Neuromyelitis optica in the elderly

Acute transverse myelitis and monolateral optic neuritis developed within a few weeks of each other in a 68-year-old woman. CSF findings consisted of elevated protein, pleocytosis, increased IgG and presence of one oligoclonal band in the electrophoresis. MRI investigation revealed diffusely increased signal on the T2-weighted images in the cervical and thoracic tracts of the spinal cord. Notwithstanding an intense steroid therapy, the patient died after 6 weeks. Despite the absence of post-mortem examination, clinical, laboratory and neuroimaging findings are consistent with the diagnosis of neuromyelitis optica (NO) related to multiple sclerosis. This case serves to document that NO can occur initially at an advanced age.