Longitudinally extensive spinal cord lesion

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 spectrum disorder (NMOSD) but can be seen in a number of other conditions, including ^1-5:

• neuromyelitis optica spectrum disorder (NMOSD)

• multiple sclerosis

  • confluent short segment lesions mimicking LESCL

• myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)

• autoimmune GFAP astrocytopathy

• systemic illness

  • neurosarcoidosis

  • Sjögren syndrome

  • systemic lupus erythematosus (SLE)

  • Behçet disease

  • paraneoplastic myelitis

• other causes of transverse myelitis

  • idiopathic (aquaporin-4 negative)

  • post-infectious

• vascular

  • spinal cord infarction

  • dural arteriovenous fistula (dAVF)