An Approach to the Diagnosis of Acute Transverse Myelitis

Anu Jacob; Brian G. Weinshenker

doi:10.1055/s-2007-1019132

Seminars in Neurology, Table of Contents

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

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

Abstract

ABSTRACT

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.

KEYWORDS

Myelitis - neuromyelitis optica - multiple sclerosis

Full Text

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Brian G WeinshenkerM.D. F.R.C.P.(C.)

Department of Neurology, Mayo Clinic College of Medicine

200 First Street SW, Rochester, MN 55905

Email: weinb@mayo.edu