Rituximab (RTX) is a monoclonal antibody that targets CD20 on B cells and is used to reduce the relapse risk in neuromyelitis optica spectrum disorder (NMOSD). Some patients experience relapse or exacerbation shortly after RTX treatment. We report a 54-year-old female with seronegative NMOSD who relapsed soon after RTX treatment.

Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are common causes of optic neuritis, typically involving anti-aquaporin 4 (AQP4) and Myelin oligodendrocyte glycoprotein (MOG) antibodies. It is scarce for both AQP4 and MOG antibodies to be simultaneously positive. Although NMOSD and MOGAD share clinical features, they differ in symptoms, magnetic resonance imaging findings and outcomes. Both conditions are treated with steroids and immunoglobulins but exhibit distinct responses. We report a case of NMOSD which was double seropositive for AQP-4 and MOG antibodies.

Autonomic dysfunction occurs frequently in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Patients with either condition may present with autonomic symptoms such as bladder, sexual, cardiovascular, thermoregulatory, and gastrointestinal dysfunction, and fatigue, but autonomic symptoms that affect quality of life are underrecognized in clinical practice. The immunopathogenesis of MS has been considered to be associated with autonomic dysfunction. Applying appropriate treatment strategies for autonomic dysfunction is important to improve the quality of life of patients. Here we review autonomic dysfunction and how this is managed in patients with MS and NMOSD.

Citations

• Sexual function and related predictors in male with multiple sclerosis and neuromyelitis optica spectrum disorder: a case–control study
  Saeed Vaheb, Mohammad Yazdan Panah, Mohammad Mohammadi, Mohammad Amin Sadri, Narges Ebrahimi, Sarina Loghmani, Marjan Beigi, Vahid Shaygannejad, Omid Mirmosayyeb
  The Journal of Sexual Medicine.2025; 22(2): 274.     CrossRef

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. Although progressive lymphadenopathy is a typical feature, extranodal involvement may also occur, including the gastrointestinal tract, skin, bone, thyroid, and testes. Central nervous system invasion is rare, so differentiating it from diseases such as inflammatory demyelinating disorder or infection is essential. DLBCL is therefore a challenge to diagnose, especially when the first findings are neurological symptoms. We report an unusual case of DLBCL that presented as transverse myelitis.

Previous studies show few cases of concomitant Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM), also described as GBS and ATM overlap syndrome. We experienced a patient who presented with acute progressive leg weakness and hyperreflexia at initial stage, but was followed by areflexia. The spine magnetic resonance imaging revealed radiological findings of ATM and nerve conduction studies showed electrodiagnostic findings of acute motor axonal neuropathy, known as GBS subtype. The response to treatment with intravenous immune globulin was good.

Background
We aimed to investigate candidates for serological biomarkers of neuropathic pain in individuals with neuromyelitis optica spectrum disorder (NMOSD).
Methods
We analyzed 38 sera samples from 38 participants with NMOSD in National Cancer Center. Neuropathic pain was evaluated using the painDETECT questionnaire. Pain with neuropathic components (painDETECT score ≥ 13) was observed in 22 participants, among whom 17 had definite neuropathic pain (painDETECT score ≥ 19). The remaining 16 participants had non-neuropathic pain (painDETECT score < 13). Serum glial fibrillary acidic protein (GFAP) levels were assessed using a single-molecule array assay. Several cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-10, and IL-17A, were measured by a multiplex bead-based immunoassay.
Results
In comparison of NMOSD participants with neuropathic pain components (or definite neuropathic pain) and those with non-neuropathic pain, the absolute values of serum GFAP, TNF-α, IL-6, and IL-10 levels were higher in participants with neuropathic pain components (or definite neuropathic pain), but these findings did not reach statistical significance.
Conclusions
Further larger-scale investigations to find reliable serological biomarkers for neuropathic pain in NMOSD are warranted.

Citations

• Neuropathic pain in multiple sclerosis: serum biomarkers and MRI lesion localization
  Mohamed Hamdy Ismail, Amal SE ELmotayam, Sara F. Saadawy, Rabab M. Elfwakhry, Hebatallah M. Fawzy, Noha T. Sarhan
  The Egyptian Journal of Neurology, Psychiatry and .2025;[Epub]     CrossRef
• Shedding light on neuropathic pain: Current and emerging tools for diagnosis, screening, and quantification
  Anas Hamdan, Rafael Galvez, Majed Katati
  SAGE Open Medicine.2024;[Epub]     CrossRef
• Systematic Review and Metanalysis of the Expression of Blood-Based and Cerebrospinal Fluid-Based Biomarkers Related to Inflammatory Mediators in Neuropathic Pain
  Marina Sanz-Gonzalez, Miguel Molina-Alvarez, Carmen Rodriguez-Rivera, David Pascual, Carlos Goicoechea
  Journal of Integrative Neuroscience.2024;[Epub]     CrossRef

Atopic myelitis (AM) is a relatively mild form of myelitis associated with allergic diathesis, and present with predominant sensory manifestations. Lhermitte’s sign has been considered as a relatively non-specific clinical sign suggesting demyelinating lesion in cervical cord. Here we report a patient with recurrent AM who presented with isolated Lhermitte’s sign, both in first and second attacks. This report suggests that either the diagnosis or recurrence of AM can be frequently underdiagnosed because of its predominant sensory manifestations.

Background
Acute transverse myelitis(ATM) is a group of disorders characterized by focal inflammation of the spinal cord and resultant neural injury. It can be diagnosed by Transverse Myelitis Consortium WorkingGroup(TMCWG) criteria. But there are some cases which were not satisfied with idiopathic ATM criteria, both clinically and radiologically, especially in acute stage. So we analyzed 27 cases retrospectively, which were diagnosed as idiopathic ATM.
Methods
All the records of the patients at Gil Medical Center with a diagnosis of idiopathic ATM from 2001 to 2005 were reviewed. And clinical manifestations including neurological examination, radiologic features and cerebrospinal fluid (CSF) findings were analyzed.
Results
Among the patients(20 men and 7 women; mean age, 45.3 years), 11 cases could not be diagnosed as idiopathic ATM according to the TMCWG criteria ; 6 cases did not have well marginated upper sensory level and 5 cases were not satisfied with spinal cord inflammation.
Conclusions
Although most cases of suspected idiopathic ATM were suitable for TMCWG criteria, some cases were not satisfied with this diagnostic criteria, especially in acute stage. Subsequent study might be needed to evaluate the reliability and clinical application of the criteria.

Guillain-Barr?syndrome(GBS) is a common demyelination disease of the peripheral nervous system. But recently, the axonal types are also reported. Acute transverse myelitis(ATM) is also a common inflammatory disease of the spinal cord. Generally, it is difficult to identify the etiology of GBS and ATM. I guess the occurrence of the 2 disease at once is hard to take the plase. A 63-years-old woman showed an acute motor axonal GBS and a cervival-upper thoracic ATM occurring at the same time. she ws treated by intravenous immunoglobulin and solumedrol therapy. Her sensory symptoms were improved rapidly but motor symptoms showed only mild improvement.

Acute motor axonal neuropathy (AMAN) is a subtype of Guillain-Barre syndrome and characterized by selectiveinvolvement of motor fibers. Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of central nervoussystem. The coincidence of central and peripheral nervous system involvement has been reported rarely. Wedescribed a 37-year-old male patient presented with fever and altered consciousness. The examination of cerebrospinalfluid and brain magnetic resonance imaging was compatible with acute disseminated encephalomyelitis. Several daysafter admissionb his mentality was improved but quadriparesis, multiple cranial neuropathies, and areflexia were detected.Electrophysiologic studies suggested axonal form of motor dominant polyneuropathy. We report a case of acutemotor axonal neuropathy combined with ADEM. We consider that this case is an example of simultaneous immunologicprocess to the common pathogenic epitope of central nervous system and peripheral nervous system.

Acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (Hurst

Tuberculous radiculomyelitis (TBRM) is a complication of tuberculous meningitis (TBM), which has been reported rarely in the modern medical literature. We describe a case of TBRM, which developed during the treatment of TBM. A 28-year-old man suddenly developed lower back pain, flaccid paraparesis, urinary incontinence, while the TBM was improving with the treatment at 9th day after admission. Spinal MRI revealed leptomeningeal enhancement along with thoracolumbar spinal canal, thickening of nerve roots, spinal meninges and intramedullary high signal lesion in T2 level.

Recurrent transverse myelitis is a rare manifestation of systemic lupus erythematosus. Recurrent transverse myelitis presents the biggest diagnostic problem, since it is common manifestation of multiple sclerosis. But it can also be the only feature or first manifestation in systemic lupus erythematosus. Neurological manifestations and magnetic resonanceimaging can be indistinguishable, and there are no specific diagnostic tools. Here we describe a 59-year-old female having a systemic lupus erythematosus with recurrent transverse myeltitis. No uniform therapeutic protocol exists for systemic lupus erythematous with transverse myelitis, and the prognosis is usually poor. We suggest that aggressivetreatment (usually with pulses of methylprednisolone and cyclophosphamide) might improve the prognosis of systemic lupus erythematosus with transverse myeltis.

A 28-year-old man presented with headache, fever, and myalgia. Subsequently, rapidly progressive quadriplegia withareflexia developed. CSF examination revealed moderate pleocytosis and protein elevation. MRI of brain and spinalcord showed hyperintense lesions on T2-weighted image at midbrain and ventral horns along the whole spinal cord.Serial serologic examinations of CSF for Epstein-Barr virus and cytomegalovirus were negative. Culture and neutralizationtests of stool and CSF for enterovirus were negative. Although the etiologic pathogen was not identified, we diagnosedhim as poliomyelitis-like syndrome by clinical features and findings of MRI.

Acute longitudinal myelitis is a group of disorder characterized by multifocal, long-segmented inflammation of the spinal cord, rapidly evolving paraparesis, a sensory level on the trunk, and bilateral Babinski signs. We report a case of 30-year-old man with longitudinal myelitis extending to long segment of spinal cord. After 15 days of aggressive treatment with intravenous pulsed methylprednisolone for 5 days, motor and sensory functions of the lower extremities were almost recovered.

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Shingles is a latent viral infection of the sensory ganglia. It can be accompanied by a variety of neurologic complications,including polyradiculitis and myelitis. A 66-year-old man with diabetes mellitus presented with progressive weakness, hypethesiaand neuralgic pain in his right arm after herpes zoster infection in right C5 dermatome. He was diagnosed with zosterpolyradiculomyelitis and treated with intravenous acyclovir and corticosteroid. It is a rare case of zoster neurologic complication inspite of oral acyclovir treatment.