Continuing Medical Education
Case Report: A young woman with weakness of the legs
A previously well 22-year-old woman presented with progressive weakness of her legs and urinary incontinence over 7 days. Clinically she was healthy, with no skin rashes. On neurological examination she had profound bilateral weakness of the lower limbs, hypertonia, hyperreflexia, a positive Babinski sign and a T6 sensory level. Tests for syphilis and HIV and screening for auto-immune conditions were
negative. Magnetic resonance imaging of the brain and spinal cord revealed extensive cord swelling between the craniocervical junction and T11, a high signal in the right optic nerve and a normal brain. Aquaporin 4 antibodies (neuromyelitis optica immunoglobulin G (NMO-IgG)) were positive with a titre of 1:1 000.
These findings confirmed a diagnosis of NMO or Devic’s disease.
P Mkoko, Department of Internal Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
J Vallie, Department of Internal Medicine, University of Cape Town and Somerset Hospital, Cape Town, South Africa
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Date published: 2014-02-14
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