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Relapse of neuromyelitis optica with occipital neuralgia and elevated CSF neopterin
Author(s) -
Miyaue Noriyuki,
Yabe Hayato,
Yamanishi Yuki,
Tada Satoshi,
Ando Rina,
Nagai Masahiro
Publication year - 2020
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.12393
Subject(s) - medicine , neuromyelitis optica , cerebrospinal fluid , pleocytosis , neopterin , myelopathy , lymphocytic pleocytosis , magnetic resonance imaging , occipital neuralgia , pathology , dysesthesia , spinal cord , gastroenterology , radiology , anesthesia , neuralgia , multiple sclerosis , immunology , encephalitis , neuropathic pain , virus , psychiatry
A 64‐year‐old woman with anti‐aquaporin‐4 antibody‐positive neuromyelitis optica presented with pain and dysesthesia in the left occipital region. Cervical magnetic resonance imaging showed a new high‐intensity area on the left side of the spine (C1‐C2 level), close to a pre‐existing lesion. Cerebrospinal fluid analysis revealed elevated neopterin (53.1 nmol/L) without pleocytosis. The neopterin level normalized 2 weeks (22.0 nmol/L) and 2 months (18.9 nmol/L) after intensified steroid therapy. Occipital neuralgia should be considered a common clinical feature of neuromyelitis optica, and cerebrospinal fluid neopterin may be a useful, sensitive biomarker for central nervous system inflammation in these patients.