title: A case of neuromyelitis optica presenting marked pleocytosis and hypoglycorrhachia.
abstract: 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.
authors.affiliation: Section of Neurology, Sapporo Kosei General Hospital.
authors.forename: Mai
authors.initials: M
authors.lastname: Fujikura
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yokokawa
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Shizukawa
authors.forename: Shun
authors.initials: S
authors.lastname: Shimohama
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D004359:Drug Therapy, Combination; D005947:Glucose / Q000134:cerebrospinal fluid*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007964:Leukocytosis / Q000134:cerebrospinal fluid / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D009900:Optic Nerve / Q000000981:diagnostic imaging; D010264:Paraplegia / Q000209:etiology; D012678:Sensation Disorders / Q000209:etiology; D013116:Spinal Cord / Q000000981:diagnostic imaging
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D051401:Aquaporin 4; D001323:Autoantibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents; D005947:Glucose