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Correspondence |

Devic Disease With Abnormal Brain Magnetic Resonance Image Findings: The First Portuguese Case—Reply

Brian G. Weinshenker, MD
Arch Neurol. 2007;64(2):291. doi:10.1001/archneur.64.2.291.
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We appreciate the report by Guimarães and Sá of a Portuguese case of NMO in which our revised criteria facilitated a correct diagnosis. This patient has NMO based on contemporary clinical criteria: recurrent optic neuritis and recurrent transverse myelitis with cord lesion extending for at least 3 vertebral segments—in this case, for almost the entire cord. In the recent past, the diagnosis of NMO may have been rejected in favor of multiple sclerosis because of the patient's relapsing course, brain MRI abnormalities, and detection of multiple oligoclonal IgG bands in the spinal fluid. However, the severity of the clinical course predominantly affecting the optic nerve and spinal cord, lack of symptoms referable to the brain, and atypical nature of the brain MRI lesions for multiple sclerosis all point to NMO as the most likely diagnosis. The authors' astute interpretation of the clinical symptoms, signs, and MRI findings were confirmed in this case by serological detection of the aquaporin 4–specific autoantibody, NMO-IgG.

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