Objective We herein present a case involving a prevertebral abscess complicated by a spinal epidural abscess (SEA) secondary to intradiscal oxygen-ozone chemonucleolysis for treatment of a cervical disc herniation. Methods A 67-year-old woman with a history of intradiscal oxygen-ozone chemonucleolysis developed numbness and weakness in her right upper and bilateral lower extremities followed by urinary retention. Her symptoms did not respond to intravenous antibiotics alone. Magnetic resonance imaging of the cervical region revealed an extensive SEA anterior to the spinal cord, spinal cord myelopathy due to anterior compression by the lesion, and a prevertebral abscess extending from C2 to T1. She underwent surgical drainage and irrigation. Results The patient was successfully treated with surgical drainage and systemic antibiotic therapy without kyphosis. Streptococcus intermedius was detected within the abscess. All clinical symptoms except for the sensory deficit in the left leg were relieved. Conclusions The safety of intradiscal oxygen-ozone therapy requires further assessment. High-dose intravenous antibiotics should be initiated empirically at the earliest possible stage of prevertebral and epidural abscesses. Surgical drainage may be a rational treatment choice for patients with a prevertebral abscess complicated by an SEA and spinal cord myelopathy.

Objective To test the level of aquaporin-4 (AQP4) antibody and assess the frequency and specificity of AQP4 antibodies in patients with neuromyelitis optica spectrum disorders (NMOSDs).Methods One hundred and fifty-three patients with demyelinating disease of the central nervous system,admitted to our hospital from May 2007 to May 2012,were chosen in our study; of them,102 had NMOSDs; AQP4 antibodies in the sera of these 102 patients were detected by cell-based immunofluorescence assay (CBA); the distinctive features of NMOSDs by autoantibodies status (AQP4 antibody-positive or antibody-negative) were analyzed retrospectively.Results The sensitivity and specificity of CBA assay for detecting AQP4 antibodies were 83.3％ and 100％,respectively.In patients with positive AQP4 antibodies,the female one took 78.8％,while in patients with negative AQP4 antibodies,the female one only took 28.6％; significant difference was noted between the two (P=0.007); the patients with both AQP4 antibody-positive and other systemic autoimmune diseases showed higher expanded disability status scale scores at the disease onset (5.9±2.0) as compared with the patients only with AQP4 antibody-positive (4.2±1.9,t=3.806,P=0.033); AQP4 antibody deduced even lost during the remission stage,and immunosuppressant medicine could remove the AQP4 antibody.Conclusion Testing for AQP4 antibodies is helpful for the differential diagnosis between NMOSDs and multiple sclerosis,and also useful for predicting the relapse and treating of NMOSDs.

Myasthenia gravis, an autoimmune disorder affecting neuromuscular transmission, is mainly sporadic while familial cases are very rare. Usually familial myasthenia gravis cases have uniform clinical symptoms as well as serum anti-acetylcholine receptor antibodies. Interestingly, in our cases varying clinical types of myasthenia gravis and seropositive/seronegative anti-acetylcholine receptor antibodies coexisted in the same family. The mother and her daughter both had ocular myasthenia gravis, detectable anti-acetylcholine receptor antibodies and non-detectable anti-muscle-specific kinase antibodies, and good responses to medications. The son displayed ocular symptoms at the onset, and then progressed into a generalized form after 1 year. His serum anti-acetylcholine receptor antibodies and anti-muscle-specific kinase antibodies were both negative. Neither corticosteroids nor thymectomy alleviated his symptoms. Human leukocyte antigen DQA1*0301 allele sharing by the three patients may be involved in their genetic susceptibility to myasthenia gravis, and subtle differences in human leukocyte antigen DQB1 alleles may be associated with their variations in clinical features and serum antibodies.