Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of neuromyelitis optica presenting marked pleocytosis and hypoglycorrhachia

Mai Fujikura, M.D.1), Kazuki Yokokawa, M.D.1), Hirohiko Shizukawa, M.D.1) and Shun Shimohama, M.D., Ph.D.2)

1)Section of Neurology, Sapporo Kosei General Hospital
2)Department of Neurology, Sapporo Medical University School of Medicine

A 57-year-old man initially developed chest discomfort, nausea, vomiting, headache and low-grade fever, followed by paraplegia, sensory disturbance below level Th5 and bilateral visual loss. He was admitted to our hospital on the 15th day of illness. MRI short T1 inversion recovery image showed multiple longitudinal lesions in the spinal cord below C3, and T2-weighted image showed abnormal hyperintensity within the left optic nerve. Cerebrospinal fluid (CSF) analysis revealed marked pleocytosis (1,719/μl) and hypoglycorrhachia (CSF glucose; 20 mg/dl). Intensive immunosuppressive therapy combined with antibiotics and antiviral agent were started immediately, resulting in relatively good visual outcome but no improvement of paraplegia and sensory disturbance. The patient's serum sample on admission was subsequently reported to be positive for anti-aquaporin-4 antibody. With no evidence of infectious diseases, neuromyelitis optica (NMO) was diagnosed. It should be borne in mind that marked hypogylcorrhachia may also be seen in NMO.
Full Text of this Article in Japanese PDF (1794K)

(CLINICA NEUROL, 56: 569|572, 2016)
key words: neuromyelitis optica, pleocytosis, hypoglycorrhachia

(Received: 17-Apr-15)