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September 19, 2024 VMR with Rabih & Maryana - tingling, numbness, and burning sensation of b/l LE
A 34-year-old woman presents with recurrent episodes of bilateral optic neuritis and longitudinally extensive transverse myelitis. She reports progressive vision loss and lower extremity weakness over the past year. MRI of the spinal cord reveals a longitudinally extensive lesion extending over 5 vertebral segments. Brain MRI shows no significant periventricular or cortical lesions. Her anti- Aquaporin-4 (AQP4) antibody test returns negative, and a follow-up test for anti-Myelin Oligodendrocyte Glycoprotein (MOG) antibodies also returns negative. Which of the following would be the next best step in managing this patient? a) Repeat anti-AQP4 antibody testing b) Diagnosis of seronegative NMOSD and initiation of immunosuppressive therapy c) Empirical treatment with disease-modifying therapies for Multiple Sclerosis (MS) d) Referral for further genetic testing e) Observation and symptomatic management only
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