Background: Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare, inflammatory CNS syndrome, which, left untreated, may result in significant disability or even death. Due to its low incidence and prevalence, the importance of demographics on disease risk and outcome remains incompletely described. Previous research has shown that Blacks may be disproportionately at risk of NMOSD and may experience greater disability. Alabama and surrounding states have some of the highest percentages of Black residents in the U.S., which provides a unique opportunity. Objectives: Examine the epidemiology of NMOSD. Methods: All clinical records at the University of Alabama at Birmingham with an NMOSD diagnosis were found using the i2b2 search engine. A retrospective chart review was conducted to collect demographics, BMI, antibody status, and details of the clinical course. Likelihood ratio Chi-square test or Fishers Exact (FE) test was used for comparisons, with p<0.05 considered meaningful. Analysis was completed using JMP Pro 15 (Cary, NC). Results: A total of 121 patients (84.3% female) were found to have a diagnosis of NMOSD. Of those, 60.3% were Black, 25.6% White, 6.6% Asian, 5.8% Other, and 1.7% Hispanic/Latino. For context, the population of the state of Alabama is 26.6% Black. Blacks presented at a younger age than Whites (45.8 vs 55.1 years of age, p=0.0034). Transverse myelitis (53.9%) was the overall most common presenting symptom, followed by optic neuritis (41.4%) and area postrema syndrome (4.8%). Presenting syndromes did not significantly differ by race. Conclusions: This analysis shows that Blacks are over-represented among NMOSD patients in this single-clinic study. There are significant differences in antibody status and type among Black patients compared to other Whites, while clinical presentations did not differ by race. Further research is needed to further characterize these clinical differences and response to treatments.