Table 3

Patients with myelitis and brainstem attacks

PatientFirst attackFurther attacks before study-baselineTime since last brainstem attackMRI at study-baseline
1Combined brainstem syndrome (double vision, nystagmus, tinnitus, headache, neck pain) and cervical myelitis (left hemiparesis)Six episodes of myelitis (incl. cervical myelitis), no further brainstem attacks20.9 years
(last brainstem attack was the first attack)
LETM including the medulla and cervical spinal cord (to level C5)
2Combined brainstem/ area postrema syndrome (double vision, nausea, vomiting, hiccups, dizziness) and cervical myelitis (sensory loss and dysaesthesias on the left)One further attack: combined brainstem syndrome (dizziness, double vision, nystagmus) and cervical myelitis (right hemiparesis and hemiataxia)3.7 yearsLETM including the medulla and cervical spinal cord (to level C6)
3Combined cervical myelitis (paresthesias on the left hemibody and spastic tetraparesis) with brainstem syndrome (‘brainstem encephalitis’; no further details available)One further attack with nausea/vomiting and fatigue (probably brainstem/area postrema syndrome)14.1 yearsLesions in the medulla and in the cervical spinal cord (level C5)
4Combined brainstem syndrome (dizziness, nystagmus, balance problems, headache and neck pain) and cervical myelitis (sensory loss in four extremities and trunk)Five episodes of optic neuritis and two of myelitis, no further brainstem attacks6.7 years (last brainstem attack was the first attack)LETM including the medulla and cervical spinal cord (to level C7)
5Brainstem syndrome/area postrema (double vision, nausea, vomiting, dizziness)One myelitis (1 month after first attack), no further brainstem attacks1.3 years (last brainstem attack was the first attack)Multiple lesions in the medulla and cervical spinal cord, LETM in thoracic spinal cord (Th4-10)
  • The lesions in the medulla and spinal cord of these patients were identified by two raters: a board-certified neurologist with experience in neuroimaging (AP) and a board-certified neuroradiologist (MS), on sagittal T2-weighted spinal cord MR images (repetition time (TR)=3500 ms, echo time (TE)=101 ms, in-plane resolution=0.91 mm×0.91 mm, slice thickness=2 mm).

  • C, cervical; LETM, longitudinal extensive transverse myelitis; Th, thoracic.