Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria

Seze, J. de; Lanctin, C.; Lebrun, C.; Malikova, Irina; Papeix, Caroline; Wiertlewski, Sandrine; Pelletier, Jean; Gout, Olivier; Clerc, Claude; Moreau, Caroline; Defer, Gilles; Edan, Gilles; Dubas, Frédéric; Vermersch, Patrick

doi:10.1212/01.wnl.0000188896.48308.26

Cited by 149 publications

(123 citation statements)

References 11 publications

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“…15 Applying this criterion, the diagnosis of idiopathic transverse myelitis was made in only 15.6% of all patients with non-compressive myelopathies. 18 In our series, patients with negative brain MRI made up 11.3%, and we also detected unspecific brain MRI lesions in 25.8%. Our patients had a mean age of 37.8 years, which was just between the mean age of studies by French investigators on idiopathic acute transverse myelitis and acute partial transverse myelitis (mean age 38.3 and 35 years, respectively).…”

Section: Discussionsupporting

confidence: 56%

“…Our patients had a mean age of 37.8 years, which was just between the mean age of studies by French investigators on idiopathic acute transverse myelitis and acute partial transverse myelitis (mean age 38.3 and 35 years, respectively). 2,18 However, transverse myelitis during childhood which has peaks between 0-2 and 5-8, and 410 years of age was not covered by the present study. 19 None fulfilled the criteria of neuromyelitis optica but testing for aquaporin-4 antibodies was not available when most of the patients were seen.…”

Section: Discussionmentioning

confidence: 67%

“…MRI lesions were found in accordance to neurological levels most frequently within the cervical cord, resembling findings from earlier studies of transverse myelitis in children and adults. 18,19 Longitudinal lesion expansion usually did not exceed the height of one vertebral body (91.8%), but a few patients showed lesions expanding over the height of two to three vertebral bodies. It is believed that patients with extensive lesions may suffer from more severe disability and have an unfavorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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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.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…The reported incidence of ATM depends on whether or not patients with MS and NMO are included in the estimate. Overall, there are approximately 25 cases of ATM per million of the population each year; if patients with MS and NMO are excluded, the annual incidence of ATM is somewhere between 1 and 8 per million, with a peak incidence between the ages of 10 and 19 and 30 and 39 [77][78][79].…”

Section: Acute Transverse Myelitismentioning

confidence: 99%

“…The cord involvement, by definition, is bilateral, but not necessarily symmetric. The diagnostic criteria suggest that there be evidence of spinal cord inflammation, either by MRI imaging (gadolinium enhancement of the cord) or by CSF analysis (pleocytosis and/or an elevated IgG index), but in reality, many patients with ATM have neither [78,79]. The differential diagnosis of longitudinally extensive cord lesions (≥3 vertebral levels) also includes NMO, SLE, sarcoidosis, Sjögren's Syndrome, and spinal ischemia [81][82][83].…”

Section: Acute Transverse Myelitismentioning

confidence: 99%

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

Geldern¹,

McPharlin

Becker

2012

Neurotherapeutics

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This chapter will review the spectrum of immunemediated diseases that affect the nervous system and may result in an admission to the neurological intensive care unit. Immunomodulatory strategies to treat acute exacerbations of neurological diseases caused by aberrant immune responses are discussed, but strategies for long-term immunosuppression are not presented. The recommendations for therapeutic intervention are based on a synthesis of the literature, and include recommendations by the Cochrane Collaborative, the American Academy of Neurology, and other key organizations. References from recent publications are provided for the disorders and therapies in which randomized clinical trials and large evidenced-based reviews do not exist. The chapter concludes with a brief review of the mechanisms of action, dosing, and side effects of commonly used immunosuppressive strategies in the neurocritical care unit.

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Assessment of Outcome Predictors in First-Episode Acute Myelitis

Gajofatto

Monaco²,

Fiorini³

et al. 2010

Arch Neurol

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Objective: To identify predictors of short-and longterm outcomes in acute myelitis (AM).Design: First episodes of AM were retrospectively identified in a single institution. Information regarding demographics, clinical status, laboratory workup, magnetic resonance imaging of the spine and brain, and electrophysiological assessment was collected. Tau, 14-3-3 protein, and cystatin C levels were assessed de novo in stored cerebrospinal fluid samples.Setting: A neurological department database.Patients: Fifty-three patients with a first episode of AM. Main Outcome Measures:The prognostic value of all variables was analyzed for the following outcomes: recovery from the initial event, symptom recurrence, conversion to multiple sclerosis (MS), and long-term disability.Results: Median follow-up was 6.2 years. Six patients (11%) remained monophasic; 5 (9%) developed recurrent myelitis; and 42 (79%) underwent conversion to MS.

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Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria

Cited by 149 publications

References 11 publications

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

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

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

Assessment of Outcome Predictors in First-Episode Acute Myelitis

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