| Spinal cord tumor versus transverse myelitis. | |
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MedLine Citation:
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PMID: 22082692 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND CONTEXT: Longitudinally extensive transverse myelitis (LETM) is one of the defining features of neuromyelitis optica (NMO). Despite the well-established criteria, clinical and paraclinical features, the disease is often misdiagnosed and erroneously treated. PURPOSE: We report on a case of LETM in a patient with spatially limited NMO spectrum disorder that was misdiagnosed as spinal cord tumor and underwent spinal cord biopsy. STUDY DESIGN: A 43-year-old female patient is described. METHODS: The patient developed spastic tetraparesis over 1 week. Spinal cord magnetic resonance imaging (MRI) revealed LETM, and she was treated with steroids and recovered. Nine months later, her condition worsened and repeat spinal cord MRI was interpreted as a large intramedullary tumor in the cervical region with irregular postcontrast enhancement. Biopsy revealed demyelination. Cerebrospinal fluid (CSF) analysis revealed positive oligoclonal IgG bands, and serum was positive for NMO-IgG antibody. RESULTS: The patient was diagnosed with spatially limited NMO spectrum disorder, treated with plasma exchange, high-dose corticosteroids, and cyclophosphamide, and with good recovery. CONCLUSIONS: The factors favoring inflammatory LETM are acute or subacute onset of clinical symptoms, positive oligoclonal bands in the CSF, positive NMO-IgG or other antibodies, and brain MRI showing demyelinating lesions. Postcontrast axial MRI sequences of the spinal cord can also be helpful. In doubtful situations, a trial of therapy and follow-up MRI a month later might be a more prudent approach if the patient is not rapidly deteriorating. |
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Authors:
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Mario Habek; Ivan Adamec; Vesna V Brinar |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-12 |
Journal Detail:
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Title: The spine journal : official journal of the North American Spine Society Volume: - ISSN: 1878-1632 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101130732 Medline TA: Spine J Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kišpaticeva 12, HR-10000 Zagreb, Croatia; Refferal Center for Demyelinating Diseases of the Central Nervous System, Department of Neurology, University Hospital Center, Kišpaticeva 12, HR-10000 Zagreb, Croatia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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