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Spinal cord tumor versus transverse myelitis.
Spine J 2011; 11(12):1143-5SJ

Abstract

BACKGROUND CONTEXT

Longitudinally extensive transverse myelitis (LETM) is one of the defining features of neuromyelitis optica (NMO). Despite the well-established criteria, clinical and paraclinical features, the disease is often misdiagnosed and erroneously treated.

PURPOSE

We report on a case of LETM in a patient with spatially limited NMO spectrum disorder that was misdiagnosed as spinal cord tumor and underwent spinal cord biopsy.

STUDY DESIGN

A 43-year-old female patient is described.

METHODS

The patient developed spastic tetraparesis over 1 week. Spinal cord magnetic resonance imaging (MRI) revealed LETM, and she was treated with steroids and recovered. Nine months later, her condition worsened and repeat spinal cord MRI was interpreted as a large intramedullary tumor in the cervical region with irregular postcontrast enhancement. Biopsy revealed demyelination. Cerebrospinal fluid (CSF) analysis revealed positive oligoclonal IgG bands, and serum was positive for NMO-IgG antibody.

RESULTS

The patient was diagnosed with spatially limited NMO spectrum disorder, treated with plasma exchange, high-dose corticosteroids, and cyclophosphamide, and with good recovery.

CONCLUSIONS

The factors favoring inflammatory LETM are acute or subacute onset of clinical symptoms, positive oligoclonal bands in the CSF, positive NMO-IgG or other antibodies, and brain MRI showing demyelinating lesions. Postcontrast axial MRI sequences of the spinal cord can also be helpful. In doubtful situations, a trial of therapy and follow-up MRI a month later might be a more prudent approach if the patient is not rapidly deteriorating.

Authors+Show Affiliations

University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kišpaticeva 12, Zagreb, Croatia. mhabek@mef.hrNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22082692

Citation

Habek, Mario, et al. "Spinal Cord Tumor Versus Transverse Myelitis." The Spine Journal : Official Journal of the North American Spine Society, vol. 11, no. 12, 2011, pp. 1143-5.
Habek M, Adamec I, Brinar VV. Spinal cord tumor versus transverse myelitis. Spine J. 2011;11(12):1143-5.
Habek, M., Adamec, I., & Brinar, V. V. (2011). Spinal cord tumor versus transverse myelitis. The Spine Journal : Official Journal of the North American Spine Society, 11(12), pp. 1143-5. doi:10.1016/j.spinee.2011.10.012.
Habek M, Adamec I, Brinar VV. Spinal Cord Tumor Versus Transverse Myelitis. Spine J. 2011;11(12):1143-5. PubMed PMID: 22082692.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal cord tumor versus transverse myelitis. AU - Habek,Mario, AU - Adamec,Ivan, AU - Brinar,Vesna V, Y1 - 2011/11/13/ PY - 2010/12/08/received PY - 2011/07/27/revised PY - 2011/10/21/accepted PY - 2011/11/16/entrez PY - 2011/11/16/pubmed PY - 2012/4/27/medline SP - 1143 EP - 5 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 11 IS - 12 N2 - BACKGROUND CONTEXT: Longitudinally extensive transverse myelitis (LETM) is one of the defining features of neuromyelitis optica (NMO). Despite the well-established criteria, clinical and paraclinical features, the disease is often misdiagnosed and erroneously treated. PURPOSE: We report on a case of LETM in a patient with spatially limited NMO spectrum disorder that was misdiagnosed as spinal cord tumor and underwent spinal cord biopsy. STUDY DESIGN: A 43-year-old female patient is described. METHODS: The patient developed spastic tetraparesis over 1 week. Spinal cord magnetic resonance imaging (MRI) revealed LETM, and she was treated with steroids and recovered. Nine months later, her condition worsened and repeat spinal cord MRI was interpreted as a large intramedullary tumor in the cervical region with irregular postcontrast enhancement. Biopsy revealed demyelination. Cerebrospinal fluid (CSF) analysis revealed positive oligoclonal IgG bands, and serum was positive for NMO-IgG antibody. RESULTS: The patient was diagnosed with spatially limited NMO spectrum disorder, treated with plasma exchange, high-dose corticosteroids, and cyclophosphamide, and with good recovery. CONCLUSIONS: The factors favoring inflammatory LETM are acute or subacute onset of clinical symptoms, positive oligoclonal bands in the CSF, positive NMO-IgG or other antibodies, and brain MRI showing demyelinating lesions. Postcontrast axial MRI sequences of the spinal cord can also be helpful. In doubtful situations, a trial of therapy and follow-up MRI a month later might be a more prudent approach if the patient is not rapidly deteriorating. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/22082692/Spinal_cord_tumor_versus_transverse_myelitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(11)01330-1 DB - PRIME DP - Unbound Medicine ER -