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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
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Publikationsdatum:
07. Februar 2008 (online)

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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

REFERENCES

  • 1 Pou Serradell A, Roquer Gonzalez J, Perich Alsina X. Acute posterior cord lesions in multiple sclerosis: an MRI study of the clinical course in 20 cases.  Rev Neurol (Paris). 2000;  156(12) 1126-1135
    PubMedGoogle Scholar
  • 2 Brex P A, Ciccarelli O, O'Riordan J I et al.. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis.  N Engl J Med. 2002;  346(3) 158-164
    CrossrefPubMedGoogle Scholar
  • 3 Miller D, Barkhof F, Montalban X, Thompson A, Filippi M. Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis.  Lancet Neurol. 2005;  4(5) 281-288
    CrossrefPubMedGoogle Scholar
  • 4 Fisniku L K, Brex P, Dan A R et al.. 20-year MRI and clinical follow-up of patients with clinically isolated syndromes suggestive of MS.  Neurology. 2007;  68(suppl 1) A331
    PubMedGoogle Scholar
  • 5 Lennon V A, Wingerchuk D M, Kryzer T J et al.. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis.  Lancet. 2004;  364(9451) 2106-2112
    CrossrefPubMedGoogle Scholar
  • 6 Weinshenker B G, Wingerchuk D M, Vukusic S et al.. Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis.  Ann Neurol. 2006;  59(3) 566-569
    CrossrefPubMedGoogle Scholar
  • 7 Pittock S J, Weinshenker B G, Lucchinetti C F et al.. Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression.  Arch Neurol. 2006;  63(7) 964-968
    CrossrefPubMedGoogle Scholar
  • 8 Wingerchuk D M. Postinfectious encephalomyelitis.  Curr Neurol Neurosci Rep. 2003;  3(3) 256-264
    CrossrefPubMedGoogle Scholar
  • 9 Das R N, Jaykumar J. Acute transverse myelitis following typhoid vaccination.  Ulster Med J. 2007;  76(1) 39-40
    PubMedGoogle Scholar
  • 10 Cizman M, Pokorn M, Osredkar D. Re: transverse myelitis after measles and rubella vaccination.  J Paediatr Child Health. 2005;  41(8) 460
    PubMedGoogle Scholar
  • 11 Fonseca L F, Noce T R, Teixeira M L, Teixeira Jr A L, Lana-Peixoto M A. Early-onset acute transverse myelitis following hepatitis B vaccination and respiratory infection: case report.  Arq Neuropsiquiatr. 2003;  61(2A) 265-268
    PubMedGoogle Scholar
  • 12 Booss J, Davis L E. Smallpox and smallpox vaccination: neurological implications.  Neurology. 2003;  60(8) 1241-1245
    PubMedGoogle Scholar
  • 13 Larner A J, Farmer S F. Myelopathy following influenza vaccination in inflammatory CNS disorder treated with chronic immunosuppression.  Eur J Neurol. 2000;  7(6) 731-733
    CrossrefPubMedGoogle Scholar
  • 14 Ahasan H A, Chowdhury M A, Azhar M A, Rafiqueuddin A K. Neuroparalytic complications after anti-rabies vaccine (inactivated nervous tissue vaccine).  Trop Doct. 1995;  25(2) 94
    PubMedGoogle Scholar
  • 15 Kaplin A I, Krishnan C, Deshpande D M, Pardo C A, Kerr D A. Diagnosis and management of acute myelopathies.  Neurologist. 2005;  11(1) 2-18
    CrossrefPubMedGoogle Scholar
  • 16 Krishnan C, Kerr D A. Idiopathic transverse myelitis.  Arch Neurol. 2005;  62(6) 1011-1013
    CrossrefPubMedGoogle Scholar
  • 17 Transverse Myelitis Consortium Working Group . Proposed diagnostic criteria and nosology of acute transverse myelitis.  Neurology. 2002;  59(4) 499-505
    PubMedGoogle Scholar
  • 18 Hummers L K, Krishnan C, Casciola-Rosen L et al.. Recurrent transverse myelitis associates with anti-Ro (SSA) autoantibodies.  Neurology. 2004;  62(1) 147-149
    CrossrefPubMedGoogle Scholar
  • 19 Frohman E M, Havrdova E, Lublin F et al.. Most patients with multiple sclerosis or a clinically isolated demyelinating syndrome should be treated at the time of diagnosis.  Arch Neurol. 2006;  63(4) 614-619
    CrossrefPubMedGoogle Scholar
  • 20 Pittock S J, Weinshenker B G, Noseworthy J H et al.. Not every patient with multiple sclerosis should be treated at time of diagnosis.  Arch Neurol. 2006;  63(4) 611-614
    CrossrefPubMedGoogle Scholar
  • 21 Villar L M, Masjuan J, Sadaba M C et al.. Early differential diagnosis of multiple sclerosis using a new oligoclonal band test.  Arch Neurol. 2005;  62(4) 574-577
    CrossrefPubMedGoogle Scholar
  • 22 Soderstrom M, Ya-Ping J, Hillert J, Link H. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings.  Neurology. 1998;  50(3) 708-714
    CrossrefPubMedGoogle Scholar
  • 23 Kincaid O, Lipton H L. Viral myelitis: an update.  Curr Neurol Neurosci Rep. 2006;  6(6) 469-474
    CrossrefPubMedGoogle Scholar
  • 24 Calgüneri M, Onat A M, Ozturk M A et al.. Transverse myelitis in a patient with Behcet's disease: favorable outcome with a combination of interferon-alpha.  Clin Rheumatol. 2005;  24(1) 64-66
    CrossrefPubMedGoogle Scholar
  • 25 Moskau S, Urbach H, Hartmann A, Schmidt S. Multifocal myelitis in Behçet's disease.  Neurology. 2003;  60(3) 517
    PubMedGoogle Scholar
  • 26 Theodoridou A, Settas L. Demyelination in rheumatic diseases.  J Neurol Neurosurg Psychiatry. 2006;  77(3) 290-295
    PubMedGoogle Scholar
  • 27 Cheshire W P, Santos C C, Massey E W, Howard Jr J F. Spinal cord infarction: etiology and outcome.  Neurology. 1996;  47(2) 321-330
    CrossrefPubMedGoogle Scholar
  • 28 Jacob A, Das K, Boggild M, Buxton N. Inflammation or neoplasm? Another side to the story.  Clin Neurol Neurosurg. 2006;  108(8) 811-812
    CrossrefPubMedGoogle Scholar
  • 29 Wang P Y, Shen W C, Jan J S. MR imaging in radiation myelopathy.  AJNR Am J Neuroradiol. 1992;  13(4) 1049-1055 discussion 1056-1048
    PubMedGoogle Scholar
  • 30 Pittock S J, Kryzer T J, Lennon V A. Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome.  Ann Neurol. 2004;  56(5) 715-719
    CrossrefPubMedGoogle Scholar
  • 31 Keegan M, Pittock S, Lennon V. Autoimmune myelopathy associated with CRMP-5 IgG.  Mult Scler. 2006;  12(suppl 1) S24
    CrossrefPubMedGoogle Scholar
  • 32 Pittock S J, Lucchinetti C F, Lennon V A. Anti-neuronal nuclear autoantibody type 2: paraneoplastic accompaniments.  Ann Neurol. 2003;  53(5) 580-587
    CrossrefPubMedGoogle Scholar
  • 33 Pittock S J, Lucchinetti C F, Parisi J E et al.. Amphiphysin autoimmunity: paraneoplastic accompaniments.  Ann Neurol. 2005;  58(1) 96-107
    CrossrefPubMedGoogle Scholar
  • 34 Pittock S J, Yoshikawa H, Ahlskog J E et al.. Glutamic acid decarboxylase autoimmunity with brainstem, extrapyramidal, and spinal cord dysfunction.  Mayo Clin Proc. 2006;  81(9) 1207-1214
    CrossrefPubMedGoogle Scholar
  • 35 Wingerchuk D M, Lennon V A, Pittock S J, Lucchinetti C F, Weinshenker B G. Revised diagnostic criteria for neuromyelitis optica.  Neurology. 2006;  66(10) 1485-1489
    CrossrefPubMedGoogle Scholar
  • 36 Majid A, Galetta S L, Sweeney C J et al.. Epstein-Barr virus myeloradiculitis and encephalomyeloradiculitis.  Brain. 2002;  125(Pt 1) 159-165
    CrossrefPubMedGoogle Scholar
  • 37 Aktipi K M, Ravaglia S, Ceroni M et al.. Severe recurrent myelitis in patients with hepatitis C virus infection.  Neurology. 2007;  68(6) 468-469
    CrossrefPubMedGoogle Scholar
  • 38 Tan E M, Cohen A S, Fries J F et al.. The 1982 revised criteria for the classification of systemic lupus erythematosus.  Arthritis Rheum. 1982;  25(11) 1271-1277
    CrossrefPubMedGoogle Scholar
  • 39 Vitali C, Bombardieri S, Jonsson R et al.. Classification criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group.  Ann Rheum Dis. 2002;  61(6) 554-558
    Google Scholar
  • 40 Alarcon-Segovia VM Classification and Diagnostic Criteria for Mixed Connective Tissue Disease. Amsterdam; Excerpta Medica 1987
    Google Scholar
  • 41 Preliminary criteria for the classification of systemic sclerosis (scleroderma).  Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee . Arthritis Rheum. 1980;  23(5) 581-590
    CrossrefPubMedGoogle Scholar
  • 42 Criteria for diagnosis of Behçet's disease.  International Study Group for Behçet's Disease . Lancet. 1990;  335(8697) 1078-1080
    PubMedGoogle Scholar
  • 43 Weidauer S, Nichtweiss M, Lanfermann H, Zanella F E. Spinal cord infarction: MR imaging and clinical features in 16 cases.  Neuroradiology. 2002;  44(10) 851-857
    CrossrefPubMedGoogle Scholar
  • 44 Masson C, Pruvo J P, Meder J F et al.. Spinal cord infarction: clinical and magnetic resonance imaging findings and short term outcome.  J Neurol Neurosurg Psychiatry. 2004;  75(10) 1431-1435
    Google Scholar
  • 45 Han J J, Massagli T L, Jaffe K M. Fibrocartilaginous embolism-an uncommon cause of spinal cord infarction: a case report and review of the literature.  Arch Phys Med Rehabil. 2004;  85(1) 153-157
    Google Scholar
  • 46 Suzuki F, Nakajima M, Matsuda M. Cervical cord compression caused by a pillow in a postlaminectomy patient undergoing magnetic resonance imaging: case report.  J Neurosurg. 1999;  90(suppl 1) 145-147
    PubMedGoogle Scholar
  • 47 Fujimoto Y, Oka S, Tanaka N et al.. Pathophysiology and treatment for cervical flexion myelopathy.  Eur Spine J. 2002;  11(3) 276-285
    CrossrefPubMedGoogle Scholar

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