A group of inflammatory disorders characterized by acute or subacute motor weakness, sensory abnormalities and autonomic (bowel, bladder, sexual) cord dysfunction.
Symptoms are usually bilateral but both unilateral and asymmetric presentations can occur.
Look for a well-defined truncal sensory level
-below which sensation of pain and temperature is altered or lost.
Causes: Autoimmune after infection or vaccination (60% of cases in children), direct infection, or a demyelinating disease such as MS. No cause is found in 15 – 30% of cases.
Incidence: Bimodal peak at 10-19 years and at 30-39 years.
Diagnostic testing: MRI of the ENTIRE spine to both rule out structural lesions and rule in an intrinsic cord lesion. If MRI is normal reconsider the original diagnosis.
Treatment: Steroids are first-line therapy. Dosing is controversial but generally involves high IV doses for 3-5 days (1000 mg methylprednisolone). Plasma exchange is second line for those who don’t respond to steroids.
References
Transverse Myelitis. Frohman EM, Wingerchuk DM. NEJM 2010 Aug 5;363(6):564-72.
