Severe neurological manifestations of LETM with brainstem involvement: A dual case report

Background: Transverse myelitis (TM) is a rare neurological disorder characterized by inflammation of the spinal cord, which can cause varying degrees of motor, sensory, and autonomic dysfunction. Longitudinally extensive transverse myelitis (LETM) refers to TM that extends over three or more vertebral segments and may be associated with brainstem involvement, leading to complex clinical symptoms.
Case presentation: This case report presents two cases of LETM with concurrent brainstem involvement, both the patients exhibited progressive neurological deficits, including limb weakness, sensory disturbances and cranial nerve related symptoms.
Imaging findings and management: MRI examination of the spine revealed T2 Hyperintense lesions extending over multiple vertebral segments, consistent with LETM. Brain MRI in both cases showed hyperintensities involving the medulla and pons, indicating brainstem involvement. The patients were managed with high-dose corticosteroids and supportive therapy. One of the patients showed marked clinical improvements, while the other required prolonged rehabilitation with partial neurological recovery.
Conclusion: LETM with brainstem involvement represents a severe neurological condition with complex clinical and radiological features. Early diagnosis through MRI and prompt immunosuppressive therapy are essential for improved outcomes.