Neuromyelitis optica

Differential diagnosis
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By Tiffani Stroup DO and Adil Javed MD PhD

Neuromyelitis optica presents with optic neuritis and myelitis. A large group of diseases can affect the optic nerves and spinal cord (see Table 2). A thorough history, physical examination, serum and CSF testing, and imaging studies can reliably distinguish neuromyelitis optica from other diseases and disorders listed in Table 2.

Table 2. Differential Diagnosis for Neuromyelitis Optica

Demyelinating and dysmyelinating diseases
Multiple sclerosis
Acute disseminated encephalomyelitis
Adrenomyeloneuropathy

Connective tissue diseases, vasculitides, and autoantibody syndromes
Sjögren disease
Systemic lupus erythematosus
Rheumatoid arthritis
Mixed connective tissue disease
Scleroderma
Antiphospholipid syndrome
CNS vasculitis
p-antineutrophil cytoplasmic antibodies
Hashimoto encephalopathy
Sarcoidosis

Infections
Viral: varicella zoster virus, Epstein-Barr virus, HIV, cytomegalovirus, human T-cell lymphotrophic virus, hepatitis B, arborviruses (West Nile virus), enteroviruses, Herpes simplex viruses
Bacterial: Lyme disease, syphilis, tuberculosis, mycoplasma

Toxic and nutritional
B12 deficiency
Copper deficiency
Clioquinol

Neoplastic
Lymphoma
Spinal glioma
Paraneoplastic

Vascular
Stroke
Spinal arteriovenous malformation

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors