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