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Bilateral oculomotor nerve palsy in a case of anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder.

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) has a wide disease spectrum and sometimes shows abnormal eye movement with brainstem manifestations. However, bilateral oculomotor nerve palsy with a midbrain lesion has never been reported in a patient with NMOSD. We describe a 61-year-old woman with progressive ptosis and diplopia. She displayed bilateral oculomotor nerve palsy and hypersomnia. Brain MRI demonstrated abnormal signal intensities in the midbrain and around the third ventricle and hypothalamus with a mild contrast enhancement. A cerebrospinal fluid study indicated elevated protein and pleocytosis. Because serum anti-aquaporin-4 IgG antibody was positive, the patient was diagnosed with neuromyelitis optica spectrum disorder with aquaporin-4 IgG. We report for the first time bilateral oculomotor nerve palsy as an initial manifestation in a patient with aquaporin-4 positive NMOSD.

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  • Authors+Show Affiliations

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    Department of Neurology, Kyoto University, Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Neurology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan. Electronic address: kenyasud@kuhp.kyoto-u.ac.jp.

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    Department of Neurology, Kyoto University, Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.

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    Department of Neurology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.

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    Department of Neurology, Kyoto University, Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.

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    Department of Neurology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

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    Department of Neuropsychiatry, Akita University School of Medicine, 44-2 Hasunuma Hiroomote, Akita 010-8543, Japan.

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    Department of Neurology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.

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    Department of Neurology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.

    ,

    Department of Neurology, Kyoto University, Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.

    Department of Neurology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31178306

    Citation

    Yasuda, Ken, et al. "Bilateral Oculomotor Nerve Palsy in a Case of Anti-aquaporin-4 Antibody-positive Neuromyelitis Optica Spectrum Disorder." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 66, 2019, pp. 271-272.
    Yasuda K, Maki T, Takata M, et al. Bilateral oculomotor nerve palsy in a case of anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. J Clin Neurosci. 2019;66:271-272.
    Yasuda, K., Maki, T., Takata, M., Kimura, K., Takahashi, T., Kanbayashi, T., ... Nakamura, M. (2019). Bilateral oculomotor nerve palsy in a case of anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 66, pp. 271-272. doi:10.1016/j.jocn.2019.05.043.
    Yasuda K, et al. Bilateral Oculomotor Nerve Palsy in a Case of Anti-aquaporin-4 Antibody-positive Neuromyelitis Optica Spectrum Disorder. J Clin Neurosci. 2019;66:271-272. PubMed PMID: 31178306.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Bilateral oculomotor nerve palsy in a case of anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. AU - Yasuda,Ken, AU - Maki,Takakuni, AU - Takata,Masaki, AU - Kimura,Kimitoshi, AU - Takahashi,Toshiyuki, AU - Kanbayashi,Takashi, AU - Murase,Nagako, AU - Ohtani,Ryo, AU - Takahashi,Ryosuke, AU - Nakamura,Michikazu, Y1 - 2019/06/06/ PY - 2019/03/10/received PY - 2019/05/27/accepted PY - 2019/6/11/pubmed PY - 2019/6/11/medline PY - 2019/6/11/entrez KW - Aquaporin-4 IgG KW - Bilateral ptosis KW - Midbrain KW - Neuromyelitis optica spectrum disorder KW - Oculomotor nerve palsy SP - 271 EP - 272 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 66 N2 - Neuromyelitis optica spectrum disorder (NMOSD) has a wide disease spectrum and sometimes shows abnormal eye movement with brainstem manifestations. However, bilateral oculomotor nerve palsy with a midbrain lesion has never been reported in a patient with NMOSD. We describe a 61-year-old woman with progressive ptosis and diplopia. She displayed bilateral oculomotor nerve palsy and hypersomnia. Brain MRI demonstrated abnormal signal intensities in the midbrain and around the third ventricle and hypothalamus with a mild contrast enhancement. A cerebrospinal fluid study indicated elevated protein and pleocytosis. Because serum anti-aquaporin-4 IgG antibody was positive, the patient was diagnosed with neuromyelitis optica spectrum disorder with aquaporin-4 IgG. We report for the first time bilateral oculomotor nerve palsy as an initial manifestation in a patient with aquaporin-4 positive NMOSD. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/31178306/Bilateral_oculomotor_nerve_palsy_in_a_case_of_anti-aquaporin-4_antibody-positive_neuromyelitis_optica_spectrum_disorder L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(19)30475-8 DB - PRIME DP - Unbound Medicine ER -