Acute Transverse Myelitis: Demyelinating, Inflammatory, and Infectious Myelopathies

Abstract

Acute transverse myelitis is a rare neurologic condition that has an estimated incidence of up to 3 per 100,000 patient years (0.003%). Although rare, acute transverse myelitis can have devastating neurologic effects with up to two-thirds of patients having a moderate to severe degree of residual disability. The term acute transverse myelitis was previously reserved for idiopathic cases, but currently is used to encompass the general clinical syndrome, whether or not the cause is known. Once adequate neuroimaging has ruled out a compressive etiology, and a lumbar puncture has demonstrated signs of inflammation within the cerebrospinal fluid, a workup of causes for an acute transverse myelitis must be undertaken. Determining the etiology of transverse myelitis can be challenging because there are autoimmune, inflammatory, and infectious diseases associated with acute transverse myelitis. The authors discuss an approach to acute transverse myelitis including clinical symptoms, neuroimaging, and biomarkers that may aid the clinician in diagnosis.

A rare case of acute transverse myelitis associated with Staphylococcus aureus bacteremia and osteomyelitis

“…1 The morbidity of the disease is significant, with~30-50% of affected patients having poor neurologic outcome. [1][2][3][4] Back pain, rapid progression of symptoms and severe initial symptoms are poor prognostic factors. [2][3][4] In many cases, a cause for the disease is not identified (idiopathic transverse myelitis).…”

“…[1][2][3][4] Back pain, rapid progression of symptoms and severe initial symptoms are poor prognostic factors. [2][3][4] In many cases, a cause for the disease is not identified (idiopathic transverse myelitis). 2,4 A history of antecedent infection is common.…”

“…[2][3][4] In many cases, a cause for the disease is not identified (idiopathic transverse myelitis). 2,4 A history of antecedent infection is common. 1 Diseases associated with secondary transverse myelitis include infections, systemic inflammatory/ autoimmune diseases (for example, systemic lupus erythematosus, Sjogren syndrome, antiphospholipid syndrome and systemic sclerosis), neurosarcoidosis, demyelinating disorders (multiple sclerosis, neuromyelitis optica, ADEM) and paraneoplastic syndromes.…”

“…Other causes of myelopathy that may mimic transverse myelitis clinically include compressive myelopathy, vascular diseases (for example, spinal cord infarct), radiation myelitis, trauma and nutritional deficiencies (for example, dorsal column degeneration with B12/vitamin E/copper deficiency). 2,4,5 A long list of pathogens have been reported in association with acute myelitis. 5 Typically, myelitis occurs after the resolution of the initial infection, 5 which suggests an immune-mediated effect.…”

Clinical Reasoning: A 64-year-old woman with progressive quadriparesis

“…3 The most important immediate determination is to exclude a compressive cause, as rapid intervention may be necessary to preserve remaining cord function.…”