | ||
Therapy | iv Solumedrol | iv Solumedrol | Nil | iv Solumedrol |
Outcome | Poor | Good | Good | Ambulatory |
Interval | 2 Months | |||
Third attack | T6 Myelitis | |||
CSF | Increased protein | |||
Cells, no OCB | ||||
MR -WML | Normal brain | |||
Mid-thoracic | ||||
Therapy | iv Solumedrol | |||
Outcome | Poor |
Case 5 | Case 6 | Case 7 | Case 8 | |
---|---|---|---|---|
Age (y) | 41 | 8 | 33 | 31 |
Sex | Female | Female | Female | Female |
Preceding illness | Nil | Nil | GIT | Nil |
First attack | Optic neuritis | Myelitis | Bulbar | Optic neuritis |
CSF | ND | ND | Increased protein | Normal protein |
No cells, no OCB | No cells, no OCB | |||
MRI-WML | ND | ND | PV, medulla | ND |
Therapy | Nil | Nil | iv Solumedrol | iv Solumedrol |
Outcome | Good | Good | Good | Good |
Interval | 5 Months | 8 Months | 18 Months | 16 Months |
Second attack | Craniocervical | Optic neuritis | Optic neuritis | Optic neuritis |
CSF | Increased protein | ND | Increased protein | ND |
No cells, no OCB | Cells, no OCB | |||
MRI | PV, CR, CS | PV | ND | ND |
Midbrain, left cerebellum | ||||
C1 to T1 elongated lesion | ||||
Therapy | iv Solumedrol | Oral steroids | iv Solumedrol | Nil |
Outcome | Ambulatory | Poor | Poor | Poor |
Interval | 9 Months | 1 Month | 10 Months | |
Third attack | Craniocervical | C4 Myelitis | C2 Myelitis | |
CSF | Normal protein | ND | Increased protein | |
No cells, no OCB | Cells, no OCB | |||
MRI-WML | CC, subcortical | PV, CS | PV, CR, CS | |
Midbrain | C2 to C6 Lesion | C1 to C6 lesion | ||
Cervicomedullary | ||||
Therapy | iv Solumedrol | iv Solumedrol | iv Solumedrol | |
Outcome | Ambulatory | Poor | Good | |
Interval | 12 Months | |||
Fourth attack | C2 Myelitis/OPN | |||
CSF | Increased protein | |||
Cells, no OCB | ||||
MRI-WML | CC | |||
CCJ to C4/5 lesion | ||||
Therapy | iv Solumedrol | |||
Outcome | Poor |
OPN=Optic neuritis; CCJ=craniocervical junction myelitis; WML=white matter lesions; CC=corpus callosum; CR=corona radiata; CS=centrum semiovale; PV=periventricular; OCB=oligoclonal antibody bands; GIT=gastrointestinal tract illness; C=cervical level; T=thoracic level; iv=intravenous. The iv steroid used in all patients was methylprednisolone (solumedrol).