Objective:

To Assess whether presence of identifiable triggers influence the clinical profile and radiological profile of NMOSD patients.

Background:

Neuromyelitis optic spectrum disorder (NMOSD) is an autoimmune inflammatory demyelinating disorder of the central nervous system (CNS) characterized by optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM). This study aimed to compare the clinical, radiological, and laboratory characteristics of NMOSD patients with identifiable triggers—including recent malignancy, infection or vaccination (within the preceding month), associated autoimmune or rheumatological disorders, and pregnancy or postpartum states—with those without such triggers.

Design/Methods:

We conducted a single center retrospective cohort analysis of south jersey population from electronic medical records from January 2000 to December 2024, who were tested for aquaporin-4 antibodies. Patients were dichotomised into NMOSD with and without triggers and relevant data was collected. Descriptive and bivariate analysis used for dichotomous variables to summarise results.

Results:

A total of 43 NMOSD patients were analyzed, comprising 19 with and 24 without identifiable triggers. The median age at onset was lower among those with triggers (28.5 vs. 37.5 years), with comparable female predominance (16/19 vs. 17/24). Clinical features such as acute presentation, optic neuritis, transverse myelitis, and sensory deficits were similar between groups. Area postrema syndrome was significantly more frequent in patients with identifiable triggers (31.6% vs. 4.2%, p=0.033). Trends toward higher CSF protein levels (p=0.054) and predominant central cord involvement on spinal MRI (p=0.067) were observed in the trigger group. No significant differences were noted in antibody positivity, MRI brain abnormalities, use of steroid with plasma exchange at presentation, relapse rates, or discharge diagnosis of NMOSD (p>0.05).

Conclusions:

Patients with NMOSD associated with identifiable triggers tend to present at a younger age and may exhibit certain distinctive features such as area postrema syndrome and central cord involvement, although overall disease characteristics and outcomes appear largely similar to those without triggers.