A 23 years-old female without significant past medical history presented with a 2-week history of pruritus followed by paresthesia and left arm hypoesthesia. The physical exam was significant for excoriated skin lesions in the right submaxillary region, unilateral left-sided ptosis, left hemiparesis , hyperreflexia in the all the extremities, a positive bilateral Hoffman sign, a positive left Babinski sign, left upper extremity and right lower extremity hypoesthesia. Spinal magnetic resonance imaging (MRI) showed a central lesion from C1 to C6, extending to the area postrema with minimal contrast enhancement .
During the course of her hospitalization patient also developed nausea, vomiting and urinary retention. Given her clinical presentation, the MRI lesions with a LETM associated and her aquaporin-4 antibody-positive, the patient was diagnosed of NMOSD.