Unusual Presentation of Neuromyelitis Optica Spectrum Disorder (NMOSD) (P6.403)

Objective: NA Background: NMOSD is an inflammatory disorder affecting the central nervous system and considered a distinct entity associated with antibodies to aquaporin-4. It presents as several distinct clinical syndromes. We describe a 36-year-old woman who presented with mild manifestations not hitherto described as part of the spectrum. Design/Methods: NA Results: Case: A 36-year-old woman presented to the neurology clinic with 1-1/2 month history of paresthesias in the legs described as an electric shock like sensation worsened by neck movement especially flexion. She also had painful spasms of low and mid back. Neurological examination was normal except for hyperreflexia in the lower extremities. MRI cervical thoracic and lumbar spine with and without contrast were normal. MRI brain showed non-specific non enhancing white matter lesions on T2/FLAIR images in the frontal lobes. CSF examination revealed elevated protein, elevation of IgG index and IgG synthesis rate, oligoclonal bands were negative. NMO antibody was elevated at 28.7 (N Discussion: Diagnostic criteria for NMOSD in a patient with positive antibodies requires the presence of at least one core clinical syndrome including optic neuritis, myelitis, brainstem syndrome, area postrema syndrome, narcolepsy or cerebral syndrome. However our patient manifested only with mild neurological symptoms in the form of a Lhermitte’s phenomenon and tonic spasms in the trunk. Over a period of 15 months the patient has not developed any progression of disease and is not on treatment. Our patient suggests that NMOSD may include mild disease without progression and that more clinical syndromes will likely be added to the current list of core syndromes Conclusions: NA Disclosure: Dr. Paul has nothing to disclose. Dr. Pirzada has nothing to disclose.