Transverse myelitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Transverse myelitis (TM) is a heterogeneous focal inflammatory disorder of the spinal cord characterized by acute or subacute development of motor weakness, sensory impairment, and autonomic dysfunction.
TM causes motor weakness, a sensory impairment below the lesions, and bowel and bladder dysfunction.
Clinical characteristics and magnetic resonance imaging (MRI) of the spinal cord classify TM into acute partial or longitudinally extensive variants.
The presence of TM is confirmed by lumbar puncture demonstrating increased white blood cell count and absence of infection, with or without spinal cord MRI revealing a cord lesion that enhances after gadolinium administration.
For people with a characteristic brain MRI, the acute partial variant suggests a high future risk of developing multiple sclerosis (MS).

Sagittal T2-weighted MRI of cervical spinal cord showing myelitis lesion

From the personal collection of Dean M. Wingerchuk, MD, MSc, FRCP(C); used with permission

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Sagittal T2-weighted MRI of cervical spinal cord showing myelitis lesion
Axial T2-weighted MRI of cervical spinal cord showing myelitis lesion
Sagittal T2-weighted MRI showing multiple sclerosis-related myelitis lesion
Sagittal T2-weighted MRI showing longitudinally extensive TM lesion
Sagittal T1-weighted MRI showing enhancement of neuromyelitis optica-related lesion
The McDonald criteria for the diagnosis of multiple sclerosis

Citations

Key Articles

Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002 Aug 27;59(4):499-505.[Abstract]
Sechi E, Shosha E, Williams JP, et al. Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology. Neurology. 2019 Jul 23;93(4):e414-20.[Abstract]
de Seze J, Lanctin C, Lebrun C, et al. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology. 2005 Dec 27;65(12):1950-3.[Abstract]
Weinshenker BG, Wingerchuk DM. Neuromyelitis spectrum disorders. Mayo Clin Proc. 2017 Apr;92(4):663-79.[Abstract][Full Text]
Weinshenker BG, O'Brien PC, Petterson TM, et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol. 1999 Dec;46(6):878-86.[Abstract]
Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis. Neurology. 2018 Apr 24;90(17):777-88.[Abstract][Full Text]
Cortese I, Chaudhry V, So YT, et al. Evidence-based guideline update: plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011 Jan 18;76(3):294-300.[Abstract][Full Text]

Referenced Articles

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