Solmaz Asnafi1, P Pearse Morris2, Elia Sechi1, Sean J Pittock3, Brian G Weinshenker1, Jacqueline Palace4, Silvia Messina5, Eoin P Flanagan6. 1. Departments of Neurology, Mayo Clinic, Rochester, MN, USA. 2. Departments of Radiology, Mayo Clinic, Rochester, MN, USA. 3. Departments of Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA. 4. Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; Department of Pharmacology, University of Oxford, Oxford, UK. 5. Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK. 6. Departments of Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA. Electronic address: Flanagan.Eoin@mayo.edu.
Abstract
BACKGROUND: Determining the frequency of longitudinally-extensive transverse myelitis (LETM: T2-lesion ≥3 vertebral segments) in multiple sclerosis (MS) is essential to assess its utility in differentiating from aquaporin-4-IgG (AQP4-IgG) positive neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein-IgG (MOG-IgG) myelitis. We sought to determine the frequency of LETM in MS during a myelitis attack. METHODS: We identified Olmsted County (MN, USA) residents on 12/31/2011 with inflammatory demyelinating disease. Inclusion criteria were: 1) Clinical myelitis episode accompanied by a new spinal magnetic resonance imaging (MRI) lesion (≤6 weeks from onset); 2) MS diagnosis by 2010 McDonald criteria; 3) Seronegative for AQP4-IgG and MOG-IgG. MRI characteristics were determined. RESULTS: Sixty-seven patients (median age at myelitis: 41 years [range, 16-65]; 76% females) with 92 myelitis attacks accompanied by a new MRI spinal cord lesion were identified. The frequency of LETM was 0%. The median T2-hyperintense lesion length in vertebral segments was 1.0 (range, 0.5-2.5) and 82/92 (89%) were peripheral in location on axial sequences; 58% had associated gadolinium enhancement. Two patients (2% of attacks) had multiple short lesions resembling LETM on sagittal images but axial sequences confirmed multiple non-contiguous short lesions. CONCLUSION: LETM is rare in adult MS myelitis and its presence should prompt evaluation for AQP4-IgG, MOG-IgG or other etiologies. Careful scrutiny of axial images is important as coalescence of multiple short lesions may lead to the artifactual appearance of an LETM.
BACKGROUND: Determining the frequency of longitudinally-extensive transverse myelitis (LETM: T2-lesion ≥3 vertebral segments) in multiple sclerosis (MS) is essential to assess its utility in differentiating from aquaporin-4-IgG (AQP4-IgG) positive neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein-IgG (MOG-IgG) myelitis. We sought to determine the frequency of LETM in MS during a myelitis attack. METHODS: We identified Olmsted County (MN, USA) residents on 12/31/2011 with inflammatory demyelinating disease. Inclusion criteria were: 1) Clinical myelitis episode accompanied by a new spinal magnetic resonance imaging (MRI) lesion (≤6 weeks from onset); 2) MS diagnosis by 2010 McDonald criteria; 3) Seronegative for AQP4-IgG and MOG-IgG. MRI characteristics were determined. RESULTS: Sixty-seven patients (median age at myelitis: 41 years [range, 16-65]; 76% females) with 92 myelitis attacks accompanied by a new MRI spinal cord lesion were identified. The frequency of LETM was 0%. The median T2-hyperintense lesion length in vertebral segments was 1.0 (range, 0.5-2.5) and 82/92 (89%) were peripheral in location on axial sequences; 58% had associated gadolinium enhancement. Two patients (2% of attacks) had multiple short lesions resembling LETM on sagittal images but axial sequences confirmed multiple non-contiguous short lesions. CONCLUSION: LETM is rare in adult MS myelitis and its presence should prompt evaluation for AQP4-IgG, MOG-IgG or other etiologies. Careful scrutiny of axial images is important as coalescence of multiple short lesions may lead to the artifactual appearance of an LETM.
Authors: Elia Sechi; Laura Cacciaguerra; John J Chen; Sara Mariotto; Giulia Fadda; Alessandro Dinoto; A Sebastian Lopez-Chiriboga; Sean J Pittock; Eoin P Flanagan Journal: Front Neurol Date: 2022-06-17 Impact factor: 4.086
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Authors: Pietro Zara; Valentina Floris; Eoin P Flanagan; A Sebastian Lopez-Chiriboga; Brian G Weinshenker; Paolo Solla; Elia Sechi Journal: Mult Scler J Exp Transl Clin Date: 2021-11-19
Authors: Giulia Fadda; Cesar A Alves; Julia O'Mahony; Denise A Castro; E Ann Yeh; Ruth Ann Marrie; Douglas L Arnold; Patrick Waters; Amit Bar-Or; Arastoo Vossough; Brenda Banwell Journal: JAMA Netw Open Date: 2021-10-01
Authors: Elia Sechi; Karl N Krecke; Steven A Messina; Marina Buciuc; Sean J Pittock; John J Chen; Brian G Weinshenker; A Sebastian Lopez-Chiriboga; Claudia F Lucchinetti; Nicholas L Zalewski; Jan Mendelt Tillema; Amy Kunchok; Salvatore Monaco; Padraig P Morris; James P Fryer; Adam Nguyen; Tammy Greenwood; Stephanie B Syc-Mazurek; B Mark Keegan; Eoin P Flanagan Journal: Neurology Date: 2021-07-14 Impact factor: 9.910