Masatake Kobayashi

Immunoadsorption therapy for neuromyelitis optica spectrum disorders long after the acute phase

Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disease with exacerbations involving recurrent or bilateral optic neuritis and longitudinally extensive transverse myelitis. Pulse steroid therapy is recommended as the initial, acute‐phase treatment for NMO. If ineffective, treatment with plasma exchange (PE) should commence. However, no evidence exists to support the effectiveness of PE long after the acute phase. Immunoadsorption therapy (IA) eliminates pathogenic antibodies while sparing other plasma proteins. With IA, side effects of PE resulting from protein substitution can be avoided. However, whether IA is effective for NMO remains unclear. We describe a patient with anti‐aquaporin‐4‐positive myelitis who responded to IA using a tryptophan polyvinyl alcohol gel column that was begun 52 days after disease onset following the acute phase. Even long after the acute phase when symptoms appear to be stable, IA may be effective and should not be excluded as a treatment choice. J. Clin. Apheresis 30:43–45, 2015.

Superficial siderosis with cerebrospinal fluid leakage

The patient was a 73-year-old man with a history of traffic accident in 1999. In 2004, blood patch treatment was carried out for cerebrospinal fluid (CSF) hypovolemia. In 2009, he became aware of hearing loss and dizziness. T2*-weighted magnetic resonance images showed a symmetric hypointense rim partially delineating the cerebellum. CSF analysis showed xanthochromia and elevated red blood cell count. We diagnosed superficial siderosis (SS). We carried out computed tomography myelogram and magnetic resonance imaging of the full spine, and epidural fluid accumulation was detected from the second cervical vertebra to the 11th thoracic vertebra (Fig. 1). The 24-h residual rate on cisternal scintigraphy was decreased to 20.9%, suggesting CSF leakage. In the pathogenesis of SS with epidural fluid accumulation, a dural tear might be the source of bleeding, and it might also cause CSF hypovolemia. When SS is observed, it is important to detect fluid accumulation carefully with spinal magnetic resonance imaging to locate the site of bleeding. References