How would you manage and treat a 28 yo woman who develops acute thoracic
transverse myelitis (Power 3-/5 and sensory level at T5-6 with moderate bladder
and bowel involvelment) and bilateral optic neuritis (color desaturation and
reduced VA to 20/120)? She had not responded favourably to 2 courses of IV
solumedrol pulses (1 gm daily for 3 days followed by po prednisone taper). There
was no evidence of SLE, systemic vaculitis or CNS lymphoma during her workup.
Her MRI of her thoracic spine showed a longtitudinal T2-hyperintense lesion from
T2 to T5. CT brain normal but she awaits gad-MRI of her brain. I believe she has
Devic's disease (neuromyelitis optica).
1. Treat with IVIG
2. Treat with PLEX
3. Treat with immunosuppressives such as azathiaprine, cyclophosphamide, or
mycophenolate
Please support your answers with evidence.
Joe Chu
CANADA
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January 10, 2005
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