入院後確定診断がついたNMOSDに対するリハビリテーション治療経験

抄録

Introduction：The concept of neuromyelitis optica spectrum disorder (NMOSD) has been proposed as a type of multiple sclerosis. This inflammatory demyelinating disease is often used to distinguish strokes from brain tumors. We report two cases of NMOSD patients during rehabilitation after the initial diagnosis of a cerebral infarction or brain tumor.

[Case 1] A 77-year-old woman presented with weakness of bilateral lower limbs. Brain magnetic resonance imaging (MRI) showed a high signal area in both cerebral hemispheres. During the course, the movement of the left lower limb worsened. Brain MRI did not show new lesions. However, thoracic MRI showed a wide range of lesions from C7 to T10, and anti-AQP antibody was positive. She was diagnosed with NMOSD. After steroid therapy, she was rehabilitated. At discharge, she required more assistance in a wheelchair.

[Case 2] A 69-year-old woman presented with weakness of bilateral lower limbs. Brain MRI revealed a space occupying lesion in the left occipital lobe, and the patient was admitted to the hospital on suspicion of a brain tumor. Vision weakness appeared during the course, and thoracic MRI revealed high signal in T2-8. Anti-MOG antibody was positive. Plasma exchange and steroid pulse therapy were performed and she was diagnosed with NMOSD. After rehabilitation, she required partial assistance by a wheelchair.

Discussion：Symptoms may worsen during rehabilitation for stroke and brain tumor. If there are no findings that explain the symptoms for the diagnosis, it is necessary to consider the possibility of other diseases like NMOSD.