Ref Number = PITIKA-ASPR0173
Marsintauli Hasudungan Siregar 
Objective: To report a case of Devic’s disease and identify the diagnosis of  Neuromyelitis Optica
Case : In June 2019, a ten year old child was admitted to the emergency room of the Hospital dr Moch. Ansari Saleh  Banjarmasin with suspicion of Guillain Barre syndrome. Seven days after admission the patient complained of bilateral lower limb weakness and urinary retention. Patient had presented with walking difficulty which progressed into walking disability. There was no family history of autoimmune disease. Muscle power was grade 2 out of 5 in bilateral upper limbs, and grade 1 out of 5 in bilateral lower limbs. Babinski sign was negative. The physical examination revealed weakness of the lower limbs (without spontaneous mobility), lower limb areflexia.  The results of lab exams were: normal urinalysis, CSF with normal proteins (40 mg/dl) and hemogram with  Lekosit 3 sel/mm (PMN: 20 %, MN:80 %). Funduscopic examinatiom was normal. To investigate the diagnosis an examination for Spinal MRI  were carried out. Spinal magnetic resonance imaging/MRI showed a longitudinal extensive myelitis  centrally located within the cord from L5 to S1.  Motor Nerve Conduction study was lesions in proprioseptic  over L5 to S1.
Tracing back her medical history, it was found that she had (1) acute bilateral Optic neuritis with  total visual loss. (2) acute myelitis when he complained of  bilateral lower limb weakness and urinary retention  and spinal MRI showed high signal lesions over L5 to S1 on T2-weighted images.  
While in hospital the patient required urinary catheter and therapeutic conduct use intravenous methyl prednisolone. On the  third day in hospital, improvement of lower limb weakness was observed. grade 1 was reached.  On the fifth day in hospital, patient eyes sight was affected. Neurological exam: strength grade 5 in lower limbs and  upper limbs. On opthalmologic exam. slow pupillary light reflex of the eyes, and wandering look were observed.  At the end of 2 weeks, the patient was discharged from hospital, with some spasticity. Outpatient follow up use of corticosteroids for five months until neurological exam normal result. Opthalmologic routine exams did not show any abnormalities
Conclusion: The case which was diagnosed according to the criteria optic neuritis, transverse myelitis. The use of prednisolone has been recommended as treatment and the total remission of symtomps was obtained.
Keywords: Devic’s disease, neuromyelitis otica, transverses myelytis, prednisone, diagnosis
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