Diagnostic criteria of neuromyelitis optica

DIAGNOSTIC CRITERIA OF NEUROMYELITIS OPTICA (DEVIC’S DISEASE)
Mammadbeyli A.K.’, Mehtiyeva Sh.N.2, Talishli L.R.3

1. 
   Professor, the doctor in science, Department of Neurology
   
2. 
   Docent, Department of Neurology
   
3. 
   Group: 12044a, Course: III, Faculty: Faculty of Treatment and Prevention-1
   

Introduction: Neuromyelitis optica is an autoimmune, inflammatory, and demyelinating disease that affects the optic nerve, brain, and spinal cord. It is characterized by optic neuritis and transverse myelitis. The autoantibody NMO-IgG, which binds to the aquaporin-4 (AQP-4) protein found in the central nervous system, plays an important role in the development of neuromyelitis optica. There are two forms of the disease: the relapsing form and the monophasic form. Neuromyelitis optica affects approximately 1 to 2 per 100,000 people worldwide.

Methods and materials: Our patient was a 37-year-old woman who experienced a sharp weakening of vision since May 2022. She related this condition to another case of unknown etiology that she encountered in January of that year - numerous vesicular-type rashes appeared on the abdomen and back and passed after 3 days, but the traces of those scars remained for a few days in the form of hypopigmentation. In November 2022, she visited the doctor due to a sharp decrease in vision. According to the general examination, her skin and visible mucosas were clean and clear. Vitiligo-type white spots were visible around her eyes. In the neurological examination, her consciousness was clear, and her eye slits were symmetrical (D=S). The movements of the eyeballs in all directions were normal. The pupils were round (D=S), and the photoreaction was present (D=S). Nasolabial folds were symmetrical (D=S). Her tongue was on the midline, and swallowing was not broken. Muscle tone in the upper and lower limbs was normal (D=S), and muscle strength was assessed with 5 points in both the proximal and distal parts of the upper and lower limbs. Reflexes were increased (D=S), and pathological reflexes were not observed. The Romberg’s test result was negative. There was no change in gait, and sensation was intact. The functions of the pelvic organs were not disturbed. There were no meningeal symptoms. Her intellect seemed appropriate for her age, and her speech did not change. According to the results of the ophthalmological examination, she had high myopia and astigmatism in both eyes. Contrast-Cranial MRI – Angiography revealed increased signal in the intracranial segments of the bilateral optic nerve, the optic chiasm, and the level of the bilateral optic tract. The MRI image was initially evaluated in favor of bilateral optic neuritis. Ultrasound of the thyroid gland showed sonographic changes in favor of Hashimoto’s thyroiditis, and autoimmune thyroiditis was detected. In the MRI of the cervical and thoracic spine, a 3 mm demyelinating lesion in the spinal cord at the level of the C4 vertebral body, a 2 mm wide-based protrusion in the C4-5 disc that minimally compressed the spinal cord, annular swelling compressing the anterior subarachnoid space in the C5-6 disc, demyelinating lesions of 6 mm at the level of Th1 vertebral body, 12 mm at the