Neuromyelitis Optica Spectrum Disorder with Longitudinally Extensive Transverse Myelitis and Intractable Vomiting: A Case Report

Dr. Yuvrajsing Pakal, Dr. Mihir Awasarikar, Anandita Gulhane, Dr. Nitin Suryavanshi, Dr. Jitendra Ingole

Abstract: Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating disorder of the central nervous system characterized by recurrent episodes of optic neuritis, longitudinally extensive transverse myelitis (LETM), and area postrema involvement. Early diagnosis and prompt initiation of immunotherapy are essential to prevent irreversible neurological disability (1, 2). Case Presentation: We report the case of a 25-year-old female who presented with tingling and numbness over the neck and both upper limbs, followed by progressive quadriparesis. Initial evaluation elsewhere suggested vitamin B?? deficiency, but symptoms persisted. On admission, she developed intractable nausea and vomiting, and neurological examination revealed exaggerated deep tendon reflexes with bilateral extensor plantar responses. MRI of the cervical spine revealed long-segment T2/STIR hyperintensity extending from C2 to C7, consistent with longitudinally extensive transverse myelitis. Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis with elevated protein, and serum testing was positive for AQP4-IgG antibodies. She was treated with high-dose intravenous methylprednisolone, followed by therapeutic plasma exchange due to clinical deterioration. Significant neurological recovery was achieved after five cycles of plasma exchange (3, 7). She was discharged on oral corticosteroids and mycophenolate mofetil for maintenance immunosuppression and remained relapse-free on follow-up. Conclusion: This case highlights the importance of considering NMOSD in patients presenting with LETM and unexplained vomiting. Early recognition and prompt initiation of immunotherapy can result in excellent neurological recovery and prevention of relapses (4, 10)

Keywords: Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating disorder of the central nervous system characterized by recurrent episodes of optic neuritis, longitudinally extensive transverse myelitis (LETM), and area postrema involvement. Early diagnosis and prompt initiation of immunotherapy are essential to prevent irreversible neurological disability (1, 2). Case Presentation: We report the case of a 25-year-old female who presented with tingling and numbness over the neck and both upper limbs, followed by progressive quadriparesis. Initial evaluation elsewhere suggested vitamin B?? deficiency, but symptoms persisted. On admission, she developed intractable nausea and vomiting, and neurological examination revealed exaggerated deep tendon reflexes with bilateral extensor plantar responses. MRI of the cervical spine revealed long-segment T2/STIR hyperintensity extending from C2 to C7, consistent with longitudinally extensive transverse myelitis. Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis with elevated protein, and serum testing was positive for AQP4-IgG antibodies. She was treated with high-dose intravenous methylprednisolone, followed by therapeutic plasma exchange due to clinical deterioration. Significant neurological recovery was achieved after five cycles of plasma exchange (3, 7). She was discharged on oral corticosteroids and mycophenolate mofetil for maintenance immunosuppression and remained relapse-free on follow-up. Conclusion: This case highlights the importance of considering NMOSD in patients presenting with LETM and unexplained vomiting. Early recognition and prompt initiation of immunotherapy can result in excellent neurological recovery and prevention of relapses (4, 10)

How to Cite?: Dr. Yuvrajsing Pakal, Dr. Mihir Awasarikar, Anandita Gulhane, Dr. Nitin Suryavanshi, Dr. Jitendra Ingole, "Neuromyelitis Optica Spectrum Disorder with Longitudinally Extensive Transverse Myelitis and Intractable Vomiting: A Case Report", Volume 15 Issue 4, April 2026, International Journal of Science and Research (IJSR), Pages: 1161-1164, https://www.ijsr.net/getabstract.php?paperid=MR26418161630, DOI: https://dx.dx.doi.org/10.21275/MR26418161630

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