Optic neuritis, Devic's syndrome in disseminated lupus erythematosus (SLE)

Devic's syndrome or neuromyelitis optica is a syndrome characterized by the association of transverse myelitis and acute onset of visual loss due to optic neuritis.

Clinical history
51-year-old female with a history of disseminated lupus erythematosus treated since eighteen years.
Recently, neurological symptomatology includes sudden left blindness, pain and dysesthesia of the left arm and hypoesthesia of the right leg. The patient complains moreover from sensation problems on the right thorax (T7-T10). Progressive weakness of both legs is observed as well as urinary and fecal incontinence.

MRI findings
Image 1: Sagittal T1WI shows a moderately enlarged cervical spinal cord with a faint hypointensity (arrow).
Image 2: Sagittal T2WI: an ill defined but definite hyperintense lesion is clearly found within the cervical spinal cord (arrows).
Image 3: Axial T2WI confirms the cervical central hyperintensity (arrow).
Image 4: Sagittal T1WI at the thoraco-lumbar level. The thoracic spinal cord is not expanded.
Image 5: Sagittal T2WI and image 6: Axial T2WI: a central hyperintense lesion is equally seen at the thoracic level.

Clinical evolution
Slow progression of the sensory and motor deficits was observed not-withstanding administration of corticoids and anti-mitotic drugs.

Conclusion
Multiple lesions of the spinal cord in a patient with a Devic's syndrome associated to DLE.

Search also:
- Transverse myelitis

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