A Case of Neuromyelitis Optica Misdiagnosed as Cervicogenic Headache

Abstract

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system associated with longitudinally extensive myelitis and optic neuritis. It is characterized by relapses that lead to blindness and paralysis sequelaes. But, this is rare disease; therefore high clinical suspicion for a correct diagnosis and proper examinations are not easy. However, early diagnosis is essential to prevent sequelae. We report the case of NMO with headache. A 30-year male patient who suffered headache visited our pain clinic because of aggravated pain despite treatment. The cause of the pain was revealed as NMO by more detailed previous history and examination. (Korean J Pain 2014; 27: 77-80)

Acute‐Onset Severe Occipital Neuralgia Associated With High Cervical Lesion in Patients With Neuromyelitis Optica Spectrum Disorder

“…Recently, Kong et al reported that severe pain in NMOSD seems to be related to AQP4‐antibody status . However, Choi et al reported a case of AQP4 antibody‐negative NMOSD, which was similar to our cases in terms of the clinical course, severity, and responsiveness to corticosteroid treatment . Thus, we concluded that occipital neuralgia may be unrelated to AQP4‐antibody status.…”

“…To understand the association between high cervical inflammation and acute‐onset severe occipital neuralgia better, we reviewed 12 cases (Table ) . Occipital neuralgia is rare, but is generally found in patients with high‐cervical myelitis, independently of its etiology.…”

Systemic Lupus Erythematosus (SLE) Complicated by Neuromyelitis Optica (NMO – Devic's Disease): Clinic-Pathological Report and Review of the Literature

“…Patients with NMO and relapsing myelitis and NMO spectrum disorder (NMOSD) with brain involvement have extensive spinal cord lesions that are longitudinally contiguous or linear (extending over at least three vertebral segments) with T1-signal intensity and swelling and atrophy of the cord and often there are few T2-lesions in the brain; on the other hand, MS has a typical distribution of White matter lesions (WMLs). Nevertheless, the optical coherence tomography shows more severe alterations in NMO than in MS, because a thinner retinian cell layer indicates widespread axonal and neuronal loss 2,4,48–51. Myelin-bearing oligodendrocytes are the primary inflammatory target in MS, but astrocytes are lost first in NMO.…”

Headaches attributed to visual disturbances

“…Other than multiple sclerosis, optic neuritis can be associated with neuromyelitis optica (NMO), immune-mediated diseases (Behcet, LES, sarcoidosis), retinitis (neuroretinitis) or infectious diseases (cat scratch disease, syphilis, TBC, Lyme disease, viral etiology) possibly also involving other regions of the CNS (neurobrucellosis, meningoencephalitis, chlamydia) [19,20]. Treatment requires intravenous corticosteroids in acute phase followed by immunosuppressive or immunomodulating therapy according to the underlying diseases.…”