What are the symptoms of neuromyelitis optica?

Most patients with neuromyelitis optica are young people, and there are also quite a few children. If it recurs over a period of time, it may cause blindness or even paraplegia and other symptoms. Most people will have symptoms of eye pain before the onset of the disease, and will become completely blind within a few days or even hours.

1. The age of patients is 5 to 60 years old, with the most cases being 21 to 41 years old.

There are also many child patients. Patients over 60 years old are rare, and most of them are teenagers; females are slightly older than males. Half of the patients had a history of upper respiratory or digestive tract infection a few days or weeks before the onset of illness. Some cases have symptoms such as fever, headache, sore throat, dizziness, fatigue, nausea, vomiting and abdominal pain 1 to 3 weeks before the onset of the disease.

2. Patients with acute onset may develop spinal cord or eye symptoms within hours or days.

In patients with subacute onset, symptoms reach a peak within 1 to 2 months. In a small number of patients, the onset is chronic, with symptoms progressing steadily over several months and becoming progressively worse. Acute transverse disseminated myelitis and bilateral simultaneous or sequential optic neuritis are characteristic manifestations of this disease, which occur consecutively within a short period of time, leading to paraplegia and blindness. The disease progresses rapidly and may remit and relapse.

3. Most patients experience eye symptoms first.

Symptoms may occur in both eyes at the same time, or may appear in one eye first and then spread to the other eye after a few days or weeks. In a few cases, the other eye may be affected after several months or more than a year. It is rare that only one eye is affected. About 1/8 of patients have recurrent attacks. People with visual impairment often have an acute onset of illness, with a pattern of remission and relapse. In the early stages of the disease, patients feel eye pain, especially when the eyeballs are moved or pressed, or complain of forehead pain accompanied by blurred vision. Some people with acute onset may suffer complete vision loss within a few hours or days. Optic papillitis, retrobulbar neuritis, and visual field changes may be seen in the fundus.

4. The common site of spinal cord injury is the thoracic spinal cord, followed by the cervical spinal cord, and the lumbar spinal cord is less common.

Homer syndrome may occur in cervical spinal cord lesions. Common clinical spinal cord signs are asymmetric and incomplete, often showing signs of disseminated myelitis, incomplete transverse spinal cord hemisection or ascending myelitis. The clinical features are rapidly progressive (hours or days) paraparesis, sensory flatness of the trunk, sphincter dysfunction, and bilateral Babinski sign. There is progressive weakness in the lower limbs, with weakened tendon reflexes in the early stage and the appearance of pyramidal tract signs and pathological reflexes in the later stage. In addition to sensory, motor, and sphincter dysfunction, painful cramps are common. Sphincter disorders usually occur simultaneously with limb paralysis, and the early symptoms are urinary retention, which may later turn into urinary incontinence. Recovery of sphincter function coincides with improvement of limb paralysis in most patients. Optic nerve and spinal cord symptoms often occur one after the other or simultaneously, with the interval between them being days, weeks, months or years.