title: LETM presented with causalgia and ensued by sudden death.
abstract: BACKGROUND
  Longitudinally Extensive Transverse Myelitis LETM is a specific pattern of myelitis wherein at least three continuous vertebral segments are involved. Characteristically, it is a defining feature of neuromyelitis optica NMO. However, it is described in many other etiologies.
  
  
  METHODS
  We present a case of 60 year old male who presented with symptoms and signs of regional sympathetic dystrophy RSD followed by symptoms of myelitis. Spinal cord MRI revealed cervical LETM extending to the brainstem. In spite of serological negativity, treatment of suspected neuromyelitis optica spectrum disorder NMOSD was initiated and resulted in symptom relief. Meanwhile, sudden death occurred and autonomic dysreflexia was the main culprit.
  
  
  CONCLUSIONS
  This case suggests that RSD could be the mere primary presentation of LETM, discusses the differential diagnoses of LETM in elderly patients, and suggests the possible risk of autonomic dysreflexia in such patients.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria. iamrana13@yahoo.com.
authors.forename: Rana Alnasser
authors.initials: RA
authors.lastname: Alsukhni
authors.affiliation: Division of Neurology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Aboras
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria.
authors.forename: Ziena
authors.initials: Z
authors.lastname: Jriekh
authors.affiliation: Department of Laboratory Medicine, Aleppo University Hospital, Aleppo, Syria.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Almalla
authors.affiliation: Division of Neurology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria.
authors.forename: Ahmad Sheikh
authors.initials: AS
authors.lastname: El-Kahwateya
mesh_terms: D001933:Brain Stem / Q000473:pathology; D002422:Causalgia / Q000209:etiology*; D003645:Death, Sudden; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D009471:Neuromyelitis Optica / Q000175:diagnosis
keywords: Cervical spinal tumor; LETM; NMOSD; RSD