Neuromyelitis optica spectrum disorder (NMOSD) is characterized by optic neuritis or transverse myelitis with anti-aquaporin 4 (AQP4) antibodies (1). We herein present the case of a patient with NMOSD who also was affected with peripheral neuropathy. A 58-year-old woman developed gait disturbance and sensory impairment in the lower limbs. She exhibited longitudinally extensive transverse myelitis with anti-AQP4 antibodies. Nerve conduction studies showed demyelinating changes. Laboratory findings showed hepatitis-C virus (HCV) infection. Her peripheral neuropathy improved after immunotherapy. There have been no previous reports of NMO or NMOSD associated with neuropathy. The HCV infection or undetermined humoral factors other than the anti-AQP4 antibodies may have caused her peripheral neuropathy.

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Multiple system atrophy (MSA) affects the hypothalamus, similar to other neurological diseases. 1 Hypothalamic cells synthesize antidiuretic hormone (ADH), which increases water reuptake in the kidney. Hypothalamic disturbances can lead to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and resultant hyponatremia. ADH levels usually increase in SIADH. However, normal ADH levels are occasionally seen, but they are inappropriate in the presence of abnormally decreased osmolarity (<280 mOsm/kg), a condition thought to suppress physiological ADH secretion. 2 To date, 6 patients with MSA had SIADH (Table 1). 3 We describe the first MSA patient with extreme hyponatremia (99 mEq/L) and the highest reported ADH concentration. We also measured ADH in 14 severely disabled patients with MSA, but not symptomatic SIADH.