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The frequency of longitudinally extensive transverse myelitis in MS: A population-based study.

Authors :
Asnafi, Solmaz
Morris, P. Pearse
Sechi, Elia
Pittock, Sean J.
Weinshenker, Brian G.
Palace, Jacqueline
Messina, Silvia
Flanagan, Eoin P.
Source :
Multiple Sclerosis & Related Disorders; Jan2020, Vol. 37, pN.PAG-N.PAG, 1p
Publication Year :
2020

Abstract

• We assessed the frequency of LETM from a population-based MS cohort. • We found no cases of LETM among 92 MS myelitis attacks from 67 patients. • In two patients (2%) the coalescence of multiple short lesions mimicked LETM. Determining the frequency of longitudinally-extensive transverse myelitis (LETM: T2-lesion ≥3 vertebral segments) in multiple sclerosis (MS) is essential to assess its utility in differentiating from aquaporin-4-IgG (AQP4-IgG) positive neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein-IgG (MOG-IgG) myelitis. We sought to determine the frequency of LETM in MS during a myelitis attack. We identified Olmsted County (MN, USA) residents on 12/31/2011 with inflammatory demyelinating disease. Inclusion criteria were: 1) Clinical myelitis episode accompanied by a new spinal magnetic resonance imaging (MRI) lesion (≤6 weeks from onset); 2) MS diagnosis by 2010 McDonald criteria; 3) Seronegative for AQP4-IgG and MOG-IgG. MRI characteristics were determined. Sixty-seven patients (median age at myelitis: 41 years [range, 16–65]; 76% females) with 92 myelitis attacks accompanied by a new MRI spinal cord lesion were identified. The frequency of LETM was 0%. The median T2-hyperintense lesion length in vertebral segments was 1.0 (range, 0.5–2.5) and 82/92 (89%) were peripheral in location on axial sequences; 58% had associated gadolinium enhancement. Two patients (2% of attacks) had multiple short lesions resembling LETM on sagittal images but axial sequences confirmed multiple non-contiguous short lesions. LETM is rare in adult MS myelitis and its presence should prompt evaluation for AQP4-IgG, MOG-IgG or other etiologies. Careful scrutiny of axial images is important as coalescence of multiple short lesions may lead to the artifactual appearance of an LETM. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
22110348
Volume :
37
Database :
Supplemental Index
Journal :
Multiple Sclerosis & Related Disorders
Publication Type :
Academic Journal
Accession number :
142206807
Full Text :
https://doi.org/10.1016/j.msard.2019.101487