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Consciousness disturbance and poikilothermia revealing brain involvement in neuromyelitis optica


A 21-year-old woman was admitted due to altered mental status and hypothermia. The patient had a diagnosis of neuromyelitis optica (NMO) for 12 years and she was positive for serum anti-aquaporin 4 antibody. On admission, physical examination revealed coma with decerebration rigidity and poikilothermia. Magnetic resonance images of the brain revealed widespread, gadolinium enhancing lesions in the periventricular areas and the diencephalic structures. Laboratory investigations revealed hyponatremia and hypothyroidism. The patient was treated with high dose steroids. Both symptomatic and asymptomatic brain lesions may develop in patients with NMO. However, poikilothermia has not been reported in patients with NMO before.

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  1. Wingerchuck DM, Hogancamp WF, O’Brien PC, Weinshenker BG (1999) The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 53:1107–1114

    Article  Google Scholar 

  2. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66:1485–1489

    PubMed  Article  CAS  Google Scholar 

  3. Cabrera-Gomez JA, Quevedo-Sotolongo L, Gonzalez-Quevedo A, Lima S, Real-González Y et al (2007) Brain magnetic resonance imaging findings in relapsing neuromyelitis optica. Multiple Scler 13:186–192

    Article  Google Scholar 

  4. Pittock SJ, Weinshenker BG, Lucchinetti CF, Wingerchuk DM, Corboy JR et al (2006) Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol 63:964–968

    PubMed  Article  Google Scholar 

  5. Poppe AY, Lapierre Y, Melancon D, Lowden D, Wardell L et al (2005) Neuromyelitis optica with hypothalamic involvement. Mult Scler 11:617–621

    PubMed  Article  Google Scholar 

  6. Lennon VA, Kryzer TJ, Pittock SJ, Verkman AS, Hinson SR (2005) IgG marker of optic spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med 202:473–477

    PubMed  Article  CAS  Google Scholar 

  7. MacKenzie MA, Hermus AR, Wollersheim HC, Pieters GF, Smals AG et al (1991) Poikilothermia in man: pathophysiology and clinical implications. Medicine (Baltimore) 70:257–268

    CAS  Google Scholar 

  8. Martin JB, Riskind PN (1992) Neurologic manifestations of hypothalamic disease. Prog Brain Res 93:31–40

    PubMed  Article  CAS  Google Scholar 

  9. Eichel R, Meiner Z, Abramsky O, Gotkine M (2008) Acute disseminating encephalomyelitis in neuromyelitis optica: closing the floodgates. Arch Neurol 65:267–271

    PubMed  Article  Google Scholar 

  10. Ito S, Mori M, Makino T, Hayakawa S, Kuwabara S (2009) “Cloud-like enhancement” is a magnetic resonance imaging abnormality specific to neuromyelitis optica. Ann Neurol 66:425–428

    PubMed  Article  Google Scholar 

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Correspondence to Ozlem Kayim Yildiz.

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Yildiz, O.K., Cevik, S. & Oztoprak, I. Consciousness disturbance and poikilothermia revealing brain involvement in neuromyelitis optica. Acta Neurol Belg 112, 213–215 (2012).

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  • Neuromyelitis optica
  • Brain lesions
  • Hypothalamic lesions
  • Consciousness disturbance
  • Poikilothermia
  • Endocrinopathy