Superficial Abdominal Reflex - NEJM
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A 59-year-old man presented with a 5-day history of bilateral lower-limb numbness, unsteadiness of gait, and urinary incontinence. On examination, he had bilateral lower-limb weakness (strength, 4/5), with normal tone and deep-tendon reflexes. The plantar reflexes were normal bilaterally. There was a sensory level at T10. Visual evoked responses were delayed on both sides. Absence of the superficial abdominal reflex on the right side correlated with the finding of a hyperintense lesion in the spinal cord on T2-weighted magnetic resonance imaging, spanning T7 to T10 (Panel A), predominantly on the right side (Panel B). The analysis of the cerebrospinal fluid was normal. A test for anti–aquaporin 4 (NMO-IgG) antibodies was positive. He was given a diagnosis of neuromyelitis optica and treated with intravenous methylprednisolone for 5 days. Azathioprine therapy was also initiated. At 1-month follow-up, his neurologic deficits had resolved completely except for some residual sensory symptoms...

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