A Case of Neuromyelitis Optica Misdiagnosed as Cervicogenic Headache
A 33-year-old male patient came to the hospital complaining of headache that had been occurring for two weeks prior to his visit. One week before visiting the hospital, he received a cervical facet joint block and drug treatment in another hospital, but the pain continued so he visited the pain clinic at our hospital. In the first medical examination, the patient said that he did not have any unusual past history. The headache began at the left occipital region and then gradually spread to the posterior neck, where numbness and aching developed; there was no paresthesia. Additionally, during the same period, the patient had blurred vision as a symptom. The physical examination performed at the time of the hospital visit appeared to be normal.\nAt first, it was suspected to be a general cervicogenic headache, so a bilateral greater occipital nerve block was performed as a diagnostic block and his progress was monitored. Three days later in the clinic, the ache in the head area had slightly decreased, but the numbness had spread from the face to the posterior neck, both shoulders, and both arms. In addition, during the physical examination performed this time, the Lhermitte sign appeared to be positive. Hence, a more detailed past history was examined, and it was found that 15 years ago the patient's eyesight suddenly failed so he was diagnosed with optic neuritis, and during the same period, he also suffered from myelitis. Secondary headache due to central pain was suspected from the progress of the disease, past history, and physical examination, and thus C-spine MRI was performed. As a result, an extensive intramedullary high signal intensity was observed from the medulla oblongata to the C5 (). Visual acuity test, color vision test, visual field test, and fundus examination performed in ophthalmology to check for anomalies in the optic nerve all appeared to be normal, but in the subsequent goggle VEPS (visual evoked potentials), a bilateral ocular or prechiasmal lesion and suspicious bilateral upper brainstem lesion were observed. In addition, the oligoclonal band IgG appeared negative in the CSF analysis. There were no abnormalities in the brain MRI, and the NMO-Ab test was negative.\nBased on the past medical history and test results above, the patient was diagnosed with neuromyelitis optica, and steroid pulse therapy was performed for 5 days in which 1 g of solumedrol was given on each day. Subsequently, the neurological symptoms and MRI observations improved, so the drugs were changed to oral steroids and the patient was discharged ().