Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India
Introduction An inflammatory lesion of the spinal cord where three or more than three vertebral segments of the cord is involved is called longitudinal extensive myelitis (LETM). It has several varied causes out of which neuromyelitis optica (NMO) and its spectrum disorder have received a distinct e...
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doaj-7fc3e20f24e146e484591897c915e0702021-09-28T22:59:25ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neurosciences in Rural Practice0976-31470976-31552021-09-0110.1055/s-0041-1735826Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East IndiaBaiakmenlang Synmon0Pranjal Phukan1Shri Ram Sharma2Mussaraf Hussain3Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, IndiaDepartment of Radiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, IndiaDepartment of Neurology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, IndiaDepartment of Neurology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, IndiaIntroduction An inflammatory lesion of the spinal cord where three or more than three vertebral segments of the cord is involved is called longitudinal extensive myelitis (LETM). It has several varied causes out of which neuromyelitis optica (NMO) and its spectrum disorder have received a distinct entity. Various radiological and clinical features help us to suspect an etiology which then further guides us into the treatment protocol and prognosis of the patients. Materials and Methods A retrospective study performed in a referral center in North East India in 15 months. Thirty-two patients of LETM were enrolled based on clinical and radiological available data. An attempt was made to classify the various etiologies and correlate with their radiological findings. Results The most common etiology noted was NMO seen in 7 patients (21.8%) followed by tuberculosis (TB) (18.7%) and post-infection myelitis (18.7%). Other etiology seen was acute disseminated encephalomyelitis (6.24%), spinal cord infarct (3.12%), radiation myelitis (6.24%), Japanese encephalitis sequalae (3.12%), systemic lupus erythematosus (3.12%), and remained undiagnosed in six patients (18.7%). Radiologically, cervico-dorsal spine was most common location in NMO (71%) whereas dorsolumbar in TB (50%). The lesion was predominantly central in both NMO (100%) and TB (80%) as compared with the other causes of LETM. It was noted that more than 50% of the transverse area of the cord was involved in both NMO (71%) and TB (50%), but < 50% involvement were more common in the post-infectious and others causes of LETM. Conclusion LETM has a various differential diagnosis, infection need to be kept in mind while ruling out NMO. Radiological features can suggest or help differentiate the various etiologies of LETM but NMO and infection like TB almost has the same features except for a different cord site predilection.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1735826longitudinal extensive myelitis (letm)neuromyelitis optica (nmo)tuberculosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Baiakmenlang Synmon Pranjal Phukan Shri Ram Sharma Mussaraf Hussain |
spellingShingle |
Baiakmenlang Synmon Pranjal Phukan Shri Ram Sharma Mussaraf Hussain Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India Journal of Neurosciences in Rural Practice longitudinal extensive myelitis (letm) neuromyelitis optica (nmo) tuberculosis |
author_facet |
Baiakmenlang Synmon Pranjal Phukan Shri Ram Sharma Mussaraf Hussain |
author_sort |
Baiakmenlang Synmon |
title |
Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India |
title_short |
Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India |
title_full |
Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India |
title_fullStr |
Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India |
title_full_unstemmed |
Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India |
title_sort |
etiological and radiological spectrum of longitudinal myelitis: a hospital-based study in north east india |
publisher |
Thieme Medical and Scientific Publishers Pvt. Ltd. |
series |
Journal of Neurosciences in Rural Practice |
issn |
0976-3147 0976-3155 |
publishDate |
2021-09-01 |
description |
Introduction An inflammatory lesion of the spinal cord where three or more than three vertebral segments of the cord is involved is called longitudinal extensive myelitis (LETM). It has several varied causes out of which neuromyelitis optica (NMO) and its spectrum disorder have received a distinct entity. Various radiological and clinical features help us to suspect an etiology which then further guides us into the treatment protocol and prognosis of the patients.
Materials and Methods A retrospective study performed in a referral center in North East India in 15 months. Thirty-two patients of LETM were enrolled based on clinical and radiological available data. An attempt was made to classify the various etiologies and correlate with their radiological findings.
Results The most common etiology noted was NMO seen in 7 patients (21.8%) followed by tuberculosis (TB) (18.7%) and post-infection myelitis (18.7%). Other etiology seen was acute disseminated encephalomyelitis (6.24%), spinal cord infarct (3.12%), radiation myelitis (6.24%), Japanese encephalitis sequalae (3.12%), systemic lupus erythematosus (3.12%), and remained undiagnosed in six patients (18.7%). Radiologically, cervico-dorsal spine was most common location in NMO (71%) whereas dorsolumbar in TB (50%). The lesion was predominantly central in both NMO (100%) and TB (80%) as compared with the other causes of LETM. It was noted that more than 50% of the transverse area of the cord was involved in both NMO (71%) and TB (50%), but < 50% involvement were more common in the post-infectious and others causes of LETM.
Conclusion LETM has a various differential diagnosis, infection need to be kept in mind while ruling out NMO. Radiological features can suggest or help differentiate the various etiologies of LETM but NMO and infection like TB almost has the same features except for a different cord site predilection. |
topic |
longitudinal extensive myelitis (letm) neuromyelitis optica (nmo) tuberculosis |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1735826 |
work_keys_str_mv |
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