Flaccid paralysis in neuromyelitis optica: An atypical presentation with possible involvement of the peripheral nervous system.

BACKGROUND: Neuromyelitis optica spectrum disorders (NMOSD) typically lead to spastic paraparesis and spare the peripheral nervous system (PNS).

CASE REPORT: Here, we describe an anti-aquaporin-4-seropositive NMOSD patient suffering from acute transverse myelitis with painful, flaccid paralysis and incontinence of urine and feces. Due to the involvement of the PNS as indicated by electrodiagnostic examination, we verified the expression of aquaporin-4-channels on the proximal dorsal spinal radix of rats by staining rat tissue with human NMOSD serum.

CONCLUSION: This case suggests a manifestation of the proximal PNS in NMOSD. Thus, NMOSD should be considered as a differential diagnosis for patients presenting with signs of spinal cord disease and additional radicular involvement.