Spectrum of spinal cord demyelination: A retrospective study in a tertiary care hospital of eastern India

Abstract

Background: The Idiopathic inflammatory demyelinating diseases of Central nervous system (IIDD) are common neurological disorders in neurology indoor. CNS demyelinations which affect brain, spinal cord and optic nerve are important neurological disorder in view of multi axial involvement and frequent relapse and causing significant morbidity. Materials and Methods : It is a retrospective study done in a tertiary care hospital in eastern India from Aug2018-jul2019 (one year). Patients presenting with paraplegia or paraparesis, quadriplegia or quadriparesis with MRI showing features of demyelination were included in the study. Different criteria was taken for diagnosis to know the etiology of disease (mentioned in the introduction). Statistical Analysis Done Using SPSS Software Version-21. Result: Among all spinal cord demyelination longitudinally extended transverse myelitis (LETM) was more common than short segment demyelination. In our study >40yrs group is most commonly affected with more female preponderance. Serum AQP4-Ab was positive in 28% of LETM patients. EDSS was higher in LETM patients than non LETM patients. Conclusion: Among all spinal cord demyelination LETM is more common than short segment demyelination. Optic neuritis and multiphasic course was more associated in LETM with AQP4 positive NMOSD. Tuberculosis is a cause of LETM. Therefore, patients presenting with LETM require a thorough investigative workup to exclude treatable causes like infectious, inflammatory or metabolic. Key message: Spinal cord demyelination possess a wide range with multiple etiologies. Disease course, treatment and prognosis varies in different conditions. All spinal cord demyelination should be evaluated in detail to prevent frequent relapse and morbidity As spinal cord biopsy is an invasive procedure with significant morbidity MRI lesion location, length and enhancement pattern will help to narrow the possibilities. Keywords: LETM, NMOSD, AQ4A