Idiopathic longitudinally extensive myelitis: a brief historical excursion (review) and own clinical observation

Abstract

Background: Idiopathic longitudinally extensive transverse myelitis is defined as a focal spinal cord lesion that involves three or more segments of the spinal cord as shown by neuroimaging, and results in a profound disability. The clinical picture of a patient with idiopathic longitudinally advanced transverse myelitis is often dramatic and may consist of paraparesis or tetraparesis, sensory disturbances, and pelvic dysfunction. Idiopathic longitudinally advanced transverse myelitis is a common manifestation of the neuromyelitis optica spectrum disorders, but can also occur in various other autoimmune and inflammatory diseases of the CNS, such as multiple sclerosis, sarcoidosis, or Sjogren’s syndrome, or in infectious diseases involving the CNS. It is less likely to occur in isolation, as the only manifestation of a demyelinating disease of the nervous system of an unknown etiology (idiopathic myelitis).

Clinical case description: The clinical observation presented in the article demonstrates the difficulties of establishing a nosological diagnosis in the case of a monophasic course of TM in the absence of other autoimmune and infectious diseases of the central nervous system. The patient with idiopathic longitudinally distributed TM had no visual disturbances and no antibodies to aquaporin 4 and to myelin oligodendrocyte glycoprotein (MOG-IgG) with twice repeated tests.

Conclusion: In this regard, it is important to dynamically monitor the clinical manifestations and MRI signs in patients with an isolated lesion of a demyelinating nature in the form of longitudinally extensive transverse myelitis.

Keywords

transverse myelitis / neuromyelitis optica spectrum disorder / aquaporin 4 / antibodies to myelin oligodendrocyte glycoprotein / clinical observation / female

References

[1] Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59(4):499–505. doi: 10.1212/wnl.59.4.499

[2] Scott TF, Frohman EM, de Seze J, et al. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011;77(24):2128–2134. doi: 10.1212/WNL.0b013e31823dc535

[3] Miller D, Barkhof F, Montalban X, et al. Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol. 2005;4(5):281–288. doi: 10.1016/S1474-4422(05)70071-5

[4] Weinshenker BG, Wingerchuk DM, Vukusic S, et al. Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis. Ann Neurol. 2006;59(3):566–569. doi: 10.1002/ana.20770

[5] Cree BA. Acute inflammatory myelopathies. Handb Clin Neurol. 2014;122:613–667. doi: 10.1016/B978-0-444-52001-2.00027-3

[6] Borchers AT, Gershwin ME. Transversemyelitis. Autoimmun Rev. 2012;11(3):231–248. doi: 10.1016/j.autrev.2011.05.018

[7] Goh C, Desmond PM, Phal PM. MRI in transverse myelitis. J Magn Reson Imaging. 2014;40(6):1267–1279. doi: 10.1002/jmri.24563

[8] Рассеянный склероз. Продолжение учения / под ред. проф. С.В. Лобзина, проф. В.И. Головкина. Москва: МЕДпресс-информ, 2021. 248 с. [Multiple sclerosis. Continuation of the teaching. Ed. by S.V. Lobzin, V.I. Golovkin. Moscow: MEDpress-inform; 2021. 248 p. (In Russ).]

[9] Шмидт Т.Е., Яхно Н.Н. Рассеянный склероз: от патогенеза через клинику к лечению. Москва: МЕДпресс-информ, 2021. 368 с. [Schmidt TE, Yakhno NN. Multiple sclerosis: from pathogenesis through the clinic to treatment. Moscow: MEDpress-inform; 2021. 368 р. (In Russ).]

[10] Debette S, de Sèze J, Pruvo JP, et al. Long-term outcome of acute and subacute myelopathies. J Neurol. 2009;256(6):980–988. doi: 10.1007/s00415-009-5058-x

[11] Kitley JL, Leite MI, George JS, Palace JA. The differential diagnosis of longitudinally eхtensive transverse myelitis. Multiple Sclerosis J. 2012;18(3):271–285. doi: 10.1177/1352458511406165

[12] Flanagan EP. Autoimmune myelopathies. Handbook Clin Neurol. 2016;133:327–351. doi: 10.1016/B978-0-444-63432-0.00019-0

[13] Trebst C, Raab P, Voss EV, et al. Longitudinal extensive transverse myelitis — it’s not all neuromyelitis optica. Nature Rev Neurol. 2011;7(12):688–698. doi: 10.1038/nrneurol.2011.176

[14] Григорьева В.Н., Руина Е.А, Лесникова А.А. Острый миелит, ассоциированный с COVID-19 // Доктор.Ру. Неврология. Психиатрия. 2021. Т. 20, № 9. С. 31–35. [Grigorieva VN, Rubina EA, Lesnikova AA. Acute myelitis associated with COVID-19. Doctor.ru. Neurology. Psychiatry. 2021;20(9):31–35. (In Russ).]

[15] Туруспекова С.Т., Нургужаев Е.С., Демесинова Б.К., и др. Оптиконейромиелит Дэвика: краткий исторический экскурс (обзор) и собственное клиническое наблюдение // Медицина. 2021. № 2. С. 16–23. [Turuspekova ST, Nurguzhaev ES, Demesinova BK, et al. Opticoneuromyelitis Davika: a brief historical digression (review) and own clinical observation. Medicine. 2021;(2):16–23. (In Russ).]

[16] Бакулин И.С., Васильев А.В., Брюхов В.В., и др. Дифференциальная диагностика миелитов при демиелинизирующих заболеваниях // Нервные болезни. 2015. № 4. С. 9–17. [Bakulin IS, Vasiliev AV, Bryukhov VV, et al. Differential diagnosis of myelitis in demyelinating diseases. Nervous Diseases. 2015;(4):9–17. (In Russ).]

RIGHTS & PERMISSIONS

Turuspekova S.T., Almakhanova K.K., Nurguzhaev E.S., Nurzhanova R.B., Demesinova B.K., Mukasheva T.Z., Stepuk N.V.