Dr pittock’s group from mayo clinic recently published their original work focused on recurrent longitudinally extensive transverse myelitis (rletm) the goal of the study was to study aqp4-igg, a known clinical biomarker of nmo spectrum disorders, from patients with rletm using a recombinant human aqp4 based assay who were initially classified as negative for this antibody based on an assay known as iif. This study described the clinical and paraclinical features of south indian patients with longitudinally extensive transverse myelitis (letm) and contrasted the findings betweenaquaporin-4 positive versus negative patients. Transverse myelitis requires careful investigation, as although many causes respond acutely to immunomodulation, the longer term management depends upon its precise cause we describe a patient presenting acutely with a corticosteroid-responsive longitudinally extensive transverse myelitis and granulomatous lung lesions with a previous history of recurrent generalised lymphadenopathy, pyogenic.
However, 10-15% of patients may have neurological complications (neurosarcoidosis) that may be manifested as transverse myelitis, meningitis and other neurological problems myelopathies associated with neurosarcoidosis are frequently longitudinally extensive subacute or chronic and may produce significant neurological disability.
Systemic lupus erythematosus (sle) is an autoimmune disorder that can potentially affect any organ it usually presents between the ages of 15 and 45 with 9:1 ratio of female to male patients its clinical manifestations vary among people of different ethnicities longitudinally extensive transverse myelitis (letm) is a rare life-threatening complication of sle. Longitudinally extensive transverse myelitis a proposed special clinical presentation is the longitudinally extensive transverse myelitis (letm) which is defined as a tm with a spinal cord lesion that extends over 3 or more vertebral segments.
Patients had myelitis secondary to systemic lupus erythematosus, 3 due to multiple sclerosis, 6 had parainfectious myelitis, 4 due to tuberculosis, 2 sarcoidosis, 17 acute short segment transverse myelitis and 71 patients had letm among the 71 patients recruited with letm (table 1), 40 (5634%) patients were aqp4-abpositive [aqp4(+). Characteristics of longitudinally extensive transverse myelitis patients: a retrospective analysis of 40 consecutive cases at a tertiary care hospital from north-west india abstract longitudinally extensive transverse myelitis (letm), characterised by spinal cord inflammation extending three or more vertebral segments may be caused by multiple disorders most common being neuromyelitis optica(nmo.
Whereas acute transverse myelitis (atm) refers to lesions that span one to two vertebral segments, longitudinally extensive transverse myelitis (letm) refers to a rare and devastating type of transverse myelitis (tm) that involves at least three contiguous vertebrae on t2-weighted magnetic resonance imaging (mri) although letm is rare when compared to atm, it must be distinguished from other longitudinal spinal lesions to ensure early diagnosis and proper treatment.
In contrast, patients who have the more severe forms of transverse myelitis have lesions in the spinal cord extending over the length of three or more vertebrae (longitudinally extensive transverse myelitis, letm) such patients seem to be at low risk for developing multiple sclerosis many, probably the majority, will never experience another attack. Whilst rare, longitudinally extensive transverse myelitis is clinically important as it can lead to catastrophic morbidity, and a group of these patients are at risk of further attacks early identification and establishment of the underlying aetiology is vital in order to initiate appropriate therapy and optimize outcomes. The cornerstone of treatment for autoimmune-related transverse myelitis is the concomitant administration of high doses of corticosteroid and intensive immunosuppressive therapy (eg, cyclophosphamide)9 in a small case series involving 13 patients with transverse myelitis (but not longitudinally extensive transverse myelitis) related to.