Devic's Disease

by

Mark Loomus, M.D.

A 43 y/o African-American woman with a Hx of depression presented to us 1/2010 with a recent Hx of Devic Disease. She had spent a while hospital and doctor-shopping many places in SE Michigan and NW Ohio. She had moderate quadriparesis, IgG Synthesis 29 (0-3.2), IgG Index normal, 43 WBCs, 33 RBCs on CSF. I do not know if an NMO Ab was ever done. MRI brain basically normal, MRI Cervical spine c/w Devic, with a large, wide, longitudinal plaque running from top of cord thru the entire C-spine. She walked out AMA. Had colonic-vesical fistula surgery in April and went to ECF after and has not walked since. Brought in in June with mild pneumonia. Spastic quadriplegia, minimal RUE movement, eating and drinking without needing her PEG tube, and mentally and cognitively normal. She went into respiratory distress and got a tracheostomy. It was felt her high cord plaque caused the respiratory failure.

She went to an LTAC and 10 days ago "stopped communicating" after being told she would never get off the vent. A Psychologist thought she was depressed and recommended Remeron. CT brain done and read as bihemispheric edema and she was transferred back to my hospital comatose, eyes deviated down and in, with reactive pupils, normal corneal reflexes, and essentially good oculocephalics!. Remains quadriplegic. Repeat CT same. MRI finally done after 3 tries (BP up, bradycardic). Now there are lesions that look like severe acute "fulminating" MS, with enhancing plaques bilaterally and what appeaars to be demyelination of the corticospinal tracts (?) - at least, lots of demyelination running caudad through the stem into the peduncles. ACE level, NMO Ab now drawn and pending. Thoughts?


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Updated 8/15/2010

(c) 2010 M. H. Rivner