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Bilateral trochlear nerve palsy in a patient with neuromyelitis optica

Annika Plate, Joachim Havla, Tania Kümpfel

In June 2011, a 71-year-old female Caucasian patient was found to have low neutrophil counts (410 granulocytes/µl; 2.3G/l leucocytes) during a routine blood cell count (BCC) control.

The last contact was in March of that same year, when the patient received her latest cycle of rituximab (RX) therapy in light of her neuromyelitis optica (NMO). She was diagnosed with NMO in 1990 due to recurrent longitudinally extensive myelitis(LEM) and optic neuritis(ON). In 2005 the diagnosis was confirmed when she tested positive for aquaporin-4 antibodies. From 1999 through 2008 she was treated with azathioprine, but still showed clinical disease. In December 2008 the patient was switched to RX. She received her first RX cycle in December 2008, consisting of two 1000 mg infusions, two weeks apart. Further cycles of RX therapy were received in June 2009, February 2010, August 2010 and the latest in March 2011. RX led to complete B-cell depletion and stabilisation of disease activity. Besides B-cell depletion, differential BCC have always been unremarkable, until June 2011.


Based on these findings, what action should be taken?

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About the Editors

  • Prof Timothy Vartanian

    Timothy Vartanian, Professor at the Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, Cornell...
  • Dr Claire S. Riley

    Claire S. Riley, MD is an assistant attending neurologist and assistant professor of neurology in the Neurological Institute, Columbia University,...
  • Dr Rebecca Farber

    Rebecca Farber, MD is an attending neurologist and assistant professor of neurology at the Neurological Institute, Columbia University, in New...

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