Etiological spectrum, clinico-radiological profile and treatment outcomes of longitudinally extensive transverse myelitis – A prospective study from Northwest India

Choudhary, Ankita; Bhargava, Amita; Khichar, Shubhakaran; Pradhan, Sangeeta

doi:10.1016/j.jneuroim.2020.577456

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…In a study of patients presenting with LETM, Choudhary et al found the dorsal region to be involved with a frequency of 93% and cervical with 50%. The incidence of MS in their study was reported to be 9.37% [14].…”

Section: Resultsmentioning

confidence: 83%

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Clinico-Radiological Spectrum of Non-Compressive Myelopathies

Paul¹,

Mondal²,

Bhattacharyya³

et al. 2023

JNNR

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Objective: To study the etiology and clinico-radiological profile of non-compressive myelopathies. Methods: 40 consecutive admissions of non-compressive myelopathy were studied for clinical and radiological profile. Statistical methods: Descriptive statistics, linear regression and independent t-test using SPSS 20. Results: Age of the studied population ranged from 2 years to 55 years with a median age of 32.35 years and male:female ratio of 2:1. 87.5% of cases had an acute to subacute presentation. Complete cord syndrome was the most common presentation followed by anterior cord syndrome, central cord syndrome and mixed pattern. LETM was seen in nearly two-thirds of cases. Lesions involving more than two-thirds of the cross section of spinal cord were seen in more than 60% of cases, thereby accounting for significant disability at onset. Most of the lesions were hyperintense on T2 and STIR images and isointense on T1 with only 18.91% showing contrast enhancement. Optic neuritis was recorded with an overall prevalence of 28.26%. EDSS at presentation varied among the subgroups with ADEM, NMOSD and LETM form of ITM having EDSS scores of 9.5,8.0 and 7.5 respectively whereas in MS and Non-LETM form of ITM, EDSS score was 4.0 and 2.5 respectively. Conclusion: Demyelinating disorders contribute to nearly 80% cases of non-compressive myelopathies with NMOSD being the most common pathology. CSF cell count, cross-sectional involvement of spinal cord, pattern of myelitis and aquaporin-4 seropositivity were found to be predictive of the severity at onset i.e., EDSS at presentation with the initial 3 factors also showing predictability of EDSS at last visit.

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Section: Resultsmentioning

confidence: 83%

“…Ambika et al found the incidence of AQP4 antibody seropositivity to be 20% in a study of optic neuritis [20]. Choudhary et al whose study focused on LETM form of myelitis only reported the incidence of optic neuritis to be 34%, with NMOSD contributing to the bilk of cases as expected 14 .…”

Section: Resultsmentioning

confidence: 91%

Clinico-Radiological Spectrum of Non-Compressive Myelopathies

Paul¹,

Mondal²,

Bhattacharyya³

et al. 2023

JNNR

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“…LETM does not always occur in the context of NMO and has been found to originate from various etiologies, with idiopathic and parainfectious being the next most common. Multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM) have also been reported, as well as more rarely, myelin oligodendrocyte glycoprotein (MOG) antibody LETM [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Longitudinally Extensive Transverse Myelitis with Myelin Oligodendrocyte Glycoprotein Antibodies

Yang

Husein

Martinez-Perez

et al. 2022

Case Reports in Neurological Medicine

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Background. Myelin oligodendrocyte glycoprotein (MOG) antibody disease most commonly presents with optic neuritis, though myelitis is also possible. It is rare in the post-infectious and particularly post-COVID-19 setting. Case Presentation. We present the case of a 57-year-old man who tested positive for COVID-19 and experienced respiratory symptoms that completely resolved within one week. About 3 weeks after testing positive, he began experiencing acute onset anuria, followed by lower extremity paresthesia and paraparesis, which progressed to bilateral lower extremity paraplegia, complete loss of sensation of pain, temperature, vibration, and proprioception, and a T4 sensory level. He was initially diagnosed with and treated for acute inflammatory demyelinating polyradiculoneuropathy (AIDP), after which he made minimal clinical improvement. The diagnosis was shifted to longitudinally extensive transverse myelitis, and his CSF tested positive for MOG antibodies. He is being treated with a steroid regimen and extensive outpatient physical therapy. Conclusion. The neurologic manifestations of COVID-19 are still being uncovered. Neurologic symptoms should be included in patient education on symptom monitoring, even after recovery of respiratory illness, so that COVID-19-related CNS pathology can be urgently treated.

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“…The third is ATM due to noninfectious causes such as congenital spinal cord malformation, ischemic spinal cord stroke, vasculitis, intramedullary tumors, and paraneoplastic syndrome [10]. The severity of transverse myelitis is variable from complete paralysis of lower limbs to mild rapidly improving paraparesis [11]. Recently, neuro-immunological mediated cases of autoimmune neuromyelitis optica were reported and paved the way for its specific effective antibody-mediated immunotherapy [12].…”

Section: Introductionmentioning

confidence: 99%

Mycoplasma pneumoniae and Schistosoma mansoni co-infection in a young patient with extensive longitudinal acute transverse myelitis

Alayafi

Alruwaili²,

Aljumah³

et al. 2022

J Infect Dev Ctries

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Introduction: Acute transverse myelitis is an uncommon inflammatory, intramedullary, disorder of the spinal cord. Spastic paraplegia, impaired sphincter functions, and sensory loss, with sensory level, are the clinical manifestations of this devastating disorder. The utilization of magnetic resonant imaging (MRI) contributes to the surge in the diagnosis of more ATM cases. Although the causes of ATM are numerous, both Mycoplasma pneumoniae and Schistosoma mansoni are uncommon causes and their co-existence in the same patient has not been reported before in Saudi Arabia. Case: We report a 25-year-old ATM male patient presented with a history of sudden onset severe low back pain. Within four hours from the onset of the back pain, he became completely paraplegic with impaired functions of the bowel and urinary bladder sphincter. Furthermore, he lost all modalities of sensory functions in the lower limbs. His examination revealed spastic complete paraplegia with sensory level at T6. Clinical neurological examination revealed normal upper limbs and brain functions. The MRI of the cervico-dorsal spine showed extensive longitudinal hyperintense lesion extending from the upper cervical segments to the lower dorsal segments (extensive longitudinal transverse myelitis). A post-infectious immune-mediated predisposition was highly suspected due to the very high titers of anti-Mycoplasma pneumoniae IgM and IgG that were detected. The immunosuppressant therapy did not improve his paraplegia. A spinal cord biopsy revealed the presence of several Schistosoma mansoni ova surrounded by chronic inflammatory reactions and reactive gliosis. Conclusions: Both Mycoplasma pneumoniae and Schistosoma mansoni should be investigated in cases with extensive longitudinal ATM.

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Etiological spectrum, clinico-radiological profile and treatment outcomes of longitudinally extensive transverse myelitis – A prospective study from Northwest India

Cited by 5 publications

References 29 publications

Clinico-Radiological Spectrum of Non-Compressive Myelopathies

Clinico-Radiological Spectrum of Non-Compressive Myelopathies

Post-COVID-19 Longitudinally Extensive Transverse Myelitis with Myelin Oligodendrocyte Glycoprotein Antibodies

Mycoplasma pneumoniae and Schistosoma mansoni co-infection in a young patient with extensive longitudinal acute transverse myelitis

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