NMO antibody in CSF but not blood

Klawtizer EC et al. Neurology 2009
Authors have 3 cases of NMO diagnosed by antibody in CSF not blood. All had rapidly relapsing LETM, none had ON although they were followed for less than two years. Authors speculate on role for CSF testing in instances of suspected NMO with negative serum tests.

CNS aquaphorin 4 autoimmunity in children

McKeon A, Lennon VA, Lotze T et al. Neurology 2008; 71:93-100.

Spectrum is such that patients with ON and / pr LETM with positive antibodies are more likely to have recurrence, but also are more likely to have episodic symptoms especially encephalopathy, seizures, nausea, diplopia, vertigo and hiccups. Brain lesions, possibly symptomatic, are seen in 60 % of patients, contrary to prior teaching. 42 % had other coexisting autoimmune diseases including SLE, JRA, Graves, and Sjogren's . More than half had residual disability. 84 % improved with iv methylprednisolone which was usually used as first therapy.

Relationship of PRES and NMOSD

Magana SM, Matiello M, Pittock SJ et al. Posterior reversible encephalopathy syndrome in neuromyelitis optica spectrum disorders. Neurology 2009; 72:712-717.

Authors introduce NMOSD as inaugural forms of NMO. They note NMOSD and PRES previously have not been related. Authors found five patients with NMOSD who subsequently developed PRES. All patients presented with confusion/impaired consciousness/coma. Patients without clinical NMO with PRES were NMO antibody negative.