A woman with acute myelopathy in pregnancy: case outcome

Four weeks ago ( BMJ 2009;339:b3862) we described the case of 23 year old Andrea G, who presented with progressive transverse spinal cord syndrome in early pregnancy. Her symptoms recurred during a subsequent pregnancy ( BMJ 2009;339:b4025). We considered many possible causes, including autoimmune inflammatory disorders such as multiple sclerosis or systemic lupus erythematosus and acute rubella infection, but these were excluded by the combination of clinical presentation and the results of laboratory tests or magnetic resonance imaging (MRI). Since the most striking feature was the vertical extension of the spinal cord lesion on MRI, we considered recurrent relapses of longitudinally extensive transverse myelitis to be the most likely diagnosis. This condition is characterised by transverse myelitis with spinal cord lesions extending over three or more vertebral segments.1 Tests showed anti-aquaporin 4 (AQP4) antibodies in our patient’s serum, …