Etiologic spectrum and functional outcome of the acute inflammatory myelitis

Area of Science:

• Neurology
• Neuroimmunology
• Radiology

Background:

• Acute inflammatory myelitis (AIM) diagnosis is challenging due to non-specific clinical, neuroimaging, and laboratory findings.
• Longitudinally extensive transverse myelitis (LETM) on MRI is linked to poorer functional prognosis in AIM patients.

Purpose of the Study:

• To evaluate functional outcomes in first-time AIM events, comparing patients with and without LETM on MRI.
• To identify differential diagnoses associated with specific lesion patterns.

Main Methods:

• Retrospective analysis of clinical, radiological, and biochemical data.
• Assessment of functional outcomes using the Winner-Hughes Functional Disability Scale (WHFDS) at 3 and 6 months post-event.
• Correlation of MRI findings (LETM, lesion location) with clinical presentation and functional prognosis.

Main Results:

• LETM was associated with significantly worse functional outcomes, including increased wheelchair dependence (OR=7.61 at 3 months, OR=4.8 at 6 months) and need for mobility aids (OR=11.0 at 3 months, OR=4.3 at 6 months).
• Centromedullary lesions correlated with LETM, while lateral lesions were associated with partial transverse myelitis (PL).
• Brain MRI lesions indicated conditions like multiple sclerosis and acute disseminated encephalomyelitis.

Conclusions:

• Acute inflammatory myelitis (AIM) is an etiologically diverse condition.
• Longitudinally extensive transverse myelitis (LETM) predicts a worse functional prognosis compared to partial lesions (PL) in AIM patients at 3 and 6 months.