Neuromyelitis optica

Prognosis and complications
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By Tiffani Stroup DO and Adil Javed MD PhD

Neuromyelitis optica has a high morbidity and mortality. Five-year mortality rates in the past have been as high as 30% in relapsing forms of neuromyelitis optica (Wingerchuk et al 1999). However, this number has likely improved with earlier recognition and aggressive treatment. Patients who survive have severe neurologic deficits. One study suggests that 5 years after initial presentation, more than 50% of patients with neuromyelitis optica will be blind in 1 or both eyes or require ambulatory help (Awad and Stuve 2011). Death occurs from complications of transverse myelitis, such as respiratory failure (with high cervical cord lesions), infections, autonomic dysfunction, and bladder retention in up to 30% of patients. Younger patients and males tend to have a better outcome than elderly and female patients. Factors that predict worse prognosis include the following: older age at onset, high relapse rate in the first year after diagnosis, severity of the first attack, poor recovery after the first attack, elevated CSF IL-6, and a high number of brainstem lesions (Uzawa et al 2014).

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited