Tubercular longitudinally extensive transverse myelitis with lower motor neuron paralysis

Longitudinal Extensive Transverse Myelitis ◽

Spinal Segments ◽

Transverse myelitis typically extends two or less spinal segments, whereas longitudinal extensive transverse myelitis (LETM) extends three or more spinal segments in length and may occasionally span all the segments of the spinal cord. We present a case of spinal tuberculosis presenting with LETM with true lower motor neuron-type flaccid paraplegia.

Lower motor neuron involvement in longitudinally extensive transverse myelitis with and without aquaporin-4 antibodies

Clinical Neurophysiology ◽

10.1016/j.clinph.2013.12.116 ◽

2014 ◽

Vol 125 (9) ◽

pp. 1925-1926

Author(s):

Marco Luigetti ◽

Mauro Lo Monaco ◽

Amelia Evoli ◽

Massimiliano Mirabella ◽

Valentina Damato ◽

...

Keyword(s):

Motor Neuron ◽

Transverse Myelitis ◽

Aquaporin 4 ◽

Lower Motor Neuron ◽

Neuromyelitis optica spectrum disorder (NMOSD) presenting as acute transverse myelitis with positive aquaporin 4 antibodies

BMJ Case Reports ◽

10.1136/bcr-2020-238992 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238992

Author(s):

Katherine Thornley ◽

Carlo Canepa

Keyword(s):

Spinal Cord ◽

Transverse Myelitis ◽

Aquaporin 4 ◽

Sensory Level ◽

Mri Scan ◽

Acute Transverse Myelitis ◽

Longitudinal Extensive Transverse Myelitis ◽

Oral Steroids ◽

An 80-year-old, previously healthy patient presents with acute transverse myelitis with sensory level at T8. The MRI scan of the spinal cord showed longitudinal extensive transverse myelitis, and she tested positive for aquaporin 4 antibodies in serum. She received treatment with intravenous and oral steroids, with no improvement and then underwent plasma exchange. She was then started on azathioprine for prevention of relapses, while continuing physiotherapy and occupational therapy. Eventually, she was transferred to a specialised spinal cord centre for long-term rehabilitation.

Longitudinally Extensive Transverse Myelitis with Intramedullary Metastasis of Small-Cell Lung Carcinoma: An Autopsy Case Report

Case Reports in Neurological Medicine ◽

10.1155/2013/305670 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kenya Nishioka ◽

Ryota Tanaka ◽

Satoshi Tsutsumi ◽

Hideki Shimura ◽

Yutaka Oji ◽

...

Keyword(s):

Spinal Cord ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

Transverse Myelitis ◽

Small Cell ◽

Small Cell Lung ◽

Thoracic Spinal Cord ◽

Cell Lung Carcinoma ◽

Background. Longitudinally extensive transverse myelitis (LETM) is characterized by spinal cord inflammation extending vertically through three or more vertebral segments. The widespread use of MRI revealed LETM more frequency than ever. We report the case of a patient with pathologically confirmed small-cell lung carcinoma metastasis into the spinal cord presenting as LETM.Case Presentation. A 74-year-old man developed rapidly progressive sensorimotor disturbance and vesicorectal dysfunction. T2-weighted magnetic resonance imaging of the spine revealed LETM at the level of from T3 to conus medullaris; gadolinium enhancement showed concurrent tumor in the thoracic spinal cord from T10 to T11. Systemic survey identified a nodular mass in the lung that was verified as small-cell carcinoma. Following initial failed treatment by high-dose steroid, the patient underwent an emergent microsurgical tumor resection. Histological examination was identical with the lung carcinoma. The patient died of tumor progression at the 47th day after admission. At autopsy, only changes of edema were found in the gray matter of the cord, while tumor cells were not noted in it.Conclusion. Metastasis may rarely present symptoms of LETM. Prompt identification of underlying etiology by contrast examination and systemic survey is crucial for the patient assumed as LETM.

Two Cases of Probable Neuro-Behçet’s Disease with Longitudinally Extensive Transverse Myelitis

Case Reports in Neurology ◽

10.1159/000512323 ◽

2021 ◽

pp. 78-83

Author(s):

Shunya Fujiwara ◽

Yasuhiro Manabe ◽

Yumiko Nakano ◽

Yoshio Omote ◽

Taijun Yunoki ◽

...

Keyword(s):

Spinal Cord ◽

Signal Intensity ◽

Behcet’S Disease ◽

Behçet's Disease ◽

Transverse Myelitis ◽

High Signal Intensity ◽

High Signal ◽

Behcet's Disease ◽

We report 2 cases of probable neuro-Behçet’s disease (NBD) with longitudinally extensive transverse myelitis (LETM). In both cases, the patients presented paraplegia, as well as sensory, bladder, and rectal disturbances. Magnetic resonance imaging (MRI) of patient 1 showed continuous high signal intensity extending from the midbrain to the entire spinal cord in the central part of the cord on T2-weighted imaging (T2WI). Spinal MRI of patient 2 revealed high signal intensity extending from Th2 to Th10 in the central part of the cord on T2WI. Both patients received high-dose methylprednisolone. A continuous lesion from the midbrain to the entire spinal cord as in patient 1 has not been previously reported. Patient 2 dramatically improved by infliximab therapy. The present cases suggest that NBD should be considered as a differential diagnosis in patients with LETM.

Isolated High-Grade Malignancy of the Spinal Cord Presenting as Longitudinally Extensive Transverse Myelitis

The Neurohospitalist ◽

10.1177/19418744211047388 ◽

2021 ◽

pp. 194187442110473

Author(s):

Lucas Horta ◽

Deepti Virmani ◽

K. H. Vincent Lau ◽

Pria Anand

Keyword(s):

Spinal Cord ◽

Primitive Neuroectodermal Tumor ◽

Transverse Myelitis ◽

High Grade ◽

Spinal Disease ◽

Grade Malignancy ◽

High Grade Malignancy ◽

Extensive Transverse Myelitis ◽

Cns Malignancies

This article characterizes 2 cases of longitudinally extensive transverse myelitis (LETM) that did not respond to immunotherapy and were diagnosed by biopsy as primary central nervous system (CNS) malignancies. Diffuse H3 K27M-mutant glioma is a recently described entity with very few cases of isolated spinal disease described in adults. Primitive neuroectodermal tumor is similarly uncommon in the spinal cord. Malignancies should be considered in patients who fail to improve with immunomodulatory therapy. We believe the experiences of our center will raise awareness about that point, broaden the existing understanding of the diagnostic approach to LETM, and highlight the need for additional studies.

Longitudinally Extensive Transverse Myelitis (LETM) and Myopericarditis in a 7-Month-Old Child with SARs-CoV-2 Infection

Neuropediatrics ◽

10.1055/s-0041-1732364 ◽

2021 ◽

Author(s):

Giacomo Brisca ◽

Stefano Sotgiu ◽

Daniela Pirlo ◽

Barbara Tubino ◽

Laura Siri ◽

...

Keyword(s):

Cardiac Involvement ◽

Transverse Myelitis ◽

Acute Disseminated Encephalomyelitis ◽

Neurological Complications ◽

Nasopharyngeal Swab ◽

High Dose ◽

Permanent Disability ◽

Longitudinal Extensive Transverse Myelitis ◽

Abstract Introduction In the last few months, some pediatric cases with neurological and neuroradiological pictures related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported, often associated with multisystem inflammatory syndrome (MIS-C). The most frequently encountered pediatric neurological complications seem to be postinfectious immune-mediated acute disseminated encephalomyelitis (ADEM)-like changes of the brain, myelitis, neural enhancement, and splenial lesions. Concomitant neurological and cardiac involvement has been reported only in MIS-C, although specific clinical details are often not fully available. Methods In this case report, a very young child infected with SARs-CoV-2 and diagnosed as longitudinal extensive transverse myelitis with concomitant myo-pericarditis is presented. Results A previously healthy 7-month-old girl presented with abrupt onset of generalized weakness with inability to sit up. She had had mild respiratory symptoms 1 week earlier. Spinal magnetic resonance imaging (MRI) showed a T2-hyperintense intramedullary lesion extending from C4 to T2, compatible with acute longitudinally extensive transverse myelitis (LETM). Cerebrospinal fluid analysis was negative.Echocardiography and blood tests were suggestive for myo-pericarditis. Real time polymerase chain reaction for SARS-CoV-2 on nasopharyngeal swab sample tested positive. She was promptly treated with high dose of steroids and immunoglobulin with satisfactory clinical response. Conclusion To the evolving literature of neurological complications of SARs-CoV-2 infection, we add the youngest patient described to date with isolated LETM and concomitant cardiac involvement. Our case suggests that clinicians should be aware of this association, although difficult to recognize in infants. Practitioners are encouraged to consider aggressive first-line immunotherapies with the final aim to prevent permanent disability.

The differential diagnosis of longitudinally extensive transverse myelitis

Multiple Sclerosis Journal ◽

10.1177/1352458511406165 ◽

2011 ◽

Vol 18 (3) ◽

pp. 271-285 ◽

Cited By ~ 71

Author(s):

JL Kitley ◽

MI Leite ◽

JS George ◽

JA Palace

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Early Identification ◽

Transverse Myelitis ◽

Resonance Imaging ◽

Spinal Magnetic Resonance Imaging ◽

Appropriate Therapy ◽

T2 Hyperintensity ◽

Longitudinally extensive transverse myelitis refers to florid and widespread inflammation of the spinal cord causing T2 hyperintensity on spinal magnetic resonance imaging that is seen to extend over three or more vertebral segments. Whilst rare, longitudinally extensive transverse myelitis is clinically important as it can lead to catastrophic morbidity, and a group of these patients are at risk of further attacks. Early identification and establishment of the underlying aetiology is vital in order to initiate appropriate therapy and optimize outcomes. Whilst longitudinally extensive transverse myelitis is classically associated with neuromyelitis optica, there are many other causes. These include other inflammatory aetiologies, infection, malignancy and metabolic disturbance. Some of these are readily treatable. Laboratory and radiological investigations can help to differentiate these causes. Treatment of longitudinally extensive transverse myelitis hinges on distinguishing inflammatory and non-inflammatory aetiologies and identifying patients who are at high risk of a recurrent course.

Longitudinally Extensive Transverse Myelitis (LETM) in COVID-19 Infection, A Case-Report

10.21203/rs.3.rs-978297/v1 ◽

2021 ◽

Author(s):

Jean-Christophe Van Cutsem ◽

Ann-Sophie Lamon ◽

Vincent Van Belleghem ◽

Evelien Vancaester

Keyword(s):

Spinal Cord ◽

Clinical Manifestations ◽

Transverse Myelitis ◽

Sudden Onset ◽

Nasopharyngeal Swab ◽

Sensory Level ◽

Ataxic Gait ◽

Normal Glucose Level ◽

Abstract IntroductionSince the COVID-19 pandemic, a growing number of central nervous system (CNS) complications in patients with COVID-19 have been reported. Isolated, longitudinally extensive transverse myelitis (LETM), is a unique presentation of CNS involvement. The limited reports, its diverse clinical manifestations and the possible long-term consequences make the reporting crucial to further our understanding of those syndromes occurring in COVID-19 positive patients.Case PresentationA 63-year old male consulted the emergency department after a sudden onset of gait ataxia, a one-week history of paresthesia progressing from the feet to the midsternal area and urinary. He tested positive on a SARS-CoV-2 RNA RT-PCR nasopharyngeal swab two days prior to the onset of his symptoms. Neurological examination showed a sensory level at T7 with symmetrically reduced fine touch, vibration, proprioception and furthermore an ataxic gait was observed. Cerebrospinal fluid on day one of admission showed pleocytosis, predominantly neutrophils, elevated protein count and normal glucose level and IgG. MRI of the spinal cord revealed a diffusely increased signal intensity involving the near-complete spinal cord, from the brainstem to level T12, fitting the diagnosis of LETM. ConclusionThe few cases of transverse myelitis in association with COVID-infection are believed to have an immune-mediated postinfectious mechanism. In this case however, parainfectious direct viral invasion of the spinal cord is far more likely because of a neutrophilic predominance in CSF and a short timespan between infection and symptoms. It could provide more clues that the SARS-CoV-2 is acutally capable of causing direct neurotoxic effects.

Neuropathic pruritus: an early indicator of neuromyelitis optica spectrum disorders

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183286 ◽

2018 ◽

Vol 6 (8) ◽

pp. 2867

Author(s):

Pradeep Kumar Bansal ◽

C. L. Nawal ◽

Aradhana Singh ◽

Radheyshyam Chejara ◽

Sebastian Marker ◽

...

Keyword(s):

Spinal Cord ◽

Neuromyelitis Optica ◽

Transverse Myelitis ◽

Neuromyelitis Optica Spectrum Disorders ◽

Chief Complaints ◽

Neuropathic Pruritus ◽

Spectrum Disorders ◽

Tonic Spasms ◽

Neuromyelitis optica is a relapsing, inflammatory astrocytopathic disorder, affecting predominantly the optic nerves and spinal cord. It is associated with antiaquaporin-4 immunoglobulin G (AQP4-IgG) in up to 70% of patients. Spinal cord involvement typically presents as a longitudinally-extensive transverse myelitis, with associated sensorimotor and sphincter dysfunction. Sensory symptoms such as numbness, dysaesthesia, pain and tonic spasms are common. Here, we present a case of a 25years old female who came to the medicine OPD, with the chief complaints of intense itching over face and forehead, which was later on progressed to quadriparesis after 3 weeks. This case highlights neuropathic pruritus as an under-recognised early feature of neuromyelitis optica.

Foix-Alajouanine Syndrome Mimicking Longitudinally Extensive Transverse Myelitis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_002063 ◽

2020 ◽

Author(s):

Anirudha S Rathnam ◽

Anza B Memon

Keyword(s):

Spinal Cord ◽

Arteriovenous Malformation ◽

Pressure Gradient ◽

Surgical Intervention ◽

Early Recognition ◽

Venous Pressure ◽

Transverse Myelitis ◽

Good Prognosis ◽

Foix-Alajouanine syndrome is an arteriovenous malformation causing subacute congestive myelopathy that can lead to progressive paraplegia. It typically affects the lower thoracic and lumbosacral levels. Arteriovenous fistula (AVF) leads to increased venous pressure, decreasing the arteriovenous pressure gradient and leading to a decrease in spinal cord perfusion, oedema and necrosis. Early recognition and surgical intervention can result in a good prognosis.