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A case of neuromyelitis optica presenting marked pleocytosis and hypoglycorrhachia
Mai Fujikura1, Kazuki Yokokawa, Hirohiko Shizukawa
1Section of Neurology, Sapporo Kosei General Hospital.
Abstract:
A 57-year-old man initially developed chest discomfort, nausea, vomiting, headache and low-grade fever, followed by paraplegia, sensory disturbance below level Th5 and bilateral visual loss. He was admitted to our hospital on the 15th day of illness. MRI short T1 inversion recovery image showed multiple longitudinal lesions in the spinal cord below C3, and T2-weighted image showed abnormal hyperintensity within the left optic nerve. Cerebrospinal fluid (CSF) analysis revealed marked pleocytosis (1,719/μl) and hypoglycorrhachia (CSF glucose; 20 mg/dl). Intensive immunosuppressive therapy combined with antibiotics and antiviral agent were started immediately, resulting in relatively good visual outcome but no improvement of paraplegia and sensory disturbance. The patient's serum sample on admission was subsequently reported to be positive for anti-aquaporin-4 antibody. With no evidence of infectious diseases, neuromyelitis optica (NMO) was diagnosed. It should be borne in mind that marked hypogylcorrhachia may also be seen in NMO.
Insights
Neuromyelitis Optica (NMO), an autoimmune condition, can present with spinal cord and optic nerve inflammation. This case highlights that significant low glucose in cerebrospinal fluid (CSF) can be a feature of NMO.
Area of Science:
- Neurology
- Immunology
- Neuroinflammation
Background:
- Neuromyelitis Optica (NMO) is a rare autoimmune disorder targeting the central nervous system, primarily affecting the optic nerves and spinal cord.
- Distinguishing NMO from other inflammatory demyelinating diseases is crucial for appropriate treatment and prognosis.
Observation:
- A 57-year-old male presented with acute paraplegia, sensory deficits, and bilateral vision loss.
- MRI revealed spinal cord lesions and optic nerve inflammation. Cerebrospinal fluid (CSF) analysis showed significant pleocytosis and marked hypoglycorrhachia (20 mg/dl).
Findings:
- The patient tested positive for anti-aquaporin-4 antibodies, leading to a diagnosis of NMO.
- Despite immunosuppressive therapy, visual function partially recovered, but motor and sensory deficits persisted.
Implications:
- This case underscores that marked hypoglycorrhachia in CSF can be an atypical but significant finding in NMO.
- Early diagnosis and prompt treatment are vital for managing NMO, although recovery from severe neurological deficits remains challenging.
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