We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Neuromyelitis Optica and Concentric Rings of Baló in the Brainstem

Jerome J. Graber, MD, MPH; Ilya Kister, MD; Howard Geyer, MD; Mausumi Khaund, MD; Joseph Herbert, MD
Arch Neurol. 2009;66(2):274-275. doi:10.1001/archneurol.2008.539.
Text Size: A A A
Published online


A 29-year-old woman of Afro-Caribbean descent with a history of thyrotoxicosis was evaluated for right leg weakness and diagnosed as having myelitis. Three months later, she experienced painful vision loss in the right eye, paraplegia, an upper thoracic sensory level, and urinary retention. Results of an examination were consistent with optic neuritis and transverse myelitis. Magnetic resonance imaging showed a hyperintense T2 signal in both optic nerves and an enhancing lesion in the thoracic spine. A serum sample was positive for neuromyelitis optica antibodies (titer, ≥1:120). She was treated with intravenous methylprednisolone sodium succinate and plasmapheresis, which resulted in modest improvement.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

Gadolinium-enhanced magnetic resonance imaging of the brain and spinal cord revealed an expansile, enhancing lesion spanning T1 to T4 (A) and a lesion of the brainstem with alternating T2 hyperintense and hypointense rings (B).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

12 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles