A CLINICAL PROFILE OF LONGITUDINALLY EXTENSIVE TRANSVERSE MYELITIS IN A TERTIARY CARE CENTRE

Purpose : Transverse myelitis is an inammatory disorder with acute or subacute spinal cord dysfunction, characterized by motor, sensory, bladder and bowel involvement1 . Longitudinal extensive transverse myelopathy (LETM) is a spinal cord lesion involving three or more vertebral segments2.Most common etiology is Neuromyelitis optica (NMO), followed by infective, neoplastic, autoimmune diseases and connective tissue disorders, neoplasms and spinal cord trauma.3 This study assess the demographic, clinical, radiological and immunological characteristics and compares the aquaporin-4 positive versus negative in relation to clinical and radiological features. :This is a hospital based prospective Method case study that includes forty two patients presented to Neurology Department in tertiary care hospital, Hyderabad between October 2019 to November 202. The patients were studied for demographic prole, clinical presentation, blood serology,CSF studies and neuroimaging as per standard protocol. Patients with chronic progressive disease not fullling LETM criteria were excluded. : Mean age of onset was 36.5 ± Results 12.9 years. Most common complaints were sensory, followed by bowel/bladder involvement, motor weakness. Most common etiology was NMOSD (55%) Seropositive 57%, seronegative 43%. Non-NMOSD group comprised of Idiopathic (24 %), ADEM (7%), SACD (7%) and MS (5 %) and systemic autoimmune disorders (2%). Spinal cord MR imaging in NMOSD showed cervical spine involvement in 21.7 % patients, cervicodorsal spine in 43.4%,dorsal spine involvement 17.3%. Radiologically Central full thickness pattern involving >1/2 transverse segment of cord was seen with NMOSD & ADEM. Marginal & posterior in MS. Posterior/ posterolateral in SACD. 8 had positive ANA of which 75% in NMOSD group. In our NMOSD cohort, certain clinico-radiological features were predicitve of seropositivity: female predominance; paroxysmal tonic spasms; unexplained recurrent hiccups, nausea or vomiting (Area postrema syndrome); relapsing course predominantly cervico-dorsal cord involvement , bright spotty lesions and T1 hypointense lesions on spinal MRI. In this Conclusion: study, NMOSD was the commonest cause of LETM. Female sex, paroxysmal tonic spasms, cervico-dorsal cord involvement, bright spotty lesions on MRI are features favoring seropositive NMOSD. Even topographical analysis, extent of lesions on MRI and contrast pattern may also give clues to the differential diagnosis. On axial topography, bright spotty lesions favour seropositive NMOSD, postero lateral pattern suggest SACD whereas posterior & marginal pattern suggests MS