Finding the missing link in neuromyelitis optica presenting with recurrent transverse myelitis flares

Neuromyelitis optica (NMO) is a distinct clinical entity from multiple sclerosis with its own clinical, laboratory and pathological characteristics. Definitive diagnosis of NMO is challenging at times as there can be a long interval between the occurrence of the index event and other neurological deficits which would fulfill the diagnostic criteria. Detection of NMO antibody could serve as an early marker in the disease progression. We present a young woman previously identified to have NMO antibody with recurring episodes of transverse myelitis for 3 years before manifesting with optic neuritis.