Diagnosis and management of acute myelopathies.
BACKGROUND
Acute myelopathies represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. Transverse myelitis (TM) is a prototype member of this group in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations, and autonomic dysfunction. TM may exist as part of a multifocal CNS disease (eg, MS), multisystemic disease (eg, systemic lupus erythematosus), or as an isolated, idiopathic entity.


RESULTS
In this article, we summarize recent classification and diagnostic schemes, which provide a framework for the diagnosis and management of patients with acute myelopathy. Additionally, we review the state of current knowledge about the epidemiology, natural history, immunopathogenesis, and treatment strategies for patients with TM.


CONCLUSIONS
Our understanding of the classification, diagnosis, pathogenesis, and treatment of TM has recently begun to expand dramatically. With more rigorous criteria applied to distinguish acute myelopathies and with an emerging understanding of immunopathogenic events that underlie TM, it may now be possible to effectively initiate treatments in many of these disorders. Through the investigation of TM, we are also gaining a broader appreciation of the mechanisms that lead to autoimmune neurologic diseases in general.
Kaplin
Adam I
AI
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Osler 320, 600 N. Wolfe Street, Baltimore, MD 21287, USA. akaplin@jhmi.edu
Krishnan
Chitra
C
Deshpande
Deepa M
DM
Pardo
Carlos A
CA
Kerr
Douglas A
DA
D000208:Acute Disease; D003663:Decision Trees; D003937:Diagnosis, Differential; D006801:Humans; D009188:Myelitis, Transverse / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D013116:Spinal Cord / Q000276:immunology / Q000473:pathology