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

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 ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Ataxic Gait ◽  
Normal Glucose Level ◽  
Extensive Transverse Myelitis

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.

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

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 ◽  
Extensive Transverse Myelitis

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.

Tubercular longitudinally extensive transverse myelitis with lower motor neuron paralysis

2020 ◽  
pp. 004947552095644
Author(s):  
Manjeet Kumar Goyal ◽  
Mahesh Lal
Keyword(s):  
Spinal Cord ◽  
Motor Neuron ◽  
Spinal Tuberculosis ◽  
Transverse Myelitis ◽  
Lower Motor Neuron ◽  
Neuron Type ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Spinal Segments ◽  
Extensive Transverse Myelitis

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.

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

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
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 ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Small Cell Lung ◽  
Thoracic Spinal Cord ◽  
Cell Lung Carcinoma ◽  
Extensive Transverse Myelitis

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.

scholarly journals Longitudinally extensive transverse myelitis with seropositive chikungunya

2019 ◽  
Vol 12 (10) ◽  
pp. e231745 ◽  
Author(s):  
Sajid Hameed ◽  
Mubashar Memon ◽  
Hina Imtiaz ◽  
Dureshahwar Kanwar
Keyword(s):  
Transverse Myelitis ◽  
Febrile Illness ◽  
Neurological Complications ◽  
The Other ◽  
Sensory Level ◽  
Low Grade ◽  
Longitudinally Extensive Transverse Myelitis ◽  
First Case ◽  
History Of ◽  
Extensive Transverse Myelitis

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of LETM are reported worldwide in association with CHIKV fever and this is the first case from Pakistan. With frequent chikungunya outbreaks, neurological complications are increasingly seen in clinical practice. The knowledge of these associations will result in their early diagnosis and treatment.

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

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 ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Behcet's Disease ◽  
Extensive Transverse Myelitis

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

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 ◽  
Longitudinally Extensive Transverse Myelitis ◽  
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

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 ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Permanent Disability ◽  
Longitudinal Extensive Transverse Myelitis ◽  
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

2011 ◽  
Vol 18 (3) ◽  
pp. 271-285 ◽  
Author(s):  
JL Kitley ◽  
MI Leite ◽  
JS George ◽  
JA Palace
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Early Identification ◽  
Transverse Myelitis ◽  
Resonance Imaging ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Spinal Magnetic Resonance Imaging ◽  
Appropriate Therapy ◽  
T2 Hyperintensity ◽  
Extensive Transverse Myelitis

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.

scholarly journals Neuropathic pruritus: an early indicator of neuromyelitis optica spectrum disorders

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 ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Chief Complaints ◽  
Neuropathic Pruritus ◽  
Spectrum Disorders ◽  
Tonic Spasms ◽  
Extensive Transverse Myelitis

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.

scholarly journals Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222)

2021 ◽  
Vol 12 ◽  
Author(s):  
Gustavo C. Román ◽  
Fernando Gracia ◽  
Antonio Torres ◽  
Alexis Palacios ◽  
Karla Gracia ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Adverse Events ◽  
Clinical Review ◽  
Axonal Neuropathy ◽  
Neurological Complication ◽  
Clinical Manifestations ◽  
Transverse Myelitis ◽  
Sensory Level ◽  
Serious Adverse Events ◽  
Acute Transverse Myelitis

IntroductionAlthough acute transverse myelitis (ATM) is a rare neurological condition (1.34-4.6 cases per million/year) COVID-19-associated ATM cases have occurred during the pandemic.Case-finding methodsWe report a patient from Panama with SARS-CoV-2 infection complicated by ATM and present a comprehensive clinical review of 43 patients with COVID-19-associated ATM from 21 countries published from March 2020 to January 2021. In addition, 3 cases of ATM were reported as serious adverse events during the clinical trials of the COVID-19 vaccine ChAdOx1 nCoV-19 (AZD1222).ResultsAll patients had typical features of ATM with acute onset of paralysis, sensory level and sphincter deficits due to spinal cord lesions demonstrated by imaging. There were 23 males (53%) and 20 females (47%) ranging from ages 21- to 73- years-old (mean age, 49 years), with two peaks at 29 and 58 years, excluding 3 pediatric cases. The main clinical manifestations were quadriplegia (58%) and paraplegia (42%). MRI reports were available in 40 patients; localized ATM lesions affected ≤3 cord segments (12 cases, 30%) at cervical (5 cases) and thoracic cord levels (7 cases); 28 cases (70%) had longitudinally-extensive ATM (LEATM) involving ≥4 spinal cord segments (cervicothoracic in 18 cases and thoracolumbar-sacral in 10 patients). Acute disseminated encephalomyelitis (ADEM) occurred in 8 patients, mainly women (67%) ranging from 27- to 64-years-old. Three ATM patients also had blindness from myeloneuritis optica (MNO) and two more also had acute motor axonal neuropathy (AMAN).ConclusionsWe found ATM to be an unexpectedly frequent neurological complication of COVID-19. Most cases (68%) had a latency of 10 days to 6 weeks that may indicate post-infectious neurological complications mediated by the host’s response to the virus. In 32% a brief latency (15 hours to 5 days) suggested a direct neurotropic effect of SARS-CoV-2. The occurrence of 3 reported ATM adverse effects among 11,636 participants in the AZD1222 vaccine trials is extremely high considering a worldwide incidence of 0.5/million COVID-19-associated ATM cases found in this report. The pathogenesis of ATM remains unknown, but it is conceivable that SARS-CoV-2 antigens –perhaps also present in the AZD1222 COVID-19 vaccine or its chimpanzee adenovirus adjuvant– may induce immune mechanisms leading to the myelitis.

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