Introduction: Longitudinally extensive transverse myelitis (LETM) is characterized by a contiguous inflammatory lesion of the spinal cord involving more than 3 segments. It is most commonly associated with various acquired demyelinating diseases of the Central Nervous system. Clinical and Radiological differentiation can help in diagnosis and predicting disease prognosis.

Materials and Methods: We did a Retrospective observational study to evaluate the Clinical and Radiological Characteristics of LETM cases and also tried to evaluate the outcome.

Results: We observed All patients were presented with spastic Paraparesis or Quadriparesis depending on spinal cord level with predominant 13 (81.25%) patients with early bladder involvement & 2 patients (12%) presented with Brainstem Syndromes. Majority of which were found to be serum NMO positive (60%) rest 40% equally distributed among Seronegative NMOSD, MOG and Idiopathic LETM. We found Predominately Thoracic cord (31%)& lower cervical cord and thoracic cord (31%) involvement on MRI Spine with Characteristic Central Bright spotty lesion involving More than > 50 % of Areaon Axial T2 Weighted scan in Seropositive NMOSD.2 patients (12 %) with NMOSD Showed Characteristic Brainstem involvement of MRI. We also spotted outpatients who didn’t respond to Conventional immunotherapy 62% of them responded to Rituximabat a Mean follow of 18 months.

Conclusion: Longitudinally extensive transverse myelitis (LETM) has Characteristic Clinical & Radiological Presentations that need to be addressed. We observed better results with Rituximab to non-responders to conventional immunotherapy.