Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings.
METHODS
Retrospective 9-year survey.


OBJECTIVE
Clinical presentation of acute myelitis syndromes is variable, and neuroimaging and laboratory findings are not specific enough to establish the diagnosis with certainty. We evaluated the spectrum clinical features and paraclinical findings encountered during diagnostic workup and aiding the diagnosis.


METHODS
Department of Neurology, Inselspital Bern, Switzerland.


METHODS
Charts and magnetic resonance imaging (MRI) of 63 patients discharged with the diagnosis of acute transverse myelitis.


RESULTS
The diagnosis was supported by abnormal MRI and cerebrospinal fluid (CSF) findings in 52 patients (82.5%) and suspected in the remaining either because of a spinal cord MRI lesion suggestive of myelitis (n=5), or abnormal CSF findings (n=4), or electrophysiological evidence of a spinal cord dysfunction (n=2). Clinical impairment was mild (ASIA D) in the majority. All patients had sensory disturbances, whereas motor deficit and autonomic dysfunction were less frequent. Neurological levels were mainly located in cervical or thoracic dermatomes. Spinal cord lesions were visualized by MRI in 90.4% of the patients and distributed either in the cervical or thoracic cord, or both. Multiple lesions were present in more than half of the patients, and lateral, centromedullary and posterior locations were most common. A high percentage of multiple sclerosis (MS)-typical brain lesions and CSF findings suggested a substantial number of MS-related myelitis in our cohort.


CONCLUSIONS
The diagnostic workup of acute myelitis discloses a broad spectrum of CSF or MRI findings, and may be associated with diagnostic uncertainty due to lack of specific CSF or MRI features, or pathological findings.
Sellner
J
J
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. sellner@lrz.tum.de
Lüthi
N
N
Schüpbach
W M M
WM
Gebhardt
A
A
Findling
O
O
Schroth
G
G
Mattle
H P
HP
Nedeltchev
K
K
D000293:Adolescent; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000503:physiopathology*; D009460:Neurologic Examination; D012189:Retrospective Studies; D013057:Spectrum Analysis; D013116:Spinal Cord / Q000473:pathology*; D055815:Young Adult
D007074:Immunoglobulin G; D002097:C-Reactive Protein