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Images in Neurology
February 2009

Neuromyelitis Optica and Concentric Rings of Baló in the Brainstem

Arch Neurol. 2009;66(2):274-275. doi:10.1001/archneurol.2008.539

A 29-year-old woman of Afro-Caribbean descent with a history of thyrotoxicosis was evaluated for right leg weakness and diagnosed as having myelitis. Three months later, she experienced painful vision loss in the right eye, paraplegia, an upper thoracic sensory level, and urinary retention. Results of an examination were consistent with optic neuritis and transverse myelitis. Magnetic resonance imaging showed a hyperintense T2 signal in both optic nerves and an enhancing lesion in the thoracic spine. A serum sample was positive for neuromyelitis optica antibodies (titer, ≥1:120). She was treated with intravenous methylprednisolone sodium succinate and plasmapheresis, which resulted in modest improvement.