BMJ Case Reports 2018; doi:10.1136/bcr-2018-225601
  • Rare disease

Neuromyelitis optica spectrum disorder presenting in an octogenarian

  1. Olayinka Ayodele Ogundipe
  1. Medicine of the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Amy Campbell, amy.campbell10{at}
  • Accepted 12 August 2018
  • Published 8 September 2018


This case describes an 81-year-old woman with a history of Sjögren’s syndrome presenting with recurrent falls and poor balance. She subsequently developed new and rapidly evolving neurology including hyperaesthesia, spastic paraplegia and sphincteric dysfunction. Following serial clinical reviews and detailed investigations, MRI (brainstem and cervicothoracic spine) and a seropositive result for aquaporin 4 IgG, a diagnosis of neuromyelitis optica spectrum disorder (NMOSD) was made. This case describes the clinical course of this index patient with an unusual late age of onset. The report also includes a discussion on NMOSD. We review aspects of terminology, brief epidemiology, pathogenesis, notable autoimmune associations, variance in clinical presentation and current diagnostic criteria. We also review the importance of distinguishing NMOSD from multiple sclerosis in view of the significant implications for treatment and prognosis.


  • Contributors OAO conceived of the idea for the article. AC and OAO contributed to the preparation, review and editing of the manuscript. Both authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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