A recent study of the NMO disease spectrum described a 77% prevalence of LETM among 13 patients, 4 whereas another study reported diffuse spinal cord lesions in only 13% of 104 conventional MS patients. Knowledge of LETM aetiology is helpful to initiate appropriate therapy and predict prognosis.

Previous case reports of LETM have focused upon the early distinction of LETM from MS to enable prompt and appropriate therapy, here we additionally emphasise the clinical importance of NMO-IgG serological status. LETM is an inflammatory condition of the spinal cord causing variable levels of morbidity and mortality. Proprioception in the left foot was reduced up to the ankle. She had reduced sensation to light touch and vibration in her left lower limb and a sensory level at T10. Reflexes were brisk throughout the lower limbs with flexor plantar responses. She had bilateral weakness of hip flexion, right knee extension and ankle dorsiflexion (MRC grade 4). On examination, cranial nerves and upper limbs were normal. She had no symptoms in the interim and no previous neurological problems.

Following a course of intravenous steroids, power and sensation in her leg improved, and repeat spinal MRI had shown reduced cord swelling. A spinal MRI at the time showed an area of high intensity extending from C5/C6 to T3/T4 and visual evoked potentials were normal. Five years previously she had an episode of left leg numbness followed by progressive weakness over a 5-week period resulting in difficulty walking. Her vision, bowel and bladder were normal. She also complained of a ‘band like’ sensation around her trunk. A 31-year-old woman presented with progressive bilateral leg weakness and numbness over a 5-day period.

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