PMC8119990_01
MRI progression: at time of diagnosis (A1-4), 3 days after last dose of p.o. MP (B) and 11 days after last dose of p.o. MP (C). (A1) Sagittal T2-weighted MRI of columna totalis showing extensive LETM at cervical and thoracic levels. (A2) Sagittal T1-weighted MRI of columna totalis with contrast showing contrast enhancement at levels Th5-Th9. (A3) Sagittal T1-weighted MRI with contrast showing enhancement from C4-Th1. (A4) Axial T1-weighted MRI with contrast showing anterolateral multifocal contrast enhancement at level Th9. (B) Sagittal T2-weighted MRI of columna totalis showing almost complete regression of LETM. No contrast enhancement on T1 (not shown). (C) Sagittal T2-weighted MRI of columna totalis with relapsing LETM on levels Th5-Th11. Contrast enhancement on T1 weighted MRI (not shown).
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F1
While an MRI of the cerebrum showed no signs of pathology, a repeat MRI of the spinal column with contrast confirmed LETM (Figure 1A).
Indirect immunofluorescence assay on primate cerebellar and intestinal sections. (A,B) Granular cytoplasmic and dendritic fluorescence of Purkinje cells and a granular fluorescence of the molecular and granular cerebellar layers. (A) Sera in dilution 1:100, (B) undiluted CSF. (C) Granular cytoplasmic fluorescens of neurons in the intestinal plexus myentericus. Undiluted CSF.
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F2
LETM remitted during treatment and MRI confirmed LETM regression (Figure 2B). CT showed signs of paralytic ileus and an MRI showed relapsing LETM (Figure 2C).
Timeline with selected events and data. p.o., oral; i.v., intravenous; MRI, magnetic resonance imaging; CSF, cerebrospinal fluid; IFA, indirect immunofluorescence assay; MP, methylprednisolone; PEX, plasmapheresis; CT, computer tomography; GI, gastrointestinal.
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F3
An overview of the timeline is illustrated in Figure 3.