37-year-old woman with acute right visual loss and tingling along spine



        
Axial FLAIR




T2 fat sat coronal



T1 with Gad




Cervical spine T2 axial and sagittal STIR
                                                                             



Findings:

Brain: several relatively nonspecific white matter foci but greater than usual for age
Orbits: Right optic nerve swelling and edema without enhancement
Cervical Spine:  C3 focus of T2 prolongation (nonenhancing)

DDX:

Multiple Sclerosis with optic neuritis
Neuromyelitis Optica (Devic's Disease or Syndrome)



Diagnosis:

Devic's disease but with possible early progression to multiple sclerosis

Discussion:

Devic's disease is characterised by attacks of acute optic neuritis, usually bilateral/  At the same time or within a few days, weeks or occasionally months, there is severe transverse myelopathy - acute inflammation of the spinal cord.  However, in about 20% of cases, TM can precede the ON. Neurologists argue as to whether Devic's syndrome is a completely different disease to MS or whether it a variant of it. Many consider Devic's syndrome to be a variant of post-viral Acute Disseminated EncephaloMyelitis (ADEM) perhaps related to the varicella zoster virus. Other believe that, like MS, Devic's disease is an autoimmune condition.




Submitted by Ahmed Hassanin Negila, MD and Jerry Jarvik, MD, UW Neuroradiology

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