A case of longitudinally extensive viral myelitis. Clinical, radiological profile and outcome

Abstract

This case report provides a comprehensive clinical and radiological profile of a case of Longitudinally extensive transverse myelitis (LETM) in middle east Asia. This 37 year old Indian manual labourer presented with acute onset paraplegia with early bladder involvement, without any preceding febrile illness. His MRI showed a long segment T2 heterogeneous hyperintensity in the spinal cord extending from C3 to D11 level involving predominantly the central grey matter. The adjacent white matter was also involved in the upper dorsal level. Mild cord edema was present. On contrast administration, there was no significant enhancement. Patient was evaluated for the possible etiologies which were negative. But neutrophilia in CSF with normal glucose and protein suggest a probable unknown viral etiology. If no cause is identified after a thorough work-up, transverse myelitis can also be categorized as an idiopathic monophasic event, which occurs in approximately 15–30% of cases. We did not obtain a spinal angiogram to definitively rule out a spinal arteriovenous shunt, since the clinical response was good and gradient did not show any blooming. So our patient probably is a case of LETM of unknown viral etiology or idiopathic who has recovered well with steroids. Patients presenting with LETM require a thorough work-up to exclude other treatable infectious and inflammatory causes. The management of LETM is dependent on differentiating inflammatory and non-inflammatory aetiologies If there is an underlying inflammatory cause they are at high risk of further attacks. So they may require long term immuno suppression to prevent further attacks.