Recurrent Optic Neuritis and Neuromyelitis Optica Spectrum Disorders (NMOSD): a Case Report

Neuromyelitis optica spectrum disorder (NMOSD) is severe rare chronic inflammatory disease of CNS that may be presents with blindness and paraparesis and is characterized by demyelinating lesions in spinal cord and optic nerve. In most patients we can find seropositivityfor IgG_Abs against AQP4 that make us distinguish the disorder from MS. These autoantibodies target AQP4 on astrocytes, choroid plexus epithelial cells, ependymal cells, and Müller cells. NMOSD showed atrophy in brain regions related to clinical manifestations (visual cortex),but also at the level of areas with high expression of Aquaporin-4 antibodies (thalami and fourth ventricle).Certain clinical presentations which are Suggestive for NMOSD include: 1) Bilateral or unilateral optic neuritis which involves the optic chiasm or optic nerves (usually posterior parts), which can induce different varieties of visual loss or some degrees of visual field defects. 2)Complete or incomplete spinal cord syndrome especially presents with paresthesia, weakness of lower and upper limbs, urinary retention or incontinence, paroxysmal tonic spasm, sensory level and other clinical symptoms. 3) The involvement of Area postrema (up to one third of patients) which can induce severe and intractable hiccups, vomiting and nausea. Current strategies for NMO treatment are general immunosuppression (steroid therapy, cytotoxic agents), B_cell therapy (Rituximab)and plasma exchange. In this study we present some cases of recurrent optic neuritis, different degrees of paresthesia and also weakness of lower or upper limbs with relapsing manner (simultaneous or unsimultaneous), negative or positive NMO ab test which represent NMOspectrum disorders in seronegative or seropositive patterns.