Spinal cord tumor versus transverse myelitis

Area of Science:

• Neurology
• Immunology
• Radiology

Background:

• Longitudinally extensive transverse myelitis (LETM) is a hallmark of neuromyelitis optica (NMO).
• Accurate diagnosis of LETM is crucial, as misdiagnosis can lead to inappropriate treatments.
• NMO spectrum disorder (NMOSD) encompasses conditions with similar features to NMO.

Observation:

• A 43-year-old female presented with spastic tetraparesis.
• Initial MRI showed LETM, treated with steroids. Later, MRI suggested a spinal cord tumor.
• Spinal cord biopsy confirmed demyelination, and CSF revealed oligoclonal bands; serum tested positive for NMO-IgG.

Findings:

• The patient was diagnosed with spatially limited NMOSD.
• Treatment with plasma exchange, corticosteroids, and cyclophosphamide resulted in good recovery.
• Key diagnostic factors for inflammatory LETM include acute onset, CSF oligoclonal bands, NMO-IgG positivity, and MRI findings.

Implications:

• This case highlights the importance of considering inflammatory demyelinating conditions in LETM, even with tumor-like MRI appearances.
• Recognizing NMOSD can prevent misdiagnosis and guide appropriate immunosuppressive therapy.
• In ambiguous cases, therapeutic trials and follow-up imaging are valuable if the patient is not rapidly deteriorating.