Semin Neurol 2008; 28(1): 105-120
DOI: 10.1055/s-2007-1019132
© Thieme Medical Publishers

An Approach to the Diagnosis of Acute Transverse Myelitis

Anu Jacob1 , Brian G. Weinshenker2
  • 1Division of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
  • 2Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
Further Information

Publication History

Publication Date:
07 February 2008 (online)


The differential diagnosis of acute inflammatory transverse myelitis (ATM) is broad. Therefore, physicians must be aware of the many potential etiologies for acute myelopathy, and should pursue an ordered, efficient, and cost-effective approach to the diagnosis based on the patient's clinical history, examination, and magnetic resonance imaging (MRI) findings. Clinical, immunological, and radiological findings of noncompressive myelopathies are reviewed, as are how these findings can be used to distinguish between demyelinating, infectious, other inflammatory, vascular, neoplastic, and paraneoplastic etiologies. We also review predictors of further episodes of ATM in patients with demyelinating disorders. We discuss the diagnostic clues and pitfalls of the not uncommon clinical scenario of a presumed “myelopathy with normal MRI.” Finally, we suggest an algorithm for the diagnosis and management of acute myelopathies.


Brian G Weinshenker, M.D. , F.R.C.P.(C.) 

Department of Neurology, Mayo Clinic College of Medicine

200 First Street SW, Rochester, MN 55905

Email: [email protected]