Nöromiyelitis optika

Yıl 2014, Cilt: 24 Sayı: 3, 112 - 114, 01.01.2014

Tuba Berra Sarıtaş Alper Yosunkaya Hale Borazan Ahmet Keçecioğlu

Öz

Nöromyelitis optika, nadir görülen ancak oldukça ciddi bir demiyelinizan hastalıktır. Optik sinirlerin ve spinal kordun akut ya da tekrarlayan demiyelinizan enflamasyonu ile görülür. Yirmibir yaşında, kadın hasta, akut görme kaybı, tetrapleji ve solunum arresti nedeniyle yoğun bakım ünitesine kabul edildi. Beyin omurilik sıvısında pleositoz, ve artmış protein seviyesi tespit edildi. Ig G ye bağlı oligoklonal bant formasyonu negatifti. Kraniyal manyetik rezonans görüntülemesinde periventriküler bölgede, mezensefalonda ve sol temporal lob subkortikal bölgede demyelinizasyon mevcuttu. Aynı zamanda servikomeduller bileşkeden servikal vertebra 2. seviyeye kadar uzanan demiyelinizasyon vardı. Hasta steroid ve azotiyopirin tedavisine cevap vermedi. Ancak plazmaferez olgunun kliniğinde dramatik bir iyileşme sağladı

Anahtar Kelimeler

Nöromiyelitis optika, plazmaferez, steroid

Neuromyelitis optica

Öz

Neuromyelitis optica is a rare but severe demyelinating disease. It is represented with acute or relapsing inflammatory demyelination of optic nerves and spinal cord. A 21 year old woman was admitted to intensive care unit with acute visual loss, tetraplegia and respiratory arrest. The cerebrospinal fluid included prominent pleosytosis and increased protein level. Oligoclonal band formation of Ig G is negative. There were demyelination in the periventricular region, mesencephalon and left temporal lobe subcortical region in the cranial magnetic resonance imaging. Also demyelination present from cervicomedullar junction to cervical 2 vertebrae level. The patient did not respond to steroid and azothiyopirine treatment. But plasmapheresis provided a dramatic improvement in her clinical status

Anahtar Kelimeler

Neuromyelitis optica, plasmapheresis, steroid

Kaynakça

• Wingerchuk DM, Weinshenker BG. Neuromyelitis optica. Neuro- logy 2003;60:848-53.
• Amiry-Moghaddam M, Ottersen OP. The molecular basis of water transport in the brain. Nat Rev Neurosci 2003; 4: 991-1001.
• Lennon VA, Kryzer TJ, Pittock SJ, Verkman AS, Hinson SR. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin- 4 water channel. J Exp Med 2005;202:473–77.
• Csécsei P, Trauninger A, Komoly S, Illes Z. Neuromyelitis optica spectrum: Novel concept of pathogenesis, diagnosis and treatment of Devic’s disease. Orv Hetil 2009; 150:2101-9.
• Akman-Demir G, Tüzün E, Waters P, et al. Prognostic implications of aquaporin-4 antibody status in neuromyelitis optica patients. J Neurol 2011; 258:464-70.
• Weinshenker BG, O’Brien PC, Petterson TM, et al. A randomized trial of plasma exchange in acute central nervous system inflam- matory demyelinating disease. Ann Neurol 1999;46:878–86.
• Watanabe S, Nakashima I, Misu T, et al. Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyeli- tis optica. Mult Scler 2007;13:128–32.
• Keegan M, Pineda AA, McClelland RL, at al. Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 2002;58:143-6.
• Ruprecht K, Klinker E, Dintelmann T, Rieckmann P, Gold R. Plas- ma exchange for severe optic neuritis: treatment of 10 patients. Neurology 2004;63:1081-3.