What causes my hiccups and partial vision loss at 34?

Question

Hello, Doctor,

I am a 34-year-old woman who suddenly lost vision in my right eye three weeks ago, which has only partially improved despite steroid treatment. Now I am experiencing severe, shooting pain down my spine and progressive weakness in both legs, which is making it difficult to walk without assistance.

I have also been having persistent hiccups and nausea that last for days, along with episodes where I feel like my body temperature regulation is completely off. My neurologist suspects neuromyelitis optica spectrum disorder (NMOSD) after finding inflammation in my optic nerve and spinal cord on MRI scans. I have never heard of this condition before.

Is it related to multiple sclerosis?
What does this diagnosis mean for my future mobility and vision?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

What you describe does fit with neuromyelitis optica spectrum disorder (NMOSD), an autoimmune disease in which the body's immune system mistakenly attacks the optic nerves, spinal cord, and sometimes the brainstem.

NMOSD and multiple sclerosis (MS) can appear similar, but they are different diseases. In NMOSD, the immune system most commonly targets a protein called aquaporin-4. Unlike MS, attacks in NMOSD are often more severe. However, between attacks, the brain is usually less affected than in MS.

Your sudden vision loss may be explained by optic neuritis, which is inflammation of the optic nerve. The shooting pain and leg weakness can occur due to inflammation involving a long segment of the spinal cord. Symptoms such as

Persistent hiccups.
Nausea.
Problems regulating body temperature.

These may suggest involvement of the brainstem.

Treatment of acute attacks typically involves high-dose corticosteroids, which you have already received. If recovery is incomplete, plasma exchange may sometimes be recommended.

Long-term treatment focuses on preventing future attacks. Medications such as Rituximab, Inebilizumab, Mycophenolate mofetil, and Azathioprine are commonly used to reduce the risk of relapses. Preventing relapses is one of the most important goals of treatment because each attack can cause additional neurological damage.

Supportive care is also important. Physiotherapy can help improve mobility and walking ability, while pain management strategies and vision aids may help address ongoing symptoms and improve quality of life.

The long-term outlook depends largely on the severity of attacks and the amount of damage they cause. Some recovery is often possible after an attack, but repeated relapses can lead you to permanent disability. With appropriate long-term treatment and regular follow-up, the frequency of relapses can be greatly reduced, and many people are able to maintain a good level of independence.

I hope this information helps you.

Feel free to ask further queries.

Thank you.