Widely spread corticospinal tracts lesions in a case of neuromyelitis optica

Brain abnormalities have frequently been reported in neuromyelitis optica (NMO) patients, but corticospinal tract involvement has rarely been described. Here we review the case of a 56-year-old woman who presented with unusual MRI features involving the whole corticospinal tract, and summarize the clinical features, neuroimaging, and prognosis of the case. The patient presented with bilateral visual loss and developed progressive weakness in both lower limbs, and urinary incontinence 12days later. Brain MRI revealed T2-hyperintensities in the bilateral corticospinal tract (posterior limb of the internal capsule and cerebral peduncle), callosal lesions, and subcortical white matter lesions. Spinal cord MRI showed a longitudinally extensive lesion involving the cervical and lumbar regions. The patient showed minimal improvement after methylprednisolone therapy. Our case suggests that in a patient with NMO, involvement of the whole corticospinal tract with specific brain abnormalities on MRI is indicative of a poor prognosis.