Raffaele Nardone1,2,3, Giulio Zuccoli4, Francesco Brigo2,5, Eugen Trinka1,3, Ryan T Fitzgerald6. 1. a Department of Neurology, Christian Doppler Klinik , Paracelsus Medical University , Salzburg , Austria. 2. b Department of Neurology , Franz Tappeiner Hospital , Merano , Italy. 3. f Spinal Cord Injury and Tissue Regeneration Center , Paracelsus Medical University , Salzburg , Austria. 4. c Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center , Pennsylvania , USA. 5. d Department of Neurological and Movement Sciences , University of Verona , Italy. 6. e University of Arkansas for Medical Sciences , Little Rock , USA.
Abstract
CONTEXT: Dyspnea has rarely been reported as a presenting symptom in patients with neuromyelitis optica (NMO). We report an unusual case of NMO relapse presenting with rapidly progressive respiratory failure and briefly discuss the possible pathophysiological mechanisms of this potential life-threatening complication of NMO. FINDINGS: The 58-year-old woman with a history of bilateral optic neuritis presented to the emergency department with rapidly worsening dyspnea. Cervical spine magnetic resonance imaging showed extensive abnormal signal with involvement of the medulla oblongata. Since in our patient chest radiography failed to disclose a diaphragmatic palsy that is commonly observed in patients with phrenic nerve involvement, this acute manifestation of the disease may be attributed to brainstem involvement instead of cervical myelitis. CONCLUSION/CLINICAL RELEVANCE: Clinicians should be aware of this atypical presentation of NMO, which needs to be promptly recognized and aggressively treated.
CONTEXT: Dyspnea has rarely been reported as a presenting symptom in patients with neuromyelitis optica (NMO). We report an unusual case of NMO relapse presenting with rapidly progressive respiratory failure and briefly discuss the possible pathophysiological mechanisms of this potential life-threatening complication of NMO. FINDINGS: The 58-year-old woman with a history of bilateral optic neuritis presented to the emergency department with rapidly worsening dyspnea. Cervical spine magnetic resonance imaging showed extensive abnormal signal with involvement of the medulla oblongata. Since in our patient chest radiography failed to disclose a diaphragmatic palsy that is commonly observed in patients with phrenic nerve involvement, this acute manifestation of the disease may be attributed to brainstem involvement instead of cervical myelitis. CONCLUSION/CLINICAL RELEVANCE: Clinicians should be aware of this atypical presentation of NMO, which needs to be promptly recognized and aggressively treated.
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