Ghosh Monideep, Baxter Nesta, Homer-Ward Michael
Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
SAGE Open Med Case Rep. 2025 Jul 8;13:2050313X251356911. doi: 10.1177/2050313X251356911. eCollection 2025.
Neuromyelitis optica with a positive aquaporin-4 antibody is a rare autoimmune condition, which has a higher prevalence in females, and disproportionately affects Black and Asian persons with a typical age of first presentation between the ages of 30 and 40. We report a unique case of a 69-year-old Caucasian male who presented following a fall along with generalised weakness, unilateral myotomal pain, and urinary dysfunction. His medical history included two previous venous thromboembolic events, for which he was anticoagulated with warfarin. Extensive investigations, including MRI of the whole spine and lumbar puncture, revealed longitudinally extensive transverse myelitis and a positive aquaporin-4 antibody, confirming neuromyelitis optica. The patient was treated with intravenous methylprednisolone, plasma exchange, and immunoglobulin therapy, followed by rehabilitation. This case highlights the importance of considering neuromyelitis optica in atypical patient demographics and that early recognition through neurological assessment, imaging, and antibody testing is critical in preventing severe disability.
水通道蛋白4抗体阳性的视神经脊髓炎是一种罕见的自身免疫性疾病，女性患病率较高，对黑人和亚洲人影响尤甚，首次发病的典型年龄在30至40岁之间。我们报告了一例独特病例，一名69岁的白种男性，因跌倒后出现全身无力、单侧肌节段性疼痛和排尿功能障碍前来就诊。他的病史包括既往两次静脉血栓栓塞事件，为此他接受了华法林抗凝治疗。包括全脊柱MRI和腰椎穿刺在内的广泛检查显示为纵向广泛横贯性脊髓炎且水通道蛋白4抗体阳性，确诊为视神经脊髓炎。该患者接受了静脉注射甲基强的松龙、血浆置换和免疫球蛋白治疗，随后进行了康复治疗。该病例强调了在非典型患者人群中考虑视神经脊髓炎的重要性，以及通过神经学评估、影像学和抗体检测进行早期识别对预防严重残疾至关重要。
