LETM at onset is a heterogeneous syndrome with a broad range of etiologies. N-LETM has similar clinical and neuroimaging features compared to P-LETM at onset. Recurrences (p = 0.04) of myelitis and number of relapses (p = 0.03) were associated to P-LETM and normal brain MRI to N-LETM (p = 0.04) at onset. AQP4-ab positive were only observed in NMO/NMOSD patients.