tis, (3) toxic effects of alcohol, (4) a syphilitic manifestation, (5) result of malaria, (6) infec- tion with neurotropic virus, (7) a result of increased intracranial pressure ...
co-exists with acute myelitis, but the first clinical condition was described a few years later by Erb in 1879. Seguin was probably first among the American authors to report the condition (1880). The first attempt to survey the literature was made by Gault who collected 17 cases and it was he who proposed on the suggestion of his teacher Devic that the syndrome be called Neuromyelitis Optica. It is also called Devic's disease after the name of Devic.
I
The review made by Stansbury (1949) has been the most exhaustive of the series. He collected reports of 200 cases from world literature and himself also reported 20 cases. From the 'analysis he made, he drew up the following conclusions on the Syndrome. It
"1.
occurs at any age, most common
ing between 30 and 50
be-
years.
2.
Initial disability is distributed between visual and spinal cord.
3.
Severe binocular loss of vision is characteristic of the Syndrome."
equally
Scott (1952) in his address as the Guest of Honour at the 10th Clinical Meeting of the Wilmer Residents' Association, Welmer Ophthalmological Institute of the John Hopkins Hospital, and University Baltimore, reviewed the Syndrome. He was of the opinion that abortive types of the Syndrome do occur and in this he agrees with Walsh's view who also observed
abortive
cases.
In India, DE and Chatterjee (1946) described the first case and Mascati (1949) reported one girl aged 4 years. Raman and case iu a Gantayat (1950) reported one case and reviewed the literature.
Aetiology has remained yet Causation.?It (1)
and the
neuromyelitis ""vwmicuiiD
d.c.m.s. MISRA, m.b.b.s. (Pat.),
% ?T
0. g
optica
uriiLA
^
?!
Ophthalmology
and
(Lond.)
Ophthalmic
and (Pat.), m.r.c.p. AHAPATRA, m.b.b.s. d.t.m. &
h.
Surgeon
(Edin.),
(Eng.)
problems
Cuttack,
Review Historical ^^drome Neuromyelitic "
ailtWc,a
rare one, has been reviewed
^at
different
Syndrome
times.
^at SVS
same as
unknown that of Disse-
(9) allergic
reaction.
(2) Incidence.?From
Optica"
by various
its first attention as far i870, when Clifferd Allbut observed apathetic disorders of the eye at times owes
the
minated sclerosis (Russel Broin). Theories propounded are (1) interference of vascular supply by irritation produced by injury to spinal cord involving origin of sympathetic nerves at their central region, (2) a sort of ascending meningitis, (3) toxic effects of alcohol, (4) a syphilitic manifestation, (5) result of malaria, (6) infection with neurotropic virus, (7) a result of increased intracranial pressure, (8) lipolytic
and Physician Professor of Medicine Hospital, enzyme action and (fi r?m Medical College Sriram Chandra BhanjOrissa)
^
are
would
seem
has been
the historical review it that the condition is not as rare aa
presumed previously.
large proportion of cases, there is no the onset of visual loss or myelitis is preceded by either a sore throat, a cold in the nose, febrile disturbance, with or without a In
a
doubt,
530
NEUROMYELITIS OPTICA
:
[Oct., 1953
MISRA & MAHAPATRA
of malaise. Pain on movements of eyes is also often an early symptom.
general feeling
As regards the order in which signs of visual loss or of spinal involvement appear, optic neuritis has been reported to be much commoner than myelitis as the first major incident (Scott). Sex in neuromyelitis seems to have no preference. Age, let it be noted, is quite different from what one finds in Disseminated Selerosis: it may range from 6 to 66 years.
The essential feature of the lession is a demyelinisation of axis cylinders. There is also round cell perivascular infiltration, an intense proliferation of microglial cells and a multiplication of tiny vessels in affected areas. The Optic nerve presents the same type of lesion as the spinal cord, the latter showing changes either in a diffuse manner or in multiple disseminated foci.
sP,^ere
,
,
Diagnosis
The presenting features of the above conditions along with history, made of onset, and C.S.F. findings are usually enough and conclusive to differentiate them from the Syndrome of
Neuremyelitis Optica.
Reports
Case I. (Admitted under Dr. M. C. P. N. aged 62 years admitted on 19th DeC Qf ber, 1952 with a history of sudden blindness j both eyes of five days' duration. On tfl interrogation, the relatives reported that was some febrile disturbance with headache malaise prior to the onset of blindness. gg words of the patient (translated) the blind11 " P of was a bolt from the blue.'* History ^ illness and family history had no ralevancy the present state. 19th
Although the signs of Neuromyelitic Optica are protean in nature in that there is sudden blindness with paraplegia, it has to be distinguished from (a) other demyelinating diseases like (1) Disseminated sclerosis (2) Acute Disseminated encephalo-myelitis either spontaneous or following infectious diseases (3) Diffuse sclerosis (Schilders disease) and (4) syphilitic manifestation of nervous system.
n
