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A young woman presented with a 2-month history of progressive severe spastic paraparesis. An MR scan of spine showed a longitudinally-extensive myelopathy (figure 1). MR scan of the brain was normal. Cerebrospinal fluid showed elevated protein at 1.33 g/L, a normal white cell count, no malignant cells and normal glucose. An exhaustive biological blood screening was negative except for detection of antibodies targeting the M23 isoform on aquaporin-4 transfected cells.
Contributors DB and RD: study design, drafting and revising the manuscript. CD and JS: data collection, critical comments during manuscript revision. KM: data collection, drafting and revising the manuscript. OG and RM: critical comments during manuscript revision.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Jackie Palace, Oxford, UK, and Seth Love, Bristol, UK.