Transverse Myelitis

Background

• Acute demyelinating disorder of the spinal cord
• Thought to be post infectious; associated with MS (one third will go on to develop MS)
• Can occur at any age

Presentation

• Acute onset severe back or neck pain with subacute paraparesis with a sensory level

Investigations

• MRI to exclude external spinal lesion
• Lumbar puncture
  • CSF shows cellular pleocytosis, often with polymorphs at the onset
  • Oligoclonal bands are absent

Management/Prognosis

• High-dose IV methylprednisolone
• Outcome is variable
  • 1/3 do not recover
  • 1/3 go on to develop MS
    • More likely if there is severe weakness; catastrophic onset; initial lancinating pain; sensory disturbance at cervical level; spinal shock; incontinence; presence of 14-3-3 protein in CSF
    • Less likely if subacute onset; young patient; retained posterior column function (i.e. position sense and vibration); retained tendon reflexes; early recovery
  • 1/3 go on to make a good recovery

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