Objective: To describe a case of severe ataxia associated with neuromyelitis optica spectrum disorder with spinal cord and medulla oblongata involment.

Background: Although brain stem manifestations are present in up to 30 to 40 percent of patients with optic neuromyelitis, ataxia is describe in less tan 2 percent of cases.

Methods: Case report with review of clinical records and bibliografic research

Results: A 62 years old woman came to our clinic with 6 days of progressive paresis of right arm with 3 days of severe ipsilateral incoordination during voluntary movements

producing incapacity to perform daily living activities and even produces recurent blows to the face due to incontrol of the limb.

2 years ago she started with progressive paraparesis until requiring bilateral support for ambulation, 1  ½ years ago, she developed vision loss in the right eye that resolved spontaneously in one month, 2 months later symptoms began in the contralateral eye progressing until just light perceptionIn, in august 2016, began paresis of the right arm which was diagnosed as a cerebrovascular event.

Clinical evaluation showed visual acuity of finger counting in rigth eye and light perception in left eye. Quadriparesis and severe spasticity in the left arm, bilateral hypoesthesia from C3 dermatome, generalized ataxia which was severe in left arm to the degree of ballistic movements simulation.

MRI showed severe transverse myelitis from level C1 to T2 and edema in the caudal portion of medulla oblongata, lumbar puncture was unremarkable, complete hematical biometry and blood chemistry were normal.

Methylprednisolone was started with parcial control of symtoms and slight improvement of ataxia.

Conclusions: Ataxia is a rare manifestation of neuromyelitis optica and it is necessary to take it into account to perform an adequate diagnostic and therapeutic approach.

References: Koon Ho Chan, T. Tse, P. chumg; Brain Involvement in Neuromyelitis Optica Spectrum Disorders; Arch Neurol. 2011;68(11):1432-1439.

L Kremer, M Mealy, A Jacob; Brainstem manifestations in neuromyelitis optica: a multicenter study of 258 patients; Multiple Sclerosis Journal 2014, Vol. 20(7) 843– 847

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ataxia-asociated-to-neuromyelitis-optica-spectrum-disorder/