Diagnostic Dilemma in the Management of a Cervical Spinal Cord Lesion: A Case Report of Neuromyelitis Optica Spectrum Disorder

Neuromyelitis Optica spectrum disorder is a condition in which antibodies are elaborated against aquaporin water channels in the end foot processes of astrocytes due to autoimmune dysregulation thereby initiating a cascade of neuroinflammatory events that culminates in astrocytic injury, dysfunctional axonal blebs and demyelination of the central nervous system neurons. Its cervical spine symptom may sometimes mimic a similar presentation of a cervical spine lesion, this is further underscored by its core clinical magnetic resonance image feature of longitudinally extensive transverse myelitis bearing radiologic similarities with an intramedullary spinal cord lesion thereby resonating the need to maintain a high index of suspicion when evaluating patients with either conditions. Laboratory elucidation of increased titers of aquaporin -4 immunoglobulin and seronegativity for oligoclonal bands is the diagnostic hallmark of the condition and helps differentiate it from similar conditions such as multiple sclerosis and myelin oligodendrocyte glycoprotein disorder. While the mainstay of treatment involves the use of steroids, immunosuppressive therapy and plasmapheresis, it is pertinent to highlight that surgery may have a potential benefit in patients with acute exacerbations of symptoms attributable to cervical spine compressive myelopathy due to the disease. We report a case of a 50-year-old female who had clinical features initially suspected to be a spinal cord lesion but eventually proven with laboratory parameters and histological analysis of resected tissue specimen to be in keeping with Neuromyelitis Optica spectrum disorder.