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Question Date: 24/07/2023

Question: A 54-year-old woman presents with an episode of transverse myelitis with severe quadriparesis that developed over 2 days. Spinal cord MRI demonstrates an extensive area of increased signal from T2 to T6, which enhances on postcontrast T1-weighted images. Brain MRI is normal. Which of the following laboratory results is most likely to be diagnostic in this patient?

Options:

• CSF oligoclonal bands
• Antineutrophilic cytoplasmic antibodies
• Antinuclear antibody
• Aquaporin-4 antibodies

Correct Answer: Aquaporin-4 antibodies

Explaination: This patient presents with a longitudinally extensive transverse myelitis, highly concerning for neuromyelitis optica as the underlying etiology. This patient should be tested for the presence of aquaporin-4 antibodies. The presence of these antibodies is highly specific for a diagnosis of neuromyelitis optica. Demonstration of these antibodies should prompt aggressive treatment to decrease neuromyelitis optica attacks.

Reference: Wingerchuk DM. Immune-Mediated Myelopathies. Continuum (Minneap Minn). 2018 Apr;24(2, Spinal Cord Disorders):497-522. doi: 10.1212/CON.0000000000000582. PMID: 29613897.