Longitudinal extensive transverse myelitis due to tuberculosis: a report of four cases

Tuberculosis of the central nervous system (CNS) accounts for approximately 1% of all cases of tuberculosis and half of these involve the spine. Intramedullary involvement is rare in tuberculosis and usually present in the form of radiculomyelitis, transverse myelitis, intraspinal granulomas, or thrombosis of anterior spinal artery. 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. LETM is most frequently associated with neuromyelitis optica (NMO). Moreover, associations between NMO and active pulmonary tuberculosis have been suggested by a number of case reports and case series. We present here four cases of spinal tuberculosis that presented with LETM and none of them had a clinical profile fulfilling the diagnostic criteria for NMO.