MRI studies were conducted and the local radiologist reading the MRI concluded the patient had findings consistent with a primary cord tumor (ependymoma, astrocytoma, or ganglioma).  Other considerations such as hemangioblastoma, intramedullary metastasis or lymphoma were also possible.  Intramedullary enhancement within the cord was C3 to T1 with cord expansion (C6-T1)) and extensive surrounding edema extending to T4. (see Figures 3 and 4).

Figure 3

Figure 4

The patient was immediately airlifted to a major academic Neurological Medical Center.  The specialty center ordered AQP4-IgG laboratory and CSF studies which were positive.

What is your Final Diagnosis?

The diagnosis of Devic’s Disease or Neuromyelitis Optica (NMO) with Transverse Myelitis was rendered.  The patient had the relapsing form (seropositive AQP4) which h a rare form.

What type of treatment is rendered?