Longitudinally extensive spinal cord lesion

Dr Rohit Sharma and A.Prof Frank Gaillard ◉ ◈ et al.

Longitudinally extensive spinal cord lesions (LESCL), also known as longitudinally extensive transverse myelitis (LETM), represent extensive involvement of the spinal cord, with abnormal T2 signal traversing at least three vertebral body segments in length.

Differential diagnosis

They are typical of neuromyelitis optica (NMO) but can be seen in a number of other conditions, including ^1-3:

neuromyelitis optica (NMO)
- opticospinal form of Asian MS (OSMS)
multiple sclerosis
- confluent short segment lesions mimicking LESCL
anti-MOG associated encephalomyelitis
systemic illness
other causes of transverse myelitis
- idiopathic (aquaporin 4 negative)
- post-infectious
vascular
- spinal cord infarction
- dural arteriovenous fistula (dAVF)

References

White matter disorders

white matter
normal myelination
terminology
white matter disorders
- demyelination
  - anti-MOG associated encephalomyelitis
  - Guillain-Barre Syndrome (GBS)
    - acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
    - axonal subtypes
      - acute motor axonal neuropathy (AMAN) (Chinese paralytic syndrome)
      - acute motor-sensory axonal neuropathy (AMSAN)
    - regional GBS syndromes
      - Miller Fisher variant
  - chronic inflammatory demyelinating polyneuropathy (CIDP)
  - transverse myelitis
  - tumefactive demyelinating lesions
  - acute disseminated encephalomyelitis (ADEM)
    - Callen MS-ADEM criteria
  - acute hemorrhagic encephalomyelitis (AHEM)
  - neuromyelitis optica (NMO) (Devic disease)
    - signs
      - marbled pattern of the corpus callosum
      - longitudinally extensive spinal cord lesion (LESCL)
  - multiple sclerosis (MS)
    - McDonald diagnostic criteria for MS (current 2017 revision)
      - previous 2016 MAGNIMS consensus
    - signs
    - variants
      - tumefactive multiple sclerosis
      - acute malignant Marburg type
      - Schilder type (diffuse cerebral sclerosis)
      - Balo concentric sclerosis (BCS)
      - opticospinal multiple sclerosis (OSMS)
  - radiologically isolated syndrome (RIS)
  - clinically isolated syndrome (CIS)
- astrocytopathies
- leuko-axonopathies
  - early-onset neuronal degenerative disorders
    - GM1 & GM2 gangliosidoses (e.g. Tay Sachs disease)
  - giant axonal neuropathy
  - hypomyelination with atrophy of the basal ganglia and cerebellum (H-ABC)
  - hypomyelination with congenital cataract
  - leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation
  - hypomyelination with brainstem and spinal cord involvement and leg spasticity
  - Pol III-related leukodystrophies
- leuko-vasculopathies
- microgliopathies
  - CSF1R-related disorders
    - adult-onset leukoencephalopathy with axonal spheroids and pigmented glia
    - pigmentary ortochromatic leukodystrophy
  - Nasu Hakola disease
- myelin disorders
  - hypomyelination
  - demyelination
    - metachromatic leukodystrophy
  - myelin vacuolisation
    - Canavan disease
    - globoid cell leukodystrophy (Krabbe disease)
    - mitochondrial disorders
    - multiple sulfatase deficiency
    - phenylketonuria
    - x-linked adrenoleukodystrophy
- other
  - adult-onset autosomal dominant leukodystrophy
  - cerebrotendinous xanthomathosis
  - cystic leukoencephalopathy without megalencephaly
  - L-2-hydroxyglutaric aciduria
  - lysosomal storage diseases
    - free sialic acid storage disorders (e.g. Salla disease)
    - Niemann-Pick disease
  - peroxisomal disorders
    - Zellweger syndrome
  - Sjögren-Larsson syndrome

Article information

rID: 26463

System: Central Nervous System, Spine

Section: Gamuts

Synonyms or Alternate Spellings:

Longitudinaly extensive spinal cord lesion (LESCL)
LESCL
Longitudinal extensive transverse myelitis
LETM

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Cases and figures

Case 1: NMOCase 1: NMO

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Case 2: neurosarcoidosisCase 2: neurosarcoidosis

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Case 3: neuromyelitis opticaCase 3: neuromyelitis optica

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Case 4: systemic lupus erythematosusCase 4: systemic lupus erythematosus

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