NMO in Child: Diagnostic and Therapeutic Challenges
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Case Presentation
A 13-year-old African American girl presented to the hospital with a 6-day history of fatigue, weakness, upper back and shoulder pain, subjective fever, decreased appetite, and weight loss. She was previously healthy. On examination, she was encephalopathic with waxing and waning mental status, flat affect, ophthalmoparesis, with decreased visual acuity, and color agnosia. During hospitalization, the patient's symptoms worsened with episodes of vomiting, periods of agitation, and at times unresponsiveness to environmental stimuli.

The initial brain MRI showed increased signal in the hypothalami, mammillary bodies, periaqueductal gray matter, and posterior aspect of pons and medulla, raising a question about Wernicke's encephalopathy. Subsequent MRIs showed progression of abnormalities with new enhancement of bilateral optic nerves extending to the optic chiasm, pontine tegmentum bilaterally, and gradual resolution of earlier appeared changes...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874358/
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