Legend Sagittal and Axial T2 and T1 sequences of the cervical and thoracic spine show long segment cord edema with expansion of the spinal cord involving the entire length of the cervical cord and patchy involvement of the thoracic cord.

Legend Post Contrast T1 images show patchy enhancement of the cervical and thoracic spinal cord. The axial images localize the abnormal enhancement in the outer regions of the cord. A post contrast image through the orbit shows abnormal enhancement of the optic nerves bilaterally.

Legend Sagittal images through the cervical and thoracic cord 2 years after presentation show profound cord atrophy. There is central T2 signal hyperintensity in the cervical cord likely representing gliosis and myelomalacia. Key words: mri demyelinating inflammation

Spine & ENT Diagnosis: Devic's disease (Neuromyelitis optica) An aggressive form of multiple sclerosis