Differential Diagnosis of Longitudinally Extensive Transverse Myelitis
Single Most Likely Diagnosis
- Neuromyelitis Optica Spectrum Disorder (NMOSD): This condition is characterized by the presence of autoantibodies against aquaporin-4, leading to inflammation and damage to the spinal cord and optic nerves. The longitudinally extensive nature of the myelitis is a hallmark of NMOSD, making it the most likely diagnosis.
Other Likely Diagnoses
- Multiple Sclerosis (MS): Although MS typically presents with shorter lesions, some patients can have longitudinally extensive transverse myelitis. The presence of oligoclonal bands in the cerebrospinal fluid and lesions on brain MRI can support this diagnosis.
- Systemic Lupus Erythematosus (SLE): SLE can cause transverse myelitis, and the longitudinally extensive form can occur, especially in patients with a history of SLE or other autoimmune disorders.
- Sjögren's Syndrome: This autoimmune disorder can also cause transverse myelitis, and the longitudinally extensive form has been reported in some cases.
Do Not Miss Diagnoses
- Spinal Cord Infarction: This is a medical emergency that requires prompt diagnosis and treatment. The clinical presentation can mimic longitudinally extensive transverse myelitis, and MRI can help differentiate between the two.
- Infections (e.g., HIV, HTLV-1, Syphilis): Certain infections can cause transverse myelitis, and the longitudinally extensive form can occur. These infections can have serious consequences if left untreated.
- Cancer (e.g., Lymphoma, Leukemia): Malignancies can cause transverse myelitis, and the longitudinally extensive form can be a presenting feature. Early diagnosis and treatment are crucial to improve outcomes.
Rare Diagnoses
- Acute Disseminated Encephalomyelitis (ADEM): ADEM is a rare inflammatory disorder that can cause transverse myelitis, although it typically presents with a more widespread involvement of the central nervous system.
- MOG Antibody-Associated Disease: This is a rare autoimmune disorder that can cause transverse myelitis, and the longitudinally extensive form has been reported in some cases.
- Behçet's Disease: This rare autoimmune disorder can cause transverse myelitis, although it is more commonly associated with other neurological manifestations.