4.3 Article

Contribution of spinal cord biopsy to diagnosis of aquaporin-4 antibody positive neuromyelitis optica spectrum disorder

Journal

MULTIPLE SCLEROSIS JOURNAL
Volume 20, Issue 7, Pages 882-888

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/1352458513510981

Keywords

Spinal cord tumor; longitudinally extensive spinal cord lesion; spinal biopsy; longitudinally extensive transverse myelitis; neuromyelitis optica; aquaporin-4 antibody

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Longitudinally extensive transverse myelitis is characteristic but not pathognomonic for neuromyelitis optica spectrum disorders (NMOSDs) and may mimic local tumors. In this retrospective study based on a cohort of 175 NMOSD patients we identified seven patients who initially presented with a longitudinally extensive spinal cord lesion and underwent spinal cord biopsy due to magnetic resonance imaging (MRI)-suspected malignancies. Remarkably, routine neuropathology was inconclusive and did not guide the diagnostic process to anti-aquaporin-4 (AQP4)-seropositive NMOSD. Serious postoperative complications occurred in 5/7 patients and persisted during follow-up in 2/7 patients (29%). Considering these sequelae, AQP4-antibody testing should be mandatory in patients with inconclusive longitudinally extensive spinal cord lesions prior to biopsy.

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