Cervical spinal cord atrophy in NMOSD without a history of myelitis or MRI-visible lesions

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that usually presents with optic neuritis or severe myelitis. NMOSD can be diagnosed after only one typical clinical syndrome if immunoglobulin G (IgG) antibodies against the aquaporin-4 receptor (NMO-IgG) are present.1 Patients with NMOSD can develop marked spinal cord atrophy after myelitis,2,3 but it is unknown whether atrophy can occur without a history of myelitis. To address this question, we compared the mean upper cervical cross-sectional area (MUCCA) in patients with NMOSD without MRI cord lesions or history of myelitis, patients with NMOSD with MRI cord lesions or history of myelitis, patients with multiple sclerosis (MS), and neurologically intact controls.