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February 21, 2012; 78 (8) Articles

Solitary sclerosis

Progressive myelopathy from solitary demyelinating lesion

William F. Schmalstieg, B. Mark Keegan, Brian G. Weinshenker
First published February 8, 2012, DOI: https://doi.org/10.1212/WNL.0b013e318247cc8c
William F. Schmalstieg
MD
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B. Mark Keegan
MD
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Brian G. Weinshenker
MD
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Solitary sclerosis
Progressive myelopathy from solitary demyelinating lesion
William F. Schmalstieg, B. Mark Keegan, Brian G. Weinshenker
Neurology Feb 2012, 78 (8) 540-544; DOI: 10.1212/WNL.0b013e318247cc8c

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Abstract

Objective: To present a case series of patients with progressive myelopathy in the setting of a solitary demyelinating lesion.

Methods: We describe 7 patients evaluated over a 6-year period. All had progressive motor impairment attributable to an MRI lesion compatible with a demyelinating plaque in the brainstem or upper cervical spinal cord. At the time of evaluation, none met the International Panel imaging criteria for dissemination in space, and none described clinical symptoms consistent with relapses affecting other portions of the CNS.

Results: Lesions identified were in the ventral cervicomedullary junction in 4 patients, the ventral spinal cord in 2 patients, and the pons in 1 patient. Median age at onset was 43 years (range 33–51 years). Median follow-up interval was 3 years (range 2–27 years). Six patients reached an Expanded Disability Status Scale (EDSS) score of 6.0 or worse. Median time to EDSS score of 6.0 was 7.5 years (range 1.5–26 years). Four had CSF findings characteristic of multiple sclerosis (MS). None had CSF, imaging, or serologic evidence of an alternative etiology of progressive myelopathy. In 3 patients, serial MRI scans of the brain and spinal cord demonstrated no accumulation of lesions. Postmortem examination of a fourth patient demonstrated an isolated pontine demyelinating lesion.

Conclusions: Solitary demyelinating lesions may produce a progressive myelopathy similar to primary progressive MS. Demyelinating disease should be in the differential diagnosis of progressive myelopathy despite absence of dissemination in space.

Footnotes

  • EDSS=
    Expanded Disability Status Scale;
    MS=
    multiple sclerosis;
    NMO=
    neuromyelitis optica

  • Received July 8, 2011.
  • Accepted October 17, 2011.
  • Copyright © 2012 by AAN Enterprises, Inc.
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Letters: Rapid online correspondence

  • Response to Dr. Lattanzi
    • William F. Schmalstieg, Fellow, Mayo Clinicschmalstieg.william@mayo.edu
    Submitted April 09, 2012
  • Idiopathic progressive myelopathy in adults.
    • Simona Lattanzi, Medical Doctor, Institute of Neurologyalfierelattanzisimona@gmail.com
    • Simona Lattanzi, Ancona, Italy
    Submitted April 03, 2012
  • Re:Solitary sclerosis: Progressive myelopathy from solitary demyelinating lesion
    • Viviana Nociti, Medical Doctor, Institute of Neurology, Catholic University of Romeviv.nociti@libero.it
    • Anna Paola Batocchi, Marco Luigetti, Amelia Conte and Mario Sabatelli
    Submitted March 02, 2012
  • Response to Dr. Nociti
    • William F. Schmalstieg, schmalstieg.william@mayo.edu
    • B. Mark Keegan, Brian Weinshenker
    Submitted March 02, 2012
  • Solitary sclerosis: Progressive myelopathy from solitary demyelinating lesion
    • Thomas F. Scott, Doctor, Allegheny General HospitalTSCOTT@wpahs.org
    Submitted February 14, 2012
  • Reply to Dr. Scott
    • William F. Schmalstieg, Fellow, Mayo Clinicschmalstieg.william@mayo.edu
    • B. Mark Keegan and Brian Weinshenker
    Submitted February 14, 2012
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