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Longitudinally extensive spinal cord lesion

Last revised by Rohit Sharma ◉ on 11 Jan 2025

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Sharma R, Alwalid O, et al. Longitudinally extensive spinal cord lesion. Reference article, Radiopaedia.org (Accessed on 17 Jan 2025) https://doi.org/10.53347/rID-26463

DOI:

https://doi.org/10.53347/rID-26463

Permalink:

https://radiopaedia.org/articles/26463

rID:

26463

Article created:

23 Dec 2013, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

11 Jan 2025, Rohit Sharma ◉

Disclosures:

At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.

View Rohit Sharma's current disclosures

Revisions:

27 times, by 13 contributors - see full revision history and disclosures

Systems:

Central Nervous System, Spine

Synonyms:

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

Longitudinally extensive spinal cord lesions (LESCL) represent extensive involvement of the spinal cord, with abnormal T2 signal traversing at least three vertebral body segments in length.

Longitudinally extensive spinal cord lesions (LESCL) are also commonly referred to as longitudinally extensive transverse myelitis (LETM), however, the two are not completely synonymous. The latter only includes inflammatory etiologies, whilst the former is more inclusive of other pathologies (e.g. spinal cord infarction).

Pathology

There are many potential causes, including ^1-9:

primary CNS autoimmune illness
systemic autoimmune illness
- neurosarcoidosis
- Sjögren syndrome
- systemic lupus erythematosus (SLE)
- Behçet disease
- paraneoplastic myelitis (e.g. anti-CRMP-5, anti-amphiphysin, anti-Hu)
other causes of transverse myelitis
- idiopathic
- post-infectious or infectious (e.g. HTLV-1-associated myelopathy, poliomyelitis, poliomyelitis-like syndrome, tuberculous myelopathy)
vascular
- spinal cord infarction
- spinal dural arteriovenous fistula (dAVF)
toxic
- heroin myelopathy

Differential diagnosis

multiple sclerosis: confluent short segment lesions mimicking a longitudinally extensive spinal cord lesion

References

1. Barnett Y, Sutton IJ, Ghadiri M et-al. Conventional and Advanced Imaging in Neuromyelitis Optica. AJNR Am J Neuroradiol. 2013; . doi:10.3174/ajnr.A3592 - Pubmed citation
2. Matsuoka T, Matsushita T, Kawano Y et-al. Heterogeneity of aquaporin-4 autoimmunity and spinal cord lesions in multiple sclerosis in Japanese. Brain. 2007;130 (5): 1206-23. doi:10.1093/brain/awm027 - Pubmed citation
3. Trebst C, Raab P, Voss EV et-al. Longitudinal extensive transverse myelitis-it's not all neuromyelitis optica. Nat Rev Neurol. 2011;7 (12): 688-98. doi:10.1038/nrneurol.2011.176 - Pubmed citation
4. Shan F, Long Y, Qiu W. Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Review of the Literature. (2018) Frontiers in immunology. 9: 2802. doi:10.3389/fimmu.2018.02802 - Pubmed
5. Birnbaum J, Lalji A, Piccione E, Izbudak I. Magnetic Resonance Imaging of the Spinal Cord in the Evaluation of 3 Patients with Sensory Neuronopathies: Diagnostic Assessment, Indications of Treatment Response, and Impact of Autoimmunity: A Case Report. Medicine (Baltimore). 2017;96(49):e8483. doi:10.1097/MD.0000000000008483 - Pubmed
6. Dixon L, McNamara C, Dhasmana D, Taylor G, Davies N. Imaging Spectrum of HTLV-1–Related Neurologic Disease. Neur Clin Pract. 2023;13(3):e200147. doi:10.1212/cpj.0000000000200147 - Pubmed
7. Holroyd K & Berkowitz A. Metabolic and Toxic Myelopathies. CONTINUUM: Lifelong Learning in Neurology. 2024;30(1):199-223. doi:10.1212/con.0000000000001376 - Pubmed
8. Md Noh M, Bahari N, Abdul Rashid A. Tuberculous Myelopathy Associated with Longitudinally Extensive Lesion: A Clinicoradiological Review of Reported Cases. J Clin Neurol. 2020;16(3):369-75. doi:10.3988/jcn.2020.16.3.369 - Pubmed
9. Passeri M, Matthews E, Kammeyer R, Piquet A. Update in Autoimmune and Paraneoplastic Myelopathies: Newly Described Antigen Targets and Antibody Testing. Front Neurol. 2022;13:972143. doi:10.3389/fneur.2022.972143 - Pubmed

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Longitudinally extensive spinal cord lesion

Citation, DOI, disclosures and article data

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