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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?
Explanation
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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.
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Reference
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Wingerchuk DM. Immune-Mediated Myelopathies. Continuum (Minneap Minn). 2018 Apr;24(2, Spinal Cord Disorders):497-522. doi: 10.1212/CON.0000000000000582. PMID: 29613897.
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Option 1
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Is Correct (Option 1):
CSF oligoclonal bands
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Option 2
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Is Correct (Option 2):
Antineutrophilic cytoplasmic antibodies
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Option 3
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Is Correct (Option 3):
Antinuclear antibody
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Option 4
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Is Correct (Option 4):
Aquaporin-4 antibodies
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