Longitudinally extensive transverse myelitis associated with intrathecal synthesis of oligoclonal immunoglobulin G and with vitamin B12 deficiency

Abstract

The differential diagnosis of transverse myelitis (TM) is a challenging clinical problem due to a wide range of diseases, the pattern of which may include TM. Comorbidity is also a highly relevant problem in the development of inflammatory myelopathies. The described clinical case demonstrates difficulties in the nosological diagnosis in case of monophasic TM concurrent with its several probable causes. An examination of a female patient with longitudinally extensive TM and a history of two cerebral ischemic strokes also revealed the reduced levels of vitamin B12 in serum and oligoclonal IgG in cerebrospinal fluid. A CNS lesion is regarded as a possible interaction of two typical pathological processes: inflammation and thrombogenesis. In this case vitamin B12 deficiency could predispose to the initiation and maintenance of the above mechanisms. The specific features of formulation of a diagnosis in patients with such multifactorial conditions are considered.

Keywords

• inflammatory myelopathy
• longitudinally extensive transverse myelitis
• demyelination
• vitamin b12 deficiency
• comorbidity