Transverse myelitis versus encephalitis disseminata

Case 1: The 13-year old boy was primarily admitted to a rural hospital because of muscular pain, cramps, lack of power in his lower extremities and frequent voiding. The neurological examination showed reduced sensibility in the region of dermatoma Th 8, reduced power (3 to 4) of both lower extremities and a bilateral spontaneous Babinski reflex as well as dysfunctional voiding. During the course of the following 2 days symptoms progressed rapidly, with acute urinary retention and severe lower back pain. The patient was transferred to the Children's Hospital Linz where an MRI of the myelon was performed. The T2-weighted MRI showed signal alterations from C6 to Th1, liquor puncture showed an increased white blood cell count of 143/3 cells, oligoclonal bands were negative.

Case 2: The 15-year-old girl presented to hospital with numbness of her lower limbs. Symptoms had proceeded from toes to knees. In addition she showed a very atactic gait. MRI of cervical and thoracic spine showed oval lesions without contrast enhancement of the thoracic segment 11/12. Liquor puncture showed a white blood cell count of 10/3, oligoclonal bands were negative.

Transverse myelitis or encephalitis disseminates? Both cases represent similar symptoms. On our poster, we compare two similar cases, look on overlapping symptoms and differences between those two diseases to outline the difficulties in their diagnosis.