An Analysis of Clinico-radiological Features and Outcome in Patients with Longitudinally Extensive Transverse Myelitis

Background: Longitudinally extensive transverse myelitis (LETM) is an immune-mediated neurological disorder affecting the spinal cord. It may be associated with the demyelination of the brain and optic nerves. Clinical features, radiological picture, and treatment outcomes vary depending on the etiology. Objectives: To assess different etiologies of LETM and analyze their differences in clinicoradiological features and treatment outcome. Materials and Methods: It is a single-center retrospective cross-sectional observational study. A total of 42 patients presented with LETM to our center for over 10 years (2010-2019) were included in this study. Their clinical, radiological, CSF findings, treatment, and neurological status (at nadir and 6 months) assessed by the EDMUS scoring system were compared and presented in this study. Results: In this study, 80% of patients were females, with the highest female predominance noted in NMOSD (87%). Among various etiologies, 16 patients had NMOSD, seven were idiopathic, five had connective tissue disease, and four were due to infective etiology. Bladder involvement was seen predominantly in patients with infective and systemic causes, whereas respiratory muscle involvement was seen predominantly with infective etiology. More than six-segment involvement was seen predominantly in idiopathic cases. All Ro-52 positive patients had relapses. NMOSD had a better neurological outcome than other etiology. Conclusions: NMOSD is the most common cause of LETM, with a good neurological outcome at 6 months, while infective etiology had a poor neurological recovery. NMOSD with Ro-52 antibody positivity had relapses despite being on immunosuppressant therapy.