A reversible cause of longitudinally extensive transverse myelopathy answer

Abstract

D. Posterior reversible encephalopathy syndrome with spinal cord involvement Longitudinal transverse extensive myelitis (LETM) is defined as an inflammatory spinal cord lesion that appears on spinal MRI with high signal intensity on T2-weighted sequences and extends over three or more vertebral segments [[1]Trebst C. Raab P. Voss E.V. et al.Longitudinal extensive transverse myelitis–it’s not all neuromyelitis optica.Nat Rev Neurol. 2011; 7: 688-698Crossref PubMed Scopus (116) Google Scholar]. LETM arises secondary to a large number of etiologies, including neuromyelitis optica spectrum disorders and other demyelinating disorders, systemic inflammatory and autoimmune diseases, infectious diseases, neoplastic and paraneoplastic processes, and rarely, nutritional and vascular causes [[1]Trebst C. Raab P. Voss E.V. et al.Longitudinal extensive transverse myelitis–it’s not all neuromyelitis optica.Nat Rev Neurol. 2011; 7: 688-698Crossref PubMed Scopus (116) Google Scholar]. Posterior reversible encephalopathy syndrome (PRES) with spinal cord involvement can be present in several conditions, such as uncontrolled high blood pressure, renal failure and during the use of immunosuppressive agents [[2]Hinchey J. Chaves C. Appignani B. et al.A reversible posterior leukoencephalopathy syndrome.N Engl J Med. 1996; 334: 494-500Crossref PubMed Scopus (2706) Google Scholar]. Despite the usual association with parieto-occipital signal abnormalities, infratentorial and spine compromise have also been reported [2Hinchey J. Chaves C. Appignani B. et al.A reversible posterior leukoencephalopathy syndrome.N Engl J Med. 1996; 334: 494-500Crossref PubMed Scopus (2706) Google Scholar, 3de Havenon A. Joos Z. Longenecker L. et al.Posterior reversible encephalopathy syndrome with spinal cord involvement.Neurology. 2014; 83: 2002-2006Crossref PubMed Scopus (54) Google Scholar]. Spinal cord involvement in the context of PRES (PRES-SCI) is extremely rare, and gives rise to longitudinally extensive spinal lesions, frequently correlating with Grade IV hypertensive retinopathy [[3]de Havenon A. Joos Z. Longenecker L. et al.Posterior reversible encephalopathy syndrome with spinal cord involvement.Neurology. 2014; 83: 2002-2006Crossref PubMed Scopus (54) Google Scholar]. Therefore, PRES-SCI should be suspected in patients with longitudinally extensive transverse myelitis during hypertensive emergencies. The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication. A reversible cause of longitudinally extensive transverse myelopathy: questionJournal of Clinical NeuroscienceVol. 22Issue 11PreviewA 27-year-old man presented with a 5 day history of progressive headache with nausea, vomiting, blurred vision, weakness in the lower limbs and urinary incontinence. His past medical and familial histories were unremarkable. An examination revealed blood pressure of 230/140 mmHg, bilateral hypertensive retinopathy with papilledema, and mild paraparesis with brisk tendon reflexes. His blood tests revealed elevated creatinine (3.4 mg/dL) and urea (145 mg/dL) levels. The MRI scan of the brain and spine showed a longitudinally extensive signal change from the brainstem down to the mid-thoracic spine level, without contrast enhancement (Fig. Full-Text PDF