How to manage sudden vision loss and weakness due to NMOSD?

Question

Hello doctor,

I experienced sudden, severe vision loss in my right eye about two months ago, which was extremely frightening. Although my vision has partially improved since then, it is still not back to normal and remains blurry. A few weeks after the eye problem, I developed intense back pain followed by progressive weakness, numbness, and tingling in both legs, making walking very difficult and unsteady.

I also experienced several days of uncontrollable, persistent hiccups and severe nausea that did not respond to usual treatments, which seemed very strange and unrelated to my other symptoms. My MRI scans showed abnormalities in my brain and spinal cord, but my neurologist mentioned that this does not appear to be typical multiple sclerosis.

Could these neurological symptoms indicate a rare autoimmune condition affecting the optic nerves and spinal cord, and what specialized blood tests and treatments are available for this type of disorder?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The symptoms you described of sudden vision loss in one eye, spinal cord weakness, and episodes of persistent hiccups and nausea strongly suggest a condition called Neuromyelitis optica spectrum disorder (NMOSD), a rare autoimmune disease in which the immune system attacks the optic nerves, spinal cord, and sometimes the brainstem.

Unlike multiple sclerosis (MS), NMOSD attacks are usually more severe and can cause significant vision or movement problems. However, the disease does not typically progress continuously between relapses. Early and accurate diagnosis is crucial to prevent future attacks.

Before deciding on the next steps, the following investigations are advisable:

The neurologist will likely check for specific antibodies in the blood:

AQP4-IgG (aquaporin-4 antibody): Present in most NMOSD cases.
MOG-IgG (myelin oligodendrocyte glycoprotein antibody): Seen in some patients with similar symptoms.

These tests help confirm the diagnosis and guide appropriate treatment.

I would suggest the following measures:

Acute attacks are usually treated with high-dose intravenous (IV) corticosteroids, and if required, plasma exchange to remove harmful antibodies.
To prevent relapses, drugs such as Rituximab, Eculizumab, Inebilizumab, or Satralizumab are used. These are monoclonal antibodies that suppress immune system activity safely and effectively. Early treatment helps protect remaining vision and prevent paralysis.

Stress, infections, and inadequate rest can trigger relapses. Maintaining proper sleep, hydration, and emotional balance is essential. Physical therapy supports strength recovery and improves coordination.

The symptoms are consistent with NMOSD, and specialized antibody tests (AQP4 and MOG) are key for confirmation. With modern immune therapies, most patients achieve stability, regain function, and prevent further attacks, resulting in a favorable long-term prognosis.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.