NMO Diagnostic Criteria

2006 NMO Diagnostic Criteria
Optic neuritis and Transverse myelitis + 2 of the following:1-      Normal MRI brain
2-      Transverse myelitis with MRI changes> 3 vertebral segment
3-      AQP4 IgG positiveWingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology 2006;66:1485-1489.

2015 NMOSD Diagnostic CriteriaDiagnostic criteria for NMOSD with AQP4-IgG
1. At least 1 core clinical characteristic
2. Positive test for AQP4-IgG using best available detection method (cell-based assay strongly recommended)
3. Exclusion of alternative diagnoses
Diagnostic criteria for NMOSD without AQP4-IgG or NMOSD with unkwnown AQP4-IgG status
1. At least 2 core clinical characteristics occurring as a result of one or more clinical attacks and meeting all of the following requirements:a. At least 1 core clinical characteristic must be optic neuritis, acute myelitis with LETM, or area postrema syndromeb. Dissemination in space (2 or more different core clinical characteristics)c. Fulfillment of additional MRI requirements, as applicable2. Negative tests for AQP4-IgG using best available detection method, or testing unavailable3. Exclusion of alternative diagnoses
Core clinical characteristics
1. Optic neuritis
2. Acute myelitis
3. Area postrema syndrome: episode of otherwise unexplained hiccups or nausea and vomiting
4. Acute brainstem syndrome
5. Symptomatic narcolepsy or acute diencephalic clinical syndrome with NMOSD-typical diencephalic MRI lesions
6. Symptomatic cerebral syndrome with NMOSD-typical brain lesions
Additional MRI requirements for NMOSD without AQP4-IgG and NMOSD with unknownAQP4-IgG status

1. Acute optic neuritis: requires brain MRI showing (a) normal findings or only nonspecific white matter lesions, OR (b) optic nerve MRI with T2-hyperintense lesion or T1-weighted gadolinium enhancing lesion extending over .1/2 optic nerve length or involving optic chiasm2. Acute myelitis: requires associated intramedullary MRI lesion extending over 3 contiguous segments (LETM) OR 3 contiguous segments of focal spinal cord atrophy in patients with history compatible with acute myelitis 3. Area postrema syndrome: requires associated dorsal medulla/area postrema lesions4. Acute brainstem syndrome: requires associated periependymal brainstem lesions*IPND; International Panel for NMO DiagnosisWingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015;85:177-189.