Practice Interactive Case Report

A woman with acute myelopathy in pregnancy: case outcome

BMJ 2009; 339 doi: (Published 10 December 2009) Cite this as: BMJ 2009;339:b4026
  1. Reinhard Reuß, physician 1,
  2. Paulus S Rommer, researcher 1,
  3. Wolfgang Brück, professor2,
  4. Friedemann Paul, head of research group 39,
  5. Michael Bolz, senior physician4,
  6. Sven Jarius, neuroimmunologist5,
  7. Tobias Boettcher, clinical neurologist6,
  8. Annette Großmann, senior physician7,
  9. Alexander Bock, senior physician8,
  10. Frauke Zipp, professor9,
  11. Reiner Benecke, professor1,
  12. Uwe K Zettl, professor1
  1. 1Department of Neurology, University of Rostock, 18147 Rostock, Germany
  2. 2Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
  3. 3NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
  4. 4Department of Gynaecology, University of Rostock
  5. 5Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
  6. 6Neurology Division, Dietrich-Bonhoeffer Klinikum Neubrandenburg, Neubrandenburg, Germany
  7. 7Department of Radiology, University of Rostock
  8. 8Neuroradiology Division, Dietrich-Bonhoeffer Klinikum Neubrandenburg
  9. 9Cecilie-Vogt Clinic for Neurology, Charité-Universitätsmedizin, Berlin
  1. Correspondence to: R Reuß reinhard.reuss{at}
  • Accepted 14 August 2009

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, …

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