Longitudinally extensive spinal cord lesion

Dr Bruno Di Muzio ◈ 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
systemic illness
other causes of transverse myelitis
- idiopathic (aquaporin 4 negative)
- post-infectious
vascular
- spinal cord infarction
- dural arteriovenous fistula (dAVF)

References

Demyelination

demyelination
- primary demyelinating disorders
  - clinically isolated syndrome (CIS)
  - radiologically isolated syndrome (RIS)
  - multiple sclerosis (MS)
    - McDonald diagnostic criteria for MS (2017 revision)
      - previous 2016 MAGNIMS consensus
      - previous 2010 revision
      - previous 2001 - 2005 revisions
    - signs
    - variants
      - tumefactive multiple sclerosis
      - acute malignant Marburg type
      - Schilder type (diffuse cerebral sclerosis)
      - Balo concentric sclerosis (BCS)
      - opticospinal multiple sclerosis (OSMS)
  - neuromyelitis optica (NMO) (Devic disease)
    - signs
      - marbled pattern of the corpus callosum
      - longitudinally extensive spinal cord lesion (LESCL)
  - acute disseminated encephalomyelitis (ADEM) and acute haemorrhagic encephalomyelitis (AHEM)
  - tumefactive demyelinating lesions
  - transverse myelitis
  - chronic inflammatory demyelinating polyneuropathy (CIDP)
  - 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

Article information

rID: 26463

Systems: Central Nervous System, Spine

Section: Gamuts

Synonyms or Alternate Spellings:

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

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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