title: Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients.
abstract: Acute transverse myelitis (ATM) is a pathogenetically heterogeneous inflammatory disorder of the spinal cord. Therefore, the identification of clinical and paraclinical features providing clues of the underlying etiologies is needed. The clinical presentation, blood and cerebrospinal fluid (CSF) findings as well as magnetic resonance imaging (MRI) and neurophysiological features were retrospectively analyzed in 45 unselected consecutive patients with ATM. Parainfectious ATM was diagnosed in 38% of patients. The underlying infectious agent, however, was identified only in a minority of patients. In 36% of patients, the etiology remained uncertain ("idiopathic" ATM) and in 22% ATM was the first manifestation of possible multiple sclerosis (ATM-MS) according to recently published diagnostic criteria. Spinal cord MRI showed signal alterations in 96% of the patients. In ATM-MS, monosegmental involvement of the spinal cord was most frequent while spinal cord involvement of two or more segments was more common in ATM of other etiologies. Of particular note, neurophysiological examinations showed evidence of peripheral nervous system (PNS) involvement in 27% of patients with ATM but not in patients with ATM-MS. Therefore, neurophysiological evidence of PNS involvement may provide additional discriminatory features between ATM-MS and ATM of other etiologies.
authors.affiliation: Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany. harzheim@hotmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Harzheim
authors.forename: Uwe
authors.initials: U
authors.lastname: Schlegel
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Thomas
authors.initials: T
authors.lastname: Klockgether
authors.forename: Stephan
authors.initials: S
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002494:Central Nervous System Infections / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000276:immunology / Q000382:microbiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D009188:Myelitis, Transverse / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D010525:Peripheral Nerves / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013116:Spinal Cord / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology*