Case 1:
An 83-year-old male presented for evaluation of progressive loss of left eye vision over 48 hours. 3 weeks prior there was abrupt onset of loss of right eye vision. Over the same time period there was lower limb sensory loss and weakness.
Magnetic resonance imaging identified increased pre-chiasmal right optic nerve T2 signal and bilateral optic atrophy. Spinal imaging revealed a longitudinally extensive T3-T6 cord T2 hyperintensity.
Cerebrospinal fluid constituents were unremarkable. Serum and CSF anti-AQP4 antibodies were positive on rodent tissue and fixed transfected cell lines. Papillary thyroid carcinoma was identified during malignancy screening.
Case 2:
A 75-year old male with mesothelioma presented with lower limb paraparesis, bladder and bowel dysfunction, and a thoracic sensory level.
Magnetic resonance imaging identified longitudinally extensive T2 spinal cord hyperintensity from C3/4 to T11/12 with cord expansion.
Cerebrospinal fluid analysis demonstrated a lymphocytic pleocytosis with elevated protein. Serum anti-AQP4 antibodies were positive on rodent tissue and fixed transfected cell lines.
One year after treatment with Rituximab, a relapse with left optic neuritis occurred in the context of B-cell recovery.