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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