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NMOSD — RACP Adult Medicine MCQ

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ModerateNeurologyNMOSDRACP Adult Medicine

A 40-year-old woman presents with bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM spanning ≥3 vertebral segments). MRI brain shows periaqueductal and hypothalamic lesions. Anti-AQP4 antibody is positive. What is the most likely diagnosis?

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Correct answer: D — Neuromyelitis optica spectrum disorder

Bilateral optic neuritis with LETM (≥3 segments) and positive anti-AQP4 (aquaporin-4) antibody is diagnostic of NMOSD. The periaqueductal and hypothalamic lesions are characteristic area postrema lesions. Unlike MS, NMOSD requires long-term immunosuppression (rituximab, eculizumab, or satralizumab) from onset.

Reference: ABN – 2024 – NMOSD Guidelines; Wingerchuk 2015 NMOSD Criteria