Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis: [RETIRED]

Abstract

Objective: To assess the evidence for diagnostic tests and therapies for transverse myelitis (TM) and make evidence-based recommendations. antibodies should be considered useful to determine TM cause in patients presenting with clinical acute complete transverse myelitis (ACTM) features. The presence of NMO-IgG antibodies (aquaporin-4-specific antibodies) should be considered useful in determining increased TM recurrence risk. Level C recommendations: in suspected TM, distinction between ACTM or acute partial transverse myelitis may be considered useful to determine TM etiology and risk for relapse (more common with APTM). Age and gender may be considered useful to determine etiology in patients presenting with TM syndrome, with spinal infarcts seen more often in older patients and more female than male patients having TM due to multiple sclerosis (MS). Brain MRI characteristics consistent with those of MS may be considered useful to predict conversion to MS after a first partial TM episode. Longer spinal lesions extending over Ͼ3 vertebral segments may be considered useful in determining NMO vs MS. CSF examination for cells and oligoclonal bands may be considered useful to determine the cause of the TM syndrome. Plasma exchange may be considered in patients with TM who fail to improve after corticosteroid treatment. Rituximab may be considered in patients with TM due to NMO to decrease the number of relapses. Level U recommendations: there is insufficient evidence to support or refute the efficacy of other TM therapies or the usefulness of ethnicity to determine the cause of a subacute myelopathy. Neurology ® 2011;77:2128-2134 GLOSSARY ACTM ϭ acute complete transverse myelitis; APTM ϭ acute partial transverse myelitis; CI ϭ confidence interval; IgG ϭ immunoglobulin G; MS ϭ multiple sclerosis; NMO ϭ neuromyelitis optica; OCB ϭ oligoclonal band; TM ϭ transverse myelitis. Methods:

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

“…The brain MRI revealed bilateral nonspecific white matter lesions suggestive of chronic microvascular ischemic disease. The patient satisfied the previously described criteria for acute transverse myelitis and high-dose IV methylprednisolone (1 g daily) was started, 6 but no response was seen. The CSF cultures and PCR were negative (see Table 1 for a summary of the investigations performed).…”

Transverse Myelitis as an Unusual Complication of Dengue Fever

“…Therefore, our patient management followed the usual treatment of TM, which consists of pulse therapy with methylprednisolone for 3-7 days. 18 The emergence of new arboviruses, such as Zika virus and chikungunya virus, poses new challenges to the public health system, especially in DENV-endemic regions. Careful evaluation and follow-up of patients, with special attention to neurological complications, may allow better understanding of the role of DENV and other arboviruses in the pathogenesis of TM.…”

Longitudinal Myelitis as a Rare First Symptom of Lupus in Overlap Syndrome

“…3 This type of myelitis is rarely observed in lupus and, according to an analysis performed by Espinosa,12 there were only 22 cases diagnosed before 2008. Still, myelitis may be the very first symptom of lupus.…”

“…When the inflammatory process spans over adjacent segments of the spine, it is referred to as longitudinal myelitis. 3 Although most of the cases of longitudinal myelitis described in connective tissue diseases concern SLE, 4 there are publications describing this condition in other diseases from this group, such as Sjögren's syndrome (SS). 5 The combination of fast progressing myelitis symptoms and an extensive inflammatory process affecting most of the spine with severe neurologic deficit is sometimes specified as catastrophic longitudinal myelitis.…”