What is the differential diagnosis of an LETM lesion?
The differential is extensive and can be classified into the following: INFLAMMATORY: neuromyelitis optica, Sjogren’s, systemic lupus erythematous, Behcet’s, sarcoidosis, rheumatoid arthritis, ankylosing spondylitis, mixed connective tissue diseases, antiphospholipid syndrome, MS/ADEM. INFECTIOUS: HIV, HTLV I and II, syphilis, CMV, HSV, VZV. METABOLIC: copper deficiency, vitamin B12 deficiency. VASCULAR: dural arteriovenous fistula, infarction, fibrocartilaginous embolism. TUMOUR: primary, lymphoma, paraneoplastic. OTHERS: radiation myelopathy, trauma.
On sagittal T2, there is long segment cord abnormality with hyperintensity and cord expansion. Appearances are consistent with a longitudinal extensive transverse myelitis (LETM). Unfortunately, contrast was not administered on this unsupervised GP referral list.