Longitudinally extensive transverse myelitis preceding primary central nervous system lymphoma: Spinal sentinel neuroinflammation

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2022.2087137 · Published: May 1, 2023

Simple Explanation

A 65-year-old woman was initially diagnosed with longitudinally extensive transverse myelitis (LETM), an inflammation of the spinal cord. She responded well to treatment, and her spinal lesion disappeared within two months. Nine months later, she developed primary central nervous system lymphoma (PCNSL), a type of cancer affecting the brain, while her spinal cord remained clear of lesions. The initial LETM episode may represent an early inflammatory reaction, termed 'spinal sentinel neuroinflammation,' indicating a potential underlying condition like lymphoma.

Study Duration

2 years

Participants

One 65-year-old female

Evidence Level

Case Report

Key Findings

1
The patient presented with LETM and responded well to immunotherapy, but was later diagnosed with PCNSL.
2
The spinal lesion from LETM resolved completely with initial treatment and did not recur during the follow-up period, even after the diagnosis of PCNSL.
3
The case suggests that LETM could be a 'sentinel' neuroinflammatory event preceding the development of PCNSL.

Research Summary

This case report describes a 65-year-old female who initially presented with longitudinally extensive transverse myelitis (LETM) and subsequently developed primary central nervous system lymphoma (PCNSL). The patient's LETM responded well to immunotherapy, but nine months later, she was diagnosed with PCNSL, while the spinal cord lesion did not recur. The authors propose that the initial LETM episode might represent a spinal sentinel neuroinflammation, potentially serving as an early indicator of PCNSL.

Practical Implications

Diagnostic Awareness

Clinicians should consider the possibility of underlying malignancies, such as PCNSL, in patients presenting with LETM, especially when atypical features are present.

Further Investigation

Atypical presentations of LETM should prompt a thorough diagnostic workup, including imaging and laboratory studies to rule out other potential etiologies.

Pathophysiology Research

Further research is needed to understand the relationship between sentinel neuroinflammation and the development of PCNSL.

Study Limitations

1
Single case report limits generalizability.
2
Definitive diagnosis of the initial LETM episode remains obscure.
3
Further investigations regarding the pathophysiology sentinel neuroinflammation are needed.

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