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The differential diagnosis of longitudinally extensive transverse myelitis

J L Kitley1, M I Leite, J S George

  • 1John Radcliffe Hospital, Oxford, UK.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|June 15, 2011
PubMed

Insights

Longitudinally extensive transverse myelitis (LETM) is spinal cord inflammation seen on MRI. Early diagnosis and identifying the cause are crucial for effective treatment and preventing further attacks.

Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Longitudinally extensive transverse myelitis (LETM) is a severe spinal cord inflammation.
  • LETM is characterized by T2 hyperintensity on MRI spanning at least three vertebral segments.
  • While rare, LETM can cause significant disability and carries a risk of recurrent attacks.

Purpose of the Study:

  • To emphasize the clinical importance of early identification and etiological diagnosis of LETM.
  • To highlight the diverse causes of LETM beyond neuromyelitis optica.
  • To underscore the necessity of differentiating inflammatory and non-inflammatory etiologies for optimal patient outcomes.

Main Methods:

  • Review of clinical presentations and diagnostic criteria for LETM.
  • Analysis of laboratory and radiological investigations used in etiological differentiation.
  • Assessment of treatment strategies based on underlying causes and recurrence risk.

Main Results:

  • LETM has multiple potential causes including inflammatory, infectious, malignant, and metabolic conditions.
  • Neuromyelitis optica is a common association but not the sole cause of LETM.
  • Distinguishing between inflammatory and non-inflammatory causes is key to guiding treatment.

Conclusions:

  • Prompt diagnosis and etiological workup of LETM are vital for timely and appropriate management.
  • Identifying patients at high risk for recurrent episodes is essential for long-term care planning.
  • A comprehensive diagnostic approach involving laboratory and imaging studies aids in managing LETM effectively.

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