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Symptoms and Diagnosis of NMO

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Symptoms

Symptoms of neuromyelitis optica (NMO) can include all of the following, although visual symptoms and spinal cord inflammation (transverse myelitis) are primary. Abrupt changes in vision caused by optic neuritis include:

  • Loss or blurring of vision in one or both eyes
  • Loss of color vision
  • Eye pain

Changes in sensation and function in the limbs caused by transverse myelitis, which usually affects multiple levels in the spinal cord, include:

  • Weakness
  • Numbness (loss of sensation)
  • Loss of function (paralysis)
  • Loss of bowel or bladder control
  • Retention of urine or difficulty emptying the bladder
  • Spasticity (increased tone or stiffness in the extremities)
  • Shooting pain or tingling in the neck, back or abdomen
  • Uncontrollable nausea and vomiting
  • Uncontrollable hiccups
  • Fatigue
  • Confusion, seizures or coma can occur in children

Diagnosis

Early diagnosis of NMO is critical. Unlike MS, NMO episodes are typically quite severe. If left untreated, these episodes can have devastating, irreversible effects.

The diagnosis of NMO requires evidence of optic neuritis and transverse myelitis. Additional findings that support the diagnosis of NMO include:

  • Findings on the brain MRI that do not meet criteria for MS, and
  • Distinctive, elongated lesions in the spinal cord (referred to as longitudinally extensive transverse myelitis (LETM)
  • Lesions involving a large part of the optic nerve or a specific part of the optic nerve (called the optic chiasm)
  • Positive anti-AQP4 antibodies

The process of diagnosis includes:

  • Medical history
  • Neurologic exam-a neurologist examines the person’s mobility, muscle strength, coordination, sensation, memory and thinking functions, speech and vision
  • Magnetic resonance imaging (MRI) of the brain, optic nerves and spinal cord
  • Spinal tap (lumbar puncture) to examine cerebrospinal fluid
  • Ophthalmology (eye and vision) studies; optical coherence tomography (OCT)
  • Blood tests to detect NMO-IgG.
  • Blood tests to detec MOG-IgG
Reviewed by Elias Sotirchos, MD November 2019

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