title: Spinal cord tumor versus transverse myelitis.
abstract: BACKGROUND
  Longitudinally extensive transverse myelitis (LETM) is one of the defining features of neuromyelitis optica (NMO). Despite the well-established criteria, clinical and paraclinical features, the disease is often misdiagnosed and erroneously treated.
  
  
  OBJECTIVE
  We report on a case of LETM in a patient with spatially limited NMO spectrum disorder that was misdiagnosed as spinal cord tumor and underwent spinal cord biopsy.
  
  
  METHODS
  A 43-year-old female patient is described.
  
  
  METHODS
  The patient developed spastic tetraparesis over 1 week. Spinal cord magnetic resonance imaging (MRI) revealed LETM, and she was treated with steroids and recovered. Nine months later, her condition worsened and repeat spinal cord MRI was interpreted as a large intramedullary tumor in the cervical region with irregular postcontrast enhancement. Biopsy revealed demyelination. Cerebrospinal fluid (CSF) analysis revealed positive oligoclonal IgG bands, and serum was positive for NMO-IgG antibody.
  
  
  RESULTS
  The patient was diagnosed with spatially limited NMO spectrum disorder, treated with plasma exchange, high-dose corticosteroids, and cyclophosphamide, and with good recovery.
  
  
  CONCLUSIONS
  The factors favoring inflammatory LETM are acute or subacute onset of clinical symptoms, positive oligoclonal bands in the CSF, positive NMO-IgG or other antibodies, and brain MRI showing demyelinating lesions. Postcontrast axial MRI sequences of the spinal cord can also be helpful. In doubtful situations, a trial of therapy and follow-up MRI a month later might be a more prudent approach if the patient is not rapidly deteriorating.
authors.affiliation: University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kišpaticeva 12, Zagreb, Croatia. mhabek@mef.hr
authors.forename: Mario
authors.initials: M
authors.lastname: Habek
authors.forename: Ivan
authors.initials: I
authors.lastname: Adamec
authors.forename: Vesna V
authors.initials: VV
authors.lastname: Brinar
mesh_terms: D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008279:Magnetic Resonance Imaging; D009471:Neuromyelitis Optica / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D043025:Oligoclonal Bands / Q000032:analysis; D010951:Plasma Exchange; D011782:Quadriplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D013116:Spinal Cord / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000175:diagnosis*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G; D043025:Oligoclonal Bands; D003520:Cyclophosphamide