Diagnosis and Management of Acute Myelopathies

  title={Diagnosis and Management of Acute Myelopathies},
  author={Adam I. Kaplin and Chitra Krishnan and Deepa M. Deshpande and Carlos A. Pardo and Douglas A. Kerr},
  journal={The Neurologist},
Background:Acute myelopathies represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. Transverse myelitis (TM) is a prototype member of this group in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations, and autonomic dysfunction. TM may exist as part of a multifocal CNS disease (eg, MS), multisystemic disease (eg, systemic lupus erythematosus), or… 

Transverse Myelitis: pathogenesis, diagnosis and treatment.

Recent classification and diagnostic schemes are summarized, which provide a framework for the acute management of patients with TM and current concepts on the natural history, immunopathogenesis and treatment strategies for patients withTM are reviewed.

An approach to the diagnosis of acute transverse myelitis.

Clinical, immunological, and radiological findings of non-compressive myelopathies are reviewed, as are how these findings can be used to distinguish between demyelinating, infectious, other inflammatory, vascular, neoplastic, and paraneoplastic etiologies.

Acute Transverse Myelitis in Children, Literature Review

Acute transverse myelitis is a heterogeneous disorder in children with a broad spectrum of clinical presentation, etiology, and outcome and must be distinguished from compressive and noninflamatory myelopathies.

The Differential Diagnosis and Initial Management of Pediatric Transverse Myelitis

A guide to the basic differential considerations, diagnostic testing, and initial treatment of transverse myelitis, as well as complications to watch for and a discussion of recent data on outcomes of transVERSE Myelitis in children are provided.

Pearls: myelopathy.

Evaluation of myelopathies when no abnormalities are seen on spinal cord imaging is a commonly encountered diagnostic challenge and some "clinical pearls" in the evaluation and management of spinal cord diseases are presented.

Distinct subtypes of myelitis in systemic lupus erythematosus.

It is indicated that SLE myelitis encapsulates 2 distinct and previously unrecognized syndromes that can be distinguished clinically by gray matter versus white matter findings.

Demyelinating disorders: Update on transverse myelitis

Clinical trials testing the efficacy of promising axonoprotective agents in combination with intravenous steroids in the treatment of TM are currently underway, as the levels of interleukin-6 in the cerebrospinal fluid of acute TM patients strongly correlate with and are highly predictive of disability.

Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases

The diagnosis, demographics and management of systemic lupus erythematosus (SLE) related versus idiopathic acute transverse myelitis during the initial presentation of the disease underlines the importance of early diagnosis of patients who develop ATM related to SLE.

Post-infectious Acute Transverse Myelitis

Prognosis for children with post-infectious acute TM is quite variable, while the majority of children do have full or good recovery, many are left with residual neurologic deficits including persistent ambulatory difficulties, sensory disturbances, and/or abnormal bladder function.

The differential diagnosis of acute transverse myelitis




Treatment of myelopathy in Sjögren syndrome with a combination of prednisone and cyclophosphamide.

A 63-year-old Hispanic woman with a 10-month history of progressive spastic paraparesis associated with optic neuropathy and a T10 sensory level is reported as having primary central nervous system Sjögren syndrome, which requires a high index of suspicion and specialized clinical testing.

Proposed diagnostic criteria and nosology of acute transverse myelitis.

A set of uniform diagnostic criteria and nosology for ATM is proposed to avoid the confusion that inevitably results when investigators use differing criteria, and a framework is suggested for evaluation of individuals presenting with signs and symptoms of ATM.

Relapsing transverse myelitis

The recognition of these three patients with a previously undescribed syndrome of relapsing isolated acute transverse myelitis at a single medical center in a 1‐year period suggests that relapses of acute Transverse Myelitis may not be rare.

Acute transverse myelitis in childhood: nine cases and review of the literature

A controlled multicenter study is suggested to assess epidemiology, etiology, and prognosis of ATM and the most important differential diagnoses are multiple sclerosis and Guillain‐Barré syndrome with its variants.

Transverse myelopathy in childhood.

The purpose of the present article is to present 25 cases of transverse myelopathy in childhood and to consider their implications as to etiology, prognosis, and plan of management.

Progressive necrotic myelopathy: clinical course in 9 patients.

The saltatory course, prolonged visual evoked responses in 2 patients, and a cranial abnormality on magnetic resonance imaging in another, raised the possibility of a link to multiple sclerosis.

Transverse myelopathy and systemic lupus erythematosus. Report of a case and review of the literature

The authors believe that, in their case, such a demyelinative mechanism was responsible for the clinical picture, although a necroscopic examination was not allowed.

[Transverse myelopathy and systemic lupus erythematosus. Report of a case and review of the literature].

The authors believe that, in their case, such a demyelinative mechanism was responsible for the clinical picture, although a necroscopic examination was not allowed.

Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events.

Parainfectious TM may be distinguishable from that associated with multiple sclerosis on the basis of presentation, findings on imaging, and the presence of cerebrospinal fluid oligoclonal bands.