Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings

Abstract

Study design: Retrospective 9-year survey. Objectives: Clinical presentation of acute myelitis syndromes is variable, and neuroimaging and laboratory findings are not specific enough to establish the diagnosis with certainty. We evaluated the spectrum clinical features and paraclinical findings encountered during diagnostic workup and aiding the diagnosis. Setting: Department of Neurology, Inselspital Bern, Switzerland. Material: Charts and magnetic resonance imaging (MRI) of 63 patients discharged with the diagnosis of acute transverse myelitis. Results: The diagnosis was supported by abnormal MRI and cerebrospinal fluid (CSF) findings in 52 patients (82.5%) and suspected in the remaining either because of a spinal cord MRI lesion suggestive of myelitis (n ¼ 5), or abnormal CSF findings (n ¼ 4), or electrophysiological evidence of a spinal cord dysfunction (n ¼ 2). Clinical impairment was mild (ASIA D) in the majority. All patients had sensory disturbances, whereas motor deficit and autonomic dysfunction were less frequent. Neurological levels were mainly located in cervical or thoracic dermatomes. Spinal cord lesions were visualized by MRI in 90.4% of the patients and distributed either in the cervical or thoracic cord, or both. Multiple lesions were present in more than half of the patients, and lateral, centromedullary and posterior locations were most common. A high percentage of multiple sclerosis (MS)-typical brain lesions and CSF findings suggested a substantial number of MS-related myelitis in our cohort. Conclusion: The diagnostic workup of acute myelitis discloses a broad spectrum of CSF or MRI findings, and may be associated with diagnostic uncertainty due to lack of specific CSF or MRI features, or pathological findings.

Current and emerging treatment options for spinal cord ischemia

“…The efficacy of steroids has not been studied in acute SCI and is not recommended at the current stage. However, after weighing up the risk:benefit ratio, it might be an option to treat with steroids during the acute stage when it is not clear whether the nature of the spinal cord lesion is ischemic, inflammatory, or demyelinating [52]. The standard scheme is 1 g methylprednisolone intravenously (i.v.)…”

Hepatitis-B Associated Acute Transverse Myelitis Mimicking Syringomyelia

“…There is motor weakness of the limbs and trunk depending on the segments involved and sensory disturbances mostly in the form of reduced or absent sensations with a definite upper level. Cervical and thoracic cords are commonly involved [3]. In most cases, sooner or later, sphincter disturbances also appear [2].…”

Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old disease

“…6,26 In the chronic phase, signal alteration might disappear (see Case 1), or the extensive hyperintense signal might break up and become similar to MS lesions, which have dorsal location and rarely extend over two vertebral segments (Figs 6b and 7a). 117,125 It might be difficult to differentiate such chronic NMO lesions from ''pseudo LETM'' of MS, where a number of small signal alterations, although separated, extend over the cervical spinal cord like a chain (Fig. 7).…”

“…6b). 79,86,[115][116][117] Back pain, radicular pain or Lhermitte's sign might appear in approximately onethird of the relapsing NMO (see Case 1 and 3). 79 Somatosensory evoked potentials can be impaired in more than 80% of cases.…”

“…54 Several other diseases should be also considered, depending on the clinical presentation and medical history, especially systemic autoimmune diseases, ischemia, toxic, metabolic, neurodegenerative and space occupying lesions. 54,116,117,155 Autoimmune diseases…”