A 17 -year-old woman presenting with acute onset

A 17 -year-old woman presenting with acute onset cervical pain, followed by left arm weakness and gait disturbances Teaching Neuro. Images Neurology Resident and Fellow Section © 2013 American Academy of Neurology

Vignette • A 17 -year-old woman presented with acute onset cervical pain, followed by left arm weakness and gait disturbances • Her personal and family history was unremarkable • Spinal cord astrocytoma was diagnosed by MRI performed at an outpatient facility • The patient was admitted to the Neurosurgery Department to undergo spinal cord biopsy. • A second neurological evaluation indicated neuromyelitis optica (NMO) as the most likely diagnosis, which was confirmed by NMO-Ig. G seropositivity. © 2013 American Academy of Neurology Tsivgoulis G et al.

Imaging Tsivgoulis G et al.

Neuromyelitis optica (NMO) misdiagnosed as spinal cord tumor • NMO presenting with longitudinally-extensive spinal cord lesions resulting in a “swollen cord” appearance and involving whole cross-sectional are of the cord may be initially misdiagnosed as spinal cord intramedullary tumor. 1, 2 • Spinal lesions in NMO may produce cord expansion and lead to misdiagnosis as intramedullary tumor. 1, 2 • Spinal cord tumors should be added to the differential diagnosis of NMO including transverse myelitis, spinal cord ischemia and systemic autoimmune disease (e. g. Systemic Lupus Erythematosus). © 2013 American Academy of Neurology Tsivgoulis G et al.