ORIGINAL ARTICLE Diagnostic approach of patients with longitudinally extensive transverse myelitis Mario Habek • Ivan Adamec • Goran Pavlis ˇa • Vesna V. Brinar Received: 2 June 2011 / Accepted: 22 September 2011 / Published online: 26 January 2012 Ó Belgian Neurological Society 2012 Abstract The aim of this study is to present a diagnostic and therapeutic approach in patients with LETM. In a period between June 2008 and June 2010, all patients who fulfilled criteria for LETM were included in the study. All patients underwent a standardized protocol of investiga- tions presented in this paper. Ten patients were included (5 male, 5 female, with the age distribution from 24 to 70 years). Four patients were diagnosed with NMO/spa- tially limited NMO spectrum disorder, three patients were diagnosed with spinal cord ADEM, two multiple sclerosis (MS) and one patient with copper deficiency myelopathy. Laboratory support for the diagnosis of NMO was positive NMO-IgG antibody; for the diagnosis of ADEM signs of peripheral nervous system involvement on electromyo- neurography; and for the diagnosis of MS brain MRI lesions typical for MS, as well as positive oligoclonal bands (OCB) in the cerebrospinal fluid (CSF). All cases with inflammatory myelopathy were treated either with steroids or plasma exchange and copper replacement was started in the case of copper deficiency. The mean time from the first symptom until the final diagnosis was 16.3 months (range 1 month to 7 years). As each of idiopathic inflammatory demyelinating diseases that can present with LETM have specific therapy, the postpone- ment in making the correct diagnosis can lead to a poor recovery. In patients with LETM, a standardized diagnostic approach can result in a correct diagnosis and appropriate treatment. Keywords Longitudinally extensive transverse myelitis Á Neuromyelitis optica Á Multiple sclerosis Á Acute disseminated encephalomyelitis Introduction Longitudinally extensive transverse myelitis (LETM) is defined as a more or less symmetrical lesion which expands over three or more vertebral segments of the spinal cord and is hyperintense on T2-weighted magnetic resonance images [1]. While it is a common finding in neuromyelitis optica (NMO) [2], other inflammatory and non-inflamatory demyelinating diseases should be considered in the dif- ferential diagnosis of LETM. We report 10 consecutive patients with LETM that were referred to our center, the diagnostic procedure they underwent and therapy outcome. Patients and methods In a period between June 2008 and June 2010, all patients who fulfilled criteria for LETM (T2 hyperintense lesion that expanded for three or more vertebral segments) were included in the study. All patients underwent a standard- ized investigation protocol which included: MRI of the brain and spine, cerebrospinal fluid examination, tests for serum NMO IgG antibodies (indirect immunoflores- cence), immunologic work-up (extractable nuclear M. Habek Á I. Adamec Á V. V. Brinar Department of Neurology, University Hospital Center Zagreb, Refferal Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia M. Habek (&) Department of Neurology, School of Medicine, University of Zagreb, Kis ˇpatic ´eva 12, 10000 Zagreb, Croatia e-mail: mhabek@mef.hr G. Pavlis ˇa Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia 123 Acta Neurol Belg (2012) 112:39–43 DOI 10.1007/s13760-012-0006-4