Etiologic Spectrum and Prognosis of Longitudinally Extensive Transverse Myelopathies

Abstract

Background: Patients with a first episode of longitudinal extensive transverse myelopathy (LETM) were reviewed with two objectives: to evaluate the clinical spectrum of LETM and to analyze the related clinical and laboratory variables that can be used as functional prognostic markers. Methods: A retrospective review was conducted of clinical, radiologic and biochemical data of patients admitted for LETM between 1993 and 2011. Results: Our cohort included 72 patients [median age 41 years, interquartile range (IQR) 29-61.5]. Median follow-up was 34 months (IQR 17.2-63). The modified Rankin Scale (mRS) score was ≥2 at the end of follow-up in 72.2%. The final diagnosis was idiopathic LETM in 22 patients, multiple sclerosis in 18, parainfectious disease in 11, systemic disease in 9, spinal cord infarction and neuromyelitis optica spectrum disorders in 3 patients each, and acute demyelinating encephalomyelitis, dural fistula, and tumor-related LETM in 2 patients each. Unfavorable outcome was associated with mRS ≥2 at admission [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.16-1.66] and older age (OR 1.06, 95% CI 1.01-1.11). Conclusion: Idiopathic LETM was the most frequent diagnosis at the end of follow-up. Older age and clinically severe disease at onset were independent prognostic factors of poorer functional recovery.

MRI Predictors of Recurrence and Outcome after Acute Transverse Myelitis of Unidentified Etiology

“…Previous studies yielded conflicting results regarding the association of LETM and functional outcome. 2,9,14,15 Contrary to the studies of Carnero Contentti et al, 2,15 LETM did not predispose to poor functional outcome in our cohort. This variation may be due to differences in patient groups.…”

“…Our results were similar to those in prior studies with longer follow-up periods. 9,14 Other spinal MR imaging features that we analyzed (distribution, T1 signal, extension in a transverse section, multiplicity, and contrast enhancement) were also evaluated in a previous study in which no association could be found with clinical outcome after acute transverse myelitis. 16 Our study supports these findings, though more studies with large numbers of cases are needed for confirmation.…”

Relationship Between Neuromyelitis Optica Spectrum Disorder and Sjögren's Syndrome: Central Nervous System Extraglandular Disease or Unrelated, Co‐Occurring Autoimmunity?

“…While we also demonstrated that NMOSD is coincidental to SS, the increased frequency of NMOSD (relative to MS) in SS patients likely reflects 2 syndromes driven by robust, albeit unrelated, disorders of humoral autoimmunity . The 2 remaining non‐NMOSD patients presented with a complete transverse myelitis and an LETM, which are myelopathies not characteristic of MS and as suggested can be attributable to SS .…”

Estudo comparativo do acometimento medular entre a mielite transversa aguda idiopática e a neuromielite óptica

“…dias (Christensen et al, 1990) e de 3,0 dias (Bruna et al, 2006 (Bruna et al, 2006). Todavia, encontra-se na literatura dados que se assemelham aos encontrados neste estudo (Cobo-Calvo et al, 2014;Sepúlveda et al, 2012).…”

“…O que permite presumir que quanto mais precoce à instalação da gravidade máxima da sintomatologia da mielite pior será seu prognóstico final. Tais achados reproduzem-se por autores que embora se utilizem de metodologia e escalas de incapacidades, por vezes, distintas das implementadas neste estudo (Cobo-Calvo et al, 2014;Debette et al, 2009).…”