Abstract
Clinical, neuroimaging, and laboratory features are not specific enough to establish the etiological diagnosis of the acute inflammatory myelitis (AIM). Longitudinally extensive transverse myelitis (LETM) seen on magnetic resonance imaging (MRI) has been associated with a poor functional prognosis. The aim of this study was to assess the functional outcomes of a first AIM event comparing patients with LETM vs. no LETM on MRI and to report the differential diagnosis. Clinical, radiological, biochemical aspects were collected, and Winner–Hughes Functional Disability Scale (WHFDS) was performed after 3 and 6 months. Centromedullary lesions were associated with LETM, lateral lesions with partial lesion (PL), and brain MRI lesions with multiple sclerosis and acute encephalomyelitis disseminated. LETM patients were associated with a worse functional outcome as the need of a wheelchair after 3 and 6 months (OR = 7.61 p = 0.01; OR 4.8 p = 0.04, respectively), a walker or cane (OR = 11.0 p = 0.002, OR = 4.3 p = 0.03, respectively). In addition, we found a correlation between LETM and acute complete transverse myelitis and PL with acute partial transverse myelitis (83.3 and 90.9%, respectively; p < 0.0001). In conclusion, AIM is a heterogeneous syndrome from an etiological point of view and LETM patients had worse functional prognosis compared with PL after 3 and 6 months.
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Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG (2007) The spectrum of neuromyelitis Optica. Lancet Neurol 6:805–815
Miller DH, Weinshenker BG, Filippi M, Banwell BL, Cohen JA, Freedman MS et al (2008) Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 14:1157–1174
Frohman EM, Wingerchuk DM (2010) Transverse Myelitis. N Engl J Med 363:564–572
Transverse Myelitis Consortium Working Group (TMCW) (2002) Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 59:499–505
Scott TF, Frohman EM, De Seze J et al (2011) 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 77(24):2128–2134
Christensen PB, Wermuth L, Hinge HH, Bomers K (1990) Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand 8:431–435
Gajofatto A, Monaco S, Fiorini M, Zanusso G, Vedovello M, Rossi F et al (2010) Assessment of outcome predictors in first-episode acute myelitis: a retrospective study of 53 cases. Arch Neurol 67:724–730
Cobo Calvo A, Mañé Martínez MA, Alentorn-Palau A, Bruna Escuer J, Romero Pinel L, Martínez-Yélamos S (2013) Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol 3(13):135
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66:1485–1489
Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC et al (2013) International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 19(10):1261–1267
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277
Jeffery DR, Mandler RN, Davis LE (1993) Transverse myelitis retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events. Arch Neurol 50:532–535
De Seze J, Lanctin C, Lebrun C, Malikova I, Papeix C, Wiertlewiski S et al (2005) Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology 65:1950–1953
Swanton JK, Fernando K, Dalton CM, Miszkiel KA, Thompson AJ, Plant GT et al (2006) Modification of MRI criteria for multiple sclerosis in patients with clinically isolated syndromes. J Neurol Neurosurg Psychiatry 77:830–833
Swanton JK, Rovira A, Tintore M, Altmann DR, Barkhof F, Filippi M et al (2007) MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. Lancet Neurol 6:677–686
Kim HJ, Paul F, Lana-Peixoto MA, Tenembaum S, Asgari N, Palace J et al (2015) MRI characteristics of neuromyelitis optica spectrum disorder: an international update. Neurology 84:1–9
Wingerchuk DM, Banwell B, Bennett J, Cabre P, Carroll W, Chitnis T et al (2015) International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 85:1–13
Lennon VA, Wingerchuk DM, Kryzer TJ, Pittock SJ, Lucchinetti CF, Fujihara K et al (2004) A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 364:2106–2112
Sepúlveda M, Blanco Y, Rovira A, Rio J, Mendibe M, Llufriu S et al (2013) Analysis of prognostic factors associated with longitudinally extensive transverse myelitis. Mult Scler 19(6):742–748
Collongues N, Marignier R, Zéphir H, Papeix C, Blanc F, Ritleng C et al (2010) Neuromyelitis optica in France: a multicenter study of 125 patients. Neurology 74:737–742
Costa C, Arrambide G, Tintore M, Castilló J, Sastre-Garriga J, Tur C et al (2012) Value of NMO-IgG determination at the time of presentation as CIS. Neurology 78(20):1608–1611
Weinshenker BG, Wingerchuk DM, Vukusic S, Linbo L, Pittock SJ, Lucchinetti CF et al (2006) Neuromyelitis óptica IgG predicts relapse after longitudinally extensive transverse myelitis. Ann Neurol 59:566–569
Flanagan EP, Weinshenker BG, Krecke KN, Lennon VA, Lucchinetti CF, McKeon A et al (2015) Short Myelitis Lesions in Aquaporin-4-IgG—positive neuromyelitis optica spectrum disorders. JAMA Neurol 72(1):81–87
Harzheim M (2004) Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients. J Neurol Sci 217:217–223
Desanto J, Ross JS (2011) Spine infection/inflammation. Radiol Clin North Am 49(1):105–127
Scott TF, Kassab SL, Singh S (2005) Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically definite multiple sclerosis. Mult Scler 11:373–377
Ropper AH, Poskanzer DC (1978) The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms. Ann Neurol 4:51–59
Ruiz-Gaviria R, Baracaldo I, Castañeda C et al (2015) Specificity and sensitivity of aquaporin 4 antibody detection tests in patients with neuromyelitis optica: a meta-analysis. Mult Scler Relat Disord. 4(4):345
Acknowledgements
We thank Dr. Carmen Lessa and Edson Chiganer (Immunology and Histocompatibility Unit, Hospital Carlos G. Durand, Buenos Aires, Argentina) for their valuable recommendations in the clinical practice. In addition, we thank Dr. Florencia Ocariz and Adrian Rubstein for his critical reading of the manuscript.
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Carnero Contentti, E., Hryb, J.P., Diego, A. et al. Etiologic spectrum and functional outcome of the acute inflammatory myelitis. Acta Neurol Belg 117, 507–513 (2017). https://doi.org/10.1007/s13760-016-0742-y
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DOI: https://doi.org/10.1007/s13760-016-0742-y