You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
neuromyelitis optica ( nmo ; formerly known as devic disease ) is an inflammatory demyelinating disease of the central nervous system which is characterized by severe relapsing episodes of transverse myelitis and optic neuritis . in the early stages ,
other parts of the central nervous system are spared , but we now know that later in the course of the disease other parts of the brain can be involved . for a long time
, nmo was considered as a specific variant of multiple sclerosis , but it can now be distinguished as a different disease entity by specific mri findings and the detection of anti - aquaporin 4 antibodies ( anti - aqp4 ) or igg serum antibodies against the myelin oligodendrocyte glycoprotein [ 1 , 2 ] .
anti - aqp4 antibodies are found in patients with classic nmo , asian opticospinal multiple sclerosis , isolated longitudinally extensive transverse myelitis , isolated optic neuritis , and , in rare cases , isolated brainstem encephalitis .
anti - aqp4 antibodies are not detectable in multiple sclerosis and have a 76% sensitivity and 9499% specificity for a nmo spectrum disorder ( nmosd ) .
a 28-year - old woman was admitted to our hospital with short - term memory problems , confusion , incoherent and delusional thinking , and self - neglect since 2 weeks .
there was also loss of appetite and she had lost 7 kg of weight in the last 2 months .
she was of mixed european / african ethnicity , and her previous medical history mentioned an attention deficit hyperactivity disorder for which she used methylphenidate 10 mg daily .
her psychiatric history showed a short period of paranoid features when she was 20 years old , possibly induced by overuse of methylphenidate . on physical examination
there was a body temperature of 34.8c , an rr of 95/57 mm hg , and a pulse rate of 80 beats / min .
she had symptoms of bradyphrenia , bradykinesia , and slowed , halting speech and was disorientated in time and place .
laboratory testing showed a leukocytosis of 27.7  10/l , a c - reactive protein level of 2.1 mg / l , and a mild hypernatremia of 148 mmol / l .
she was admitted to our neurology ward , but after 2 days she was transferred to our medical psychiatric ward because of progressive confused behavior .
the psychiatrist suspected a first psychotic episode with catatonic features ; methylphenidate was discontinued and she was treated with lorazepam 0.5 mg twice a day .
an antipsychotic drug was not yet started , because a somatic cause of her behavior had not been ruled out completely .
she then developed hypothermia ( 32.6c ) and hypercapnia and was therefore transferred to the intensive care unit because of a suspected autonomic dysregulation . on the intensive care unit ,
a brain mri showed an abnormal hyperintense signal on t2-weighted images and fluid - attenuated inversion recovery images of the hypothalamus ( fig . 1 ) and , to a lesser extent , of the right optic nerve , with enhancement after gadolinium .
a cerebrospinal fluid examination revealed a mild pleocytosis of 60 cells/l , a normal protein level of 0.45 g / l , and a normal glucose level of 3.6 mmol / l .
the differential diagnosis at that moment included hypothalamic encephalitis either caused by an autoimmune disorder or of viral origin , a systemic autoimmune disease , or a paraneoplastic disorder .
a ct scan of the thorax and abdomen showed no signs of sarcoidosis or an underlying malignancy .
anti - dsdna and anti - sm antibodies were absent , ruling out systemic lupus erythematosus .
anti - sjgren syndrome - related antigen b ( anti - ssb ) antibodies were positive , but in combination with a negative test for anti - ssa and normal findings at a lip biopsy , sjgren syndrome was considered highly unlikely .
the patient was treated with intravenous methylprednisolone pulse therapy for 3 days , at 1,000 mg per day , which resulted in resolution of the hypothermia and hypercapnia .
considering all the normal results on testing and the prompt reaction to steroids , an nmosd was considered and was confirmed by positive tests for serum anti - aqp4 antibody . after the 3-day course of intravenous methylprednisolone , we continued treatment with oral prednisolone at 30 mg twice a day and azathioprine at 50 mg twice a day .
because she developed apraxia and hypomanic features such as hypersexuality and overeating in combination with the preexisting cognitive and behavioral problems , she was retransferred to the medical psychiatric ward and treated with haloperidol at 2.5 mg and with lorazepam .
an ophthalmologist confirmed vision of 0.5/200 and 20/25 , respectively , in the right and the left eye . on treatment with haloperidol and lorazepam , the hypomanic symptoms and
after 6 weeks , she was discharged to a rehabilitation center with severe memory and visual problems .
oral prednisolone was continued in a 22-month tapering schedule ; azathioprine was continued at 50 mg twice a day .
after a couple of weeks in rehabilitation , she was again transferred to a psychiatric unit with a compulsive eating disorder and aggressive behavior probably due to a combination of treatment with prednisolone and a brain injury caused by the initial brain lesions .
a repeat mri scan 3 months later showed almost complete recovery of the hypothalamic lesions , and there were no signs of new disease activity .
our patient presented with bilateral hypothalamic lesions and concomitant optic neuritis as a first episode of an nmosd .
there are only a few cases describing patients with hypothalamic lesions as an initial symptom , all of them presenting with excessive daytime sleepiness as a first symptom . our patient presented with cognitive impairment , autonomic failure , and symptoms of psychosis , but no sleep disturbances .
most of the nmosd patients were young women between 20 and 45 years of age [ 7 , 8 , 9 , 10 , 11 ] .
remarkably , all patients were of asian ethnicity , whereas our patient was of mixed caucasian / negroid origin .
it is well described that nmo is more common in nonwhite populations , in contrast to the low incidence of multiple sclerosis in nonwhite persons .
all patients were treated with intravenous methylprednisolone , some followed by oral prednisolone , with variable outcomes : no symptoms at follow - up , relapses of sleepiness , and memory disturbances , as well as symptoms matching new brain or spinal cord lesions were reported [ 7 , 8 , 9 , 10 , 11 ] . whereas in multiple sclerosis , spontaneous remission may have an equal effect to high - dose immunosuppressive medication on the long - term neurological outcome , in nmosd repetitive episodes will lead to severe damage , and the current consensus is to treat every relapse to prevent severe long - term damage . the recommended treatment for an acute episode of nmo is high - dose methylprednisolone intravenously for 5 days followed by an oral steroid taper for 28 weeks depending on the severity of the attack . if high - dose corticosteroids have no or only a minimal effect , a plasma exchange is considered to be effective .
white matter brain lesions are reported in up to 5085% of patients with nmosd , and 4370% of these brain mri abnormalities are reported at onset . usually , the lesions are asymptomatic and most often located in areas with high aqp4 expression , such as the hypothalamus , but also subcortical and deep white matter lesions are common [ 1 , 12 ] . a recent study by gao et al .   investigated the presence of hypothalamic lesions in inflammatory diseases including nmosd , multiple sclerosis , and acute disseminated encephalomyelitis , as well as in lupus , sarcoidosis , behet disease , clippers ( chronic lymphocytic inflammation with pontocerebellar perivascular enhancement responsive to steroids ) , and hypertrophic pachymeningitis
in all , 172 of the 429 study subjects were aqp4 positive and met the criteria for nmosd defined by wingerchuk et al .  
( which have recently been updated ) . in 42 subjects ( 24.4% ) with nmosd
there were hypothalamic lesions on t2-weighed mr images , of which 90% were bilateral ; 10 out of 257 apq4-negative subjects had hypothalamic lesions .
nmosd is associated with other autoimmune disorders , especially connective tissue disorders like sjgren syndrome and systemic lupus erythematosus .
the exact relationship between nmosd and other autoimmune disorders is not quite fully established , but there might be a link between aqp4 seropositivity and other connective tissue autoimmune disorders [ 1 , 15 ] .
our patient had a positive anti - ssb serologic test , but a lip biopsy showed no signs of a coexisting sjgren syndrome , and also additional tests for systemic lupus erythematosus were negative , which is why we treated her as a patient with an nmosd .
physicians should consider performing an mri and lumbar puncture in young women presenting with hypothalamic symptoms or atypical psychosis .
early treatment with high - dose methylprednisolone is recommended to prevent severe long - term damage . integrated neurological and psychiatric care for these patients is recommended .
we present the unusual case of a patient with an aquaporin 4 antibody - seropositive neuromyelitis optica spectrum disorder who presented with autonomic dysregulation , cognitive impairment , and symptoms of psychosis . 
 only a few previous cases have been described with similar psychiatric symptoms . 
 brain mri showed an abnormal hyperintense t2 signal of the hypothalamus and , to a lesser extent , a minor hyperintense signal of the right optic nerve . 
 her symptoms and mr abnormalities improved after high - dose methylprednisolone .