Materiały źródłowe

• #1 Transverse Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559302/

  Transverse myelitis (TM) is a rare, acquired focal inflammatory disorder often presenting with rapid onset weakness, sensory deficits, and bowel/bladder dysfunction. […] This activity reviews the evaluation and management of transverse myelitis and highlights the role of the interprofessional team in improving care for patients with this condition. […] Identify the appropriate evaluation of transverse myelitis. […] To diagnose TM, a compressive cord lesion must be excluded first. Exclusion is usually performed by magnetic resonance imaging (MRI). […] This is followed by a confirmation of inflammation by a gadolinium-enhanced MRI or lumbar puncture (LP). […] Diagnostic criteria include, with the top 3 being most important: Sensory, motor, or autonomic dysfunction originating from the spinal cord; T2 hyperintense signal changes on MRI; No evidence of a compressive lesion.

• #1 Transverse myelitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transverse-myelitis/diagnosis-treatment/drc-20354730

  A doctor will diagnose transverse myelitis based on your answers to questions about your signs and symptoms, your medical history, a clinical assessment of nerve function, and test results. […] These tests, which may indicate inflammation of the spinal cord and rule out other disorders, include the following: […] Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create 3D images of soft tissues. An Magnetic resonance imaging (MRI) can show inflammation of the spinal cord and other potential causes of the symptoms, including abnormalities affecting the spinal cord or blood vessels. […] Lumbar puncture (spinal tap) uses a needle to draw a small amount of cerebrospinal fluid (CSF), the protective fluid that surrounds your spinal cord and brain. […] In some people with transverse myelitis, cerebrospinal fluid (CSF) may have abnormally high numbers of white blood cells or immune system proteins that indicate inflammation. Spinal fluid can also be tested for viral infections or certain cancers.

• #1 Transverse myelitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1061

  Transverse myelitis (TM) is a heterogeneous focal inflammatory disorder of the spinal cord characterised by acute or subacute development of motor weakness, sensory impairment, and autonomic dysfunction. […] The presence of TM is confirmed by lumbar puncture demonstrating increased white blood cell count and absence of infection, with or without spinal cord MRI revealing a cord lesion that enhances after gadolinium administration. […] Clinical characteristics and magnetic resonance imaging (MRI) of the spinal cord classify TM into acute partial or longitudinally extensive variants. […] For people with aquaporin-4-IgG auto-antibody seropositivity, the longitudinally extensive variant suggests a neuromyelitis optica spectrum disorder. […] Key diagnostic factors include the presence of risk factors, age 10-19 or 30-39 years, motor weakness, paraesthesias or sensory loss, bladder symptoms, bowel symptoms, and upper motor neuron signs.

• #1 Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings | Spinal Cord

  https://www.nature.com/articles/sc2008143

  The diagnosis of acute transverse myelitis syndromes is based on the clinical symptoms and signs of a spinal cord syndrome in conjunction with evidence of inflammation within the spinal cord such as cerebrospinal fluid (CSF) abnormalities or lesions visible on magnetic resonance imaging (MRI). […] Clinical symptoms of acute transverse myelitis may include motor, sensory and autonomic dysfunction. […] The diagnostic workup of acute myelitis discloses a broad spectrum of CSF or MRI findings, and may be associated with diagnostic uncertainty due to lack of specific CSF or MRI features, or pathological findings. […] The diagnosis of acute transverse myelitis was supported by both MRI lesion detection within the spinal cord and at least one pathological CSF finding (cell count, IgG index, albumin quotient or OCB) in 52 patients (85.2%).

• #1 Transverse myelitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/transverse-myelitis?lang=us

  Transverse myelitis, also known as acute transverse myelitis, is an inflammatory condition affecting both halves (ventral and dorsal) of the spinal cord and associated with rapidly progressive motor, sensory, and autonomic dysfunction. […] MRI is the most useful imaging modality, which generally shows a long segment (3-4 segments or more) of T2 increased signal occupying greater than two-thirds of the cross-sectional area of the cord, with variable pattern of enhancement and no diffusion restriction. […] As the diagnosis does not have a sensitive and specific laboratory test, histology is usually not obtained, particularly as biopsy of the spinal cord has a high morbidity. Imaging features overlap with other inflammatory and neoplastic entities. A set of diagnostic criteria have been proposed by the Transverse Myelitis Consortium Working Group:

• #1 Transverse Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559302/

  When considering TM as a possible diagnosis, it is recommended the following investigative analyses be performed: MRI of the entire spine with and without gadolinium contrast to differentiate compressive vs. non-compressive lesions; Brain MRI with and without gadolinium contrast to evaluate for evidence of brain lesions; LP for CSF analysis, including cell count with differential, protein, glucose, the Venereal Disease Research Laboratory test, oligoclonal bands, immunoglobulin G (IgG) index, and cytology. […] Patients with evidence of longitudinally extensive spinal cord lesions additionally require the following additional studies, including serum erythrocytes sedimentation rate, C-reactive protein, ANA, antibodies to extractable nuclear antigens, rheumatoid factor, antiphospholipid antibodies, and antineutrophil cytoplasmic antibodies. […] The standard of care and the first-line therapy for the treatment of TM is intravenous glucocorticoids. High-dose intravenous glucocorticoids should be initiated as soon as possible. […] There should not be a delay in treatment while waiting for test results.

• #1 Transverse Myelitis (TM) | Diagnosis | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/transverse-myelitis/diagnosis/

  An MRI of the brain is often performed to screen for lesions suggestive of a demyelinating disorder such as MS, NMOSD, or MOG antibody disease. In patients with imaging features of TM that are consistent with MS, brain imaging may be repeated over time to see if characteristic MS lesions develop. […] If none of the tests are suggestive of a specific cause, a diagnosis of idiopathic transverse myelitis can be made. […] Even after comprehensive medical evaluation, there remains a significant proportion of individuals with spinal cord inflammation that is without a clear identifiable cause. This is a condition called idiopathic transverse myelitis. When a healthcare provider diagnoses someone with transverse myelitis, they are typically referring to idiopathic TM. Even among those labeled as having idiopathic TM, it is likely that there are multiple yet-to-be-identified causes for this inflammation.

• #1 Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings | Spinal Cord

  https://www.nature.com/articles/sc2008143

  In a few patients the diagnosis was supported either by a spinal cord lesion visible on MRI (n=5; 7.9%) or abnormal CSF findings (n=4; 8.2%) alone. […] The frequency of detectable spinal cord MRI lesions was high (90.4%) but contrast enhancement was not always present (60.3%). […] OCB (83.6%) and abnormal IgG index (82.0%) were the most common pathological CSF findings.

• #1 Transverse Myelitis (TM): Symptoms, Diagnosis and Treatment

  https://www.clevelandclinicabudhabi.ae/en/health-hub/health-resource/diseases-and-conditions/transverse-myelitis

  A test of cerebrospinal fluid may show increased white cells and protein. In TM, the spinal fluid frequently shows an increase in white blood cells at levels that may be higher than levels usually seen in MS. Also, patients with TM usually do not have oligoclonal banding, which is relatively common in MS. Oligoclonal bands are bands of proteins seen in certain spinal fluid tests that indicate immune system activity in and around the spinal fluid pathways.

• #1 Transverse myelitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transverse-myelitis/diagnosis-treatment/drc-20354730

  Blood tests may include a test that checks for antibodies associated with neuromyelitis optica, a condition in which inflammation occurs both in your spinal cord and in the nerve in your eye. People with a positive antibody test are at increased risk of experiencing multiple attacks of transverse myelitis and require treatment to prevent future attacks. […] Other blood tests can identify infections that may contribute to transverse myelitis, or rule out other causes of symptoms.

• #1 Transverse Myelitis (TM) | Diagnosis | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/transverse-myelitis/diagnosis/

  Lumbar puncture is used to look for surrogate markers of inflammation in the cerebrospinal fluid (CSF). These include elevated white cell counts, elevated protein or other markers such as oligoclonal bands. While these markers are supportive of TM, it should be noted that they are not present in all individuals. […] A series of blood tests are often recommended for patients with spinal cord disorder suspicious for TM. This commonly includes testing for aquaporin-4 and myelin oligodendrocyte glycoprotein (MOG) antibodies, in addition to tests associated with systemic autoimmune disorders such as systemic lupus erythematosus (SLE) and Sjgrens syndrome. If sarcoidosis is suspected based upon history and imaging characteristics, a CT of the chest may be considered to look for lung findings. Other common ordered tests include HIV, syphilis, vitamin B12 and copper levels.

• #1 Transverse myelitis – Wikipedia

  https://en.wikipedia.org/wiki/Transverse_myelitis

  Transverse myelitis (TM) is a rare neurological condition wherein the spinal cord is inflamed. […] The underlying cause of TM is unknown. […] In 2002, the Transverse Myelitis Consortium Working Group proposed the following diagnostic criteria for idiopathic acute transverse myelitis: Motor, sensory or autonomic dysfunction attributable to spinal cord; Signs and symptoms on both sides of the body (not necessarily symmetrical); Clearly defined sensory level; Signs of inflammation (pleocytosis of the cerebrospinal fluid, or elevated immunoglobulin G, or evidence of inflammation on gadolinium-enhanced (MRI) Magnetic resonance imaging); Peak of this condition can occur anytime between 4 hours to 21 days after onset. […] Individuals who develop TM are typically transferred to a neurologist who can urgently investigate the patient in a hospital.

• #1

  https://fpnotebook.com/Neuro/ID/Mylts.htm

  Progression to nadir (low point) with 4 hours to 21 days from symptom onset in Acute Transverse Myelitis. […] Sensory, Motor or Autonomic Dysfunction attributable to spinal cord lesion (all 3 are typically present at nadir). […] Findings are bilateral (but may be asymmetric). […] Spinal cord inflammation. […] CSF Pleocytosis or IgG Index elevated or MRI Gadolinium enhancement. […] Repeat MRI and LP again in 2 to 7 days if inflammation not present on initial testing. […] Exclusion Criteria. […] Not due to extra-axial compression on MRI or CT myelography. […] Spinal radiation in last 10 years. […] Deficits consistent with alternative diagnosis.

• #1 Transverse myelitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/transverse-myelitis?lang=us

  inclusion criteria include development of sensory, motor, or autonomic dysfunction attributable to the spinal cord, bilateral signs and symptoms (though not necessarily symmetric), clearly defined sensory level, exclusion of extra-axial compression by neuroimaging, inflammation within the spinal cord demonstrated by CSF pleocytosis or increased IgG index or gadolinium enhancement, and progression to nadir between 4 hours and 21 days after the onset of symptoms. […] exclusion criteria include radiation to the spine within the last 10 years, arterial distribution clinical deficit consistent with thrombosis of the anterior spinal artery, and abnormal flow voids on the surface of the spinal cord consistent with spinal dural arteriovenous fistula. […] exclusion criteria for idiopathic acute transverse myelitis include connective tissue disease, CNS infection, brain MRI abnormalities suggestive of multiple sclerosis, and history of clinically apparent optic neuritis.

• #1 Transverse myelitis – Wikipedia

  https://en.wikipedia.org/wiki/Transverse_myelitis

  A lumbar puncture can be performed after the MRI or at the time of CT myelography. […] The differential diagnosis of acute TM includes demyelinating disorders, such as multiple sclerosis and neuromyelitis optica, infections, such as herpes zoster and herpes simplex virus, and other types of inflammatory disorders, such as systemic lupus erythematosus and neurosarcoidosis.

• #1 Transverse Myelitis — a Review of the Presentation, Diagnosis, and Initial Management – Timothy W West – Discovery Medicine

  https://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/

  When an acute myelopathy is suspected, a thorough neurological evaluation will help determine the region of the spinal cord affected and then the next diagnostic step is to evaluate for a compressive or structural etiology. […] Once neuroimaging has excluded a compressive etiology, a lumbar puncture (LP) is indicated to determine if there are signs of inflammation within the cerebrospinal fluid (CSF). […] If the CSF shows signs of inflammation (pleocytosis, elevated protein concentration, oligoclonal bands, or elevated IgG index), then the subsequent work-up should focus on demyelinating, infectious, or other inflammatory causes of an acute myelitis as the differential diagnosis is broad. […] The presence of 2 or more OCBs in the CSF that are not found in the corresponding serum sample is considered to be indicative of increased intrathecal synthesis of gammaglobulins, and in the strictest interpretation is evidence only of compartmentalized inflammation within the CNS.

• #1 Transverse myelitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1061

  Key diagnostic factors include age 10-19 or 30-39 years, motor weakness, paresthesias or sensory loss, bladder symptoms, bowel symptoms, and upper motor neuron signs. […] For people with a characteristic brain MRI, the acute partial variant suggests a high future risk of developing multiple sclerosis (MS). […] For people with aquaporin-4-IgG autoantibody seropositivity, the longitudinally extensive variant suggests a neuromyelitis optica spectrum disorder.

• #1 Transverse Myelitis | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/transverse-myelitis

  Physicians diagnose transverse myelitis by taking a medical history and performing a thorough neurological examination. […] MRI (magnetic resonance imaging) will almost always confirm the presence of a damaged area (lesion) within the spinal cord. An MRI of the brain can provide clues to other underlying causes, especially MS. […] Blood tests can identify or rule out various disorders, including HIV infection and vitamin B12 deficiency. […] Lumbar puncture and spinal fluid analysis (also called a spinal tap) can identify infections, more protein than usual in some people with transverse myelitis and an increased number of white blood cells (leukocytes) that help the body fight infections. […] In some cases, PET (positron emission tomography), which uses a safe, radioactive tracer, can help identify diseased cells and diagnose some possible underlying causes, such as sarcoidosis or cancer.

• #1 Transverse Myelitis | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://devtest.utswmed.org/conditions-treatments/transverse-myelitis/

  UT Southwestern specialists are experts at differentiating potential mimics of TM, including spinal cord compression, arterial events of the spinal cord, and venous infarction of the spinal cord potentially caused by dural arteriovenous fistulas. […] To diagnose TM, we collect information from a variety of tests and imaging studies to find evidence of damage to the spinal cord that is consistent with inflammation and not consistent with other causes. […] We conduct a careful medical history, a neurologic exam, and a variety of tests that can include: Blood tests, Evoked potentials (EP), Optical coherence tomography (OCT), Magnetic resonance imaging (MRI), Spinal fluid analysis.

• #1 Transverse Myelitis (TM): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8980-transverse-myelitis

  If you’re experiencing symptoms of transverse myelitis (TM), your healthcare provider will review your medical history and perform a physical examination. […] Healthcare providers diagnose TM if you develop spinal cord symptoms over a few days and magnetic resonance imaging (MRI) or other imaging doesn’t show another cause for the spinal cord issues. […] Your healthcare provider may order the following tests to diagnose transverse myelitis and its cause: MRI (magnetic resonance imaging) of your entire spine: MRI is a painless test that produces very clear images of the organs and structures within your body using a large magnet, radio waves and a computer to produce detailed images. […] You may need additional tests depending on the possible cause of TM. If none of these tests suggests a specific cause, you’re presumed to have idiopathic transverse myelitis.

• #1 Transverse Myelitis — a Review of the Presentation, Diagnosis, and Initial Management – Timothy W West – Discovery Medicine

  https://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/

  Lastly, while this is a very helpful test, OCBs are no longer a part of the internationally used McDonald Criteria for the diagnosis of multiple sclerosis except in cases of Primary Progressive Multiple Sclerosis. […] When treating myelitis in the acute setting, infection must be considered first and if suspected, cultures, viral PCR studies, and serologies should be sent and appropriate antibiotic or antiviral agents should be started as soon as possible. […] When an autoimmune or demyelinating condition is thought to be likely, IV corticosteroids are the indicated first-line therapy, but plasma exchange ought to follow as soon as possible if response to the corticosteroids is suboptimal. […] Determining the etiology of transverse myelitis can be challenging, but with effective interpretation of clinical signs and symptoms, neuroimaging, serological and CSF studies, the cause of the myelitis and the treatment course can be guided to provide the patient with the optimal chance for a good outcome.

• #1 Transverse Myelitis (TM) | Diagnosis | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/transverse-myelitis/diagnosis/

  Diagnosis of TM is based on clinical features, imaging, and laboratory findings. Clinical characteristics of spinal cord injury are bilateral signs and/or symptoms of sensory, motor or autonomic dysfunction attributable to the spinal cord or a clearly defined sensory level. Evaluation for signs of inflammation to distinguish TM from other spinal cord disorders typically involves a magnetic resonance imaging (MRI) of the spine with contrast and spinal fluid analysis (which requires a lumbar puncture). […] If a myelopathy is suspected based on history and physical examination, a gadolinium-enhanced magnetic resonance imaging (MRI) of the spinal cord is first obtained to assess if there is a compressive or inflammatory (gadolinium enhancing) lesion, as signs and symptoms can overlap. It is essential to rule out compressive myelopathy (compression of the spinal cord), which can be caused by a tumor, herniated disc, stenosis (a narrowed canal for the cord), hematoma or abscess. Identifying these disorders is critical since immobilization to prevent further injury and early surgery to remove the compression may sometimes reverse neurologic injury to the spinal cord.

• #1 Comprehensive Evaluation of Acute Transverse Myelitis Spectrum Disorders: A Retrospective Analysis of 52 Patients | 2023, Volume 29 – Issue 4 | Turkish Journal of Neurology

  https://tjn.org.tr/full-text/8/eng

  In our study, OCB positivity was found in 65% of patients with sATM. […] In our study, the average age of patients with iATM was lower. […] In our study, LETM was observed at the cervicothoracic level in all AQP-4 antibody-positive patients with NMOSD, similar to the literature. […] Early diagnosis and treatment are very effective in the prognosis of ATM. […] Treatment varies depending on the determination of the underlying cause and severity of the disease. […] In the follow-up of patients with ATM whose cause cannot be determined, patients should be closely monitored for the development of autoimmune diseases, such as MS, NMOAD, and MOGAD, and, if necessary, auxiliary diagnostic tests should be repeated at regular intervals.

• #1 Transverse Myelitis | PM&R KnowledgeNow

  https://now.aapmr.org/transverse-myelitis/

  MRI of the spine with gadolinium is required as the initial workup for acute myelopathy and to rule out conditions such as extrinsic spinal cord compression, ischemia, tumor, arteriovenous malformation and toxicities such as Vitamin B12 deficiency, or post-radiation myelopathy. […] Once a diagnosis of TM is made, further differentiation is needed whether it is idiopathic or disease related. […] According to the National Institute of Health data on idiopathic TM, ultimately one-third of patients have full recovery with the ability to walk, one-third have a fair recovery with some deficits, and one-third have poor recovery with significant neurologic deficits. […] Although crucial in diagnosis, MRI findings do not predict functional neurological status and outcomes in ATM. […] Most cases of TM are singular events; however, relapses or recurrences can happen, which has prognostic and treatment implications.

• #1 Probably transverse myelitis? – New diagnosis and before diagnosis – MS Society UK | Forum

  https://forum.mssociety.org.uk/t/probably-transverse-myelitis/10521

  I think it is important to remember that whatever you do or dont get diagnosed with, that you yourself are the expert in what youre going through on a personal level and on how your body is feeling. […] To cut a long story short Im trying to focus now on staying as well as I can with or without a diagnosis. […] The good news is that means that the majority of people (two thirds) make at least a partial recovery! […] I used to think I was in the middle of the three categories, since some of my initial symptoms got quite a bit better but then I got new symptoms, so its hard to tell. […] I think it is important to remember that whatever you do or dont get diagnosed with, that you yourself are the expert in what youre going through on a personal level and on how your body is feeling. […] I still dont have a definitive diagnosis, and Im trying to learn to live with the possibility that I might not get one any time soon. […] It has helped a bit to type it all out. […] I realise that if the MRI is clear then I may well be discharged with the idiopathic TM diagnosis.

• #1 Transverse Myelitis: What It Is and How It’s Connected to MS

  https://www.healthline.com/health/multiple-sclerosis/transverse-myelitis

  Transverse myelitis is spinal cord inflammation causing damage to the covering of nerve cell fibers. […] Prompt diagnosis and treatment may help recovery. […] The National Institute of Neurological Disorders and Stroke recommends that anyone with transverse myelitis or partial myelitis gets checked for MS. […] A doctor usually orders a magnetic resonance imaging (MRI) scan to diagnose transverse myelitis. An MRI of your spinal cord will show if there is inflammation. This will help the doctor determine whether your pain is from a slipped disc or another condition like MS. […] Tests the doctor might perform include: an MRI of your spine, an MRI of your brain, a lumbar puncture, or spinal tap, to test the fluid surrounding your spinal cord, blood tests for specific antibodies and diseases like HIV. […] The doctor may ask for your medical and family history. A neurological exam is also required to diagnose transverse myelitis and MS. […] Waiting to get treatment is dangerous. The sooner you are treated after symptoms appear, the better your chance of recovery.

• #2 Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings | Spinal Cord

  https://www.nature.com/articles/sc2008143

  The diagnosis of acute transverse myelitis syndromes is based on the clinical symptoms and signs of a spinal cord syndrome in conjunction with evidence of inflammation within the spinal cord such as cerebrospinal fluid (CSF) abnormalities or lesions visible on magnetic resonance imaging (MRI). […] Clinical symptoms of acute transverse myelitis may include motor, sensory and autonomic dysfunction. […] The diagnostic workup of acute myelitis discloses a broad spectrum of CSF or MRI findings, and may be associated with diagnostic uncertainty due to lack of specific CSF or MRI features, or pathological findings. […] The diagnosis of acute transverse myelitis was supported by both MRI lesion detection within the spinal cord and at least one pathological CSF finding (cell count, IgG index, albumin quotient or OCB) in 52 patients (85.2%).

• #2 Transverse Myelitis | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/transverse-myelitis

  Physicians diagnose transverse myelitis by taking a medical history and performing a thorough neurological examination. […] MRI (magnetic resonance imaging) will almost always confirm the presence of a damaged area (lesion) within the spinal cord. An MRI of the brain can provide clues to other underlying causes, especially MS. […] Blood tests can identify or rule out various disorders, including HIV infection and vitamin B12 deficiency. […] Lumbar puncture and spinal fluid analysis (also called a spinal tap) can identify infections, more protein than usual in some people with transverse myelitis and an increased number of white blood cells (leukocytes) that help the body fight infections. […] In some cases, PET (positron emission tomography), which uses a safe, radioactive tracer, can help identify diseased cells and diagnose some possible underlying causes, such as sarcoidosis or cancer.

• #2 Transverse Myelitis | OHSU

  https://www.ohsu.edu/brain-institute/transverse-myelitis

  At the OHSU Multiple Sclerosis Center, youll find the expertise you need for transverse myelitis. Our specialists work in teams to diagnose and treat this complex condition. […] A doctor performing a full neurologic exam. If your doctor suspects transverse myelitis, diagnosis will include a full neurologic exam. […] At OHSU, your team will include expert neurologists, radiologists and rehabilitation specialists, among others. Our team-based approach means you can expect a precise diagnosis and a treatment plan tailored to your needs. […] There is no single test for transverse myelitis. Our diagnostic process includes: […] Your doctor will ask about symptoms and recent history of infection. […] The doctor will check thinking, balance, reflexes and movement to see how your nervous system is working.

• #2 Transverse Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559302/

  When considering TM as a possible diagnosis, it is recommended the following investigative analyses be performed: MRI of the entire spine with and without gadolinium contrast to differentiate compressive vs. non-compressive lesions; Brain MRI with and without gadolinium contrast to evaluate for evidence of brain lesions; LP for CSF analysis, including cell count with differential, protein, glucose, the Venereal Disease Research Laboratory test, oligoclonal bands, immunoglobulin G (IgG) index, and cytology. […] Patients with evidence of longitudinally extensive spinal cord lesions additionally require the following additional studies, including serum erythrocytes sedimentation rate, C-reactive protein, ANA, antibodies to extractable nuclear antigens, rheumatoid factor, antiphospholipid antibodies, and antineutrophil cytoplasmic antibodies. […] The standard of care and the first-line therapy for the treatment of TM is intravenous glucocorticoids. High-dose intravenous glucocorticoids should be initiated as soon as possible. […] There should not be a delay in treatment while waiting for test results.

• #2 Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings | Spinal Cord

  https://www.nature.com/articles/sc2008143

  In a few patients the diagnosis was supported either by a spinal cord lesion visible on MRI (n=5; 7.9%) or abnormal CSF findings (n=4; 8.2%) alone. […] The frequency of detectable spinal cord MRI lesions was high (90.4%) but contrast enhancement was not always present (60.3%). […] OCB (83.6%) and abnormal IgG index (82.0%) were the most common pathological CSF findings.

• #2 The differential diagnosis of longitudinally extensive transverse myelitis. — Oxford Neuroscience

  https://www.neuroscience.ox.ac.uk/publications/242072

  Longitudinally extensive transverse myelitis refers to florid and widespread inflammation of the spinal cord causing T2 hyperintensity on spinal magnetic resonance imaging that is seen to extend over three or more vertebral segments. […] Early identification and establishment of the underlying aetiology is vital in order to initiate appropriate therapy and optimize outcomes. […] Laboratory and radiological investigations can help to differentiate these causes. […] Treatment of longitudinally extensive transverse myelitis hinges on distinguishing inflammatory and non-inflammatory aetiologies and identifying patients who are at high risk of a recurrent course.

• #2 Acute Transverse Myelitis – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/acute-transverse-myelitis

  All patients are also tested for anti-MOG IgG autoantibody, which can help identify patients with myelin oligodendrocyte glycoprotein antibody disease (MOGAD). […] Brain MRI is performed as part of the diagnostic workup to help identify potential underlying etiologies such as multiple sclerosis or NMOSD.

• #2 Transverse Myelitis — a Review of the Presentation, Diagnosis, and Initial Management – Timothy W West – Discovery Medicine

  https://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/

  When an acute myelopathy is suspected, a thorough neurological evaluation will help determine the region of the spinal cord affected and then the next diagnostic step is to evaluate for a compressive or structural etiology. […] Once neuroimaging has excluded a compressive etiology, a lumbar puncture (LP) is indicated to determine if there are signs of inflammation within the cerebrospinal fluid (CSF). […] If the CSF shows signs of inflammation (pleocytosis, elevated protein concentration, oligoclonal bands, or elevated IgG index), then the subsequent work-up should focus on demyelinating, infectious, or other inflammatory causes of an acute myelitis as the differential diagnosis is broad. […] The presence of 2 or more OCBs in the CSF that are not found in the corresponding serum sample is considered to be indicative of increased intrathecal synthesis of gammaglobulins, and in the strictest interpretation is evidence only of compartmentalized inflammation within the CNS.

• #2 Transverse Myelitis — a Review of the Presentation, Diagnosis, and Initial Management – Timothy W West – Discovery Medicine

  https://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/

  Lastly, while this is a very helpful test, OCBs are no longer a part of the internationally used McDonald Criteria for the diagnosis of multiple sclerosis except in cases of Primary Progressive Multiple Sclerosis. […] When treating myelitis in the acute setting, infection must be considered first and if suspected, cultures, viral PCR studies, and serologies should be sent and appropriate antibiotic or antiviral agents should be started as soon as possible. […] When an autoimmune or demyelinating condition is thought to be likely, IV corticosteroids are the indicated first-line therapy, but plasma exchange ought to follow as soon as possible if response to the corticosteroids is suboptimal. […] Determining the etiology of transverse myelitis can be challenging, but with effective interpretation of clinical signs and symptoms, neuroimaging, serological and CSF studies, the cause of the myelitis and the treatment course can be guided to provide the patient with the optimal chance for a good outcome.

• #2 Transverse Myelitis Information – MyMyelitis

  https://mymyelitis.com/transverse-myelitis/transverse-myelitis-information/

  Blood tests can identify certain infections, diseases, and disorders such as HIV, Sjogren’s disease, and Lupus (systemic lupus erythematous). Blood tests can also specify a vitamin B12 deficiency relating to TM. […] Antibodies relating to neuro-immune conditions, such as MOG Antibody Disease and AQP4 (Aquaporin-4) associated with NMOSD, can also be found in the blood. These antibodies would change the individual’s diagnosis significantly as future treatment is likely to differ from an idiopathic TM episode.

• #2 Transverse myelitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/transverse-myelitis?lang=us

  inclusion criteria include development of sensory, motor, or autonomic dysfunction attributable to the spinal cord, bilateral signs and symptoms (though not necessarily symmetric), clearly defined sensory level, exclusion of extra-axial compression by neuroimaging, inflammation within the spinal cord demonstrated by CSF pleocytosis or increased IgG index or gadolinium enhancement, and progression to nadir between 4 hours and 21 days after the onset of symptoms. […] exclusion criteria include radiation to the spine within the last 10 years, arterial distribution clinical deficit consistent with thrombosis of the anterior spinal artery, and abnormal flow voids on the surface of the spinal cord consistent with spinal dural arteriovenous fistula. […] exclusion criteria for idiopathic acute transverse myelitis include connective tissue disease, CNS infection, brain MRI abnormalities suggestive of multiple sclerosis, and history of clinically apparent optic neuritis.

• #2 Acute Transverse Myelitis – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/spinal-cord-disorders/acute-transverse-myelitis

  Magnetic resonance imaging may help doctors make the diagnosis, but a spinal tap may be needed. […] Symptoms suggest the diagnosis of acute transverse myelitis. But doctors must distinguish acute transverse myelitis from other disorders that cause similar symptoms, such as Guillain-Barr syndrome, spinal cord compression, or blockage of the blood supply to the spinal cord. […] Magnetic resonance imaging (MRI) of the spinal cord is done first. MRI helps eliminate other, treatable possible causes of the symptoms, such as spinal cord compression. If myelitis is present, MRI typically shows swelling of the spinal cord due to inflammation. […] A spinal tap (lumbar puncture) is done to obtain a sample of cerebrospinal cord fluid. If acute transverse myelitis is present, the number of certain white blood cells and the protein level in the cerebrospinal fluid are increased. […] Tests, such as a chest x-ray and blood tests, are also done to look for causes. Doctors also ask people about use of medications and illicit drugs that can cause acute transverse myelitis.

• #2 Transverse Myelitis | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://devtest.utswmed.org/conditions-treatments/transverse-myelitis/

  UT Southwestern specialists are experts at differentiating potential mimics of TM, including spinal cord compression, arterial events of the spinal cord, and venous infarction of the spinal cord potentially caused by dural arteriovenous fistulas. […] To diagnose TM, we collect information from a variety of tests and imaging studies to find evidence of damage to the spinal cord that is consistent with inflammation and not consistent with other causes. […] We conduct a careful medical history, a neurologic exam, and a variety of tests that can include: Blood tests, Evoked potentials (EP), Optical coherence tomography (OCT), Magnetic resonance imaging (MRI), Spinal fluid analysis.

• #2 Transverse myelitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1061

  Transverse myelitis (TM) is a heterogeneous focal inflammatory disorder of the spinal cord characterized by acute or subacute development of motor weakness, sensory impairment, and autonomic dysfunction. […] The presence of TM is confirmed by lumbar puncture demonstrating increased white blood cell count and absence of infection, with or without spinal cord MRI revealing a cord lesion that enhances after gadolinium administration. […] Clinical characteristics and magnetic resonance imaging (MRI) of the spinal cord classify TM into acute partial or longitudinally extensive variants. […] Diagnostic tests include MRI spinal cord, MRI brain, serum aquaporin-4 autoantibodies and myelin oligodendrocyte glycoprotein autoantibodies, cerebrospinal fluid cell count, cell differential, protein level, IgG index, oligoclonal bands, and cerebrospinal fluid Gram stain, cultures, and polymerase chain reaction for various viruses.

• #2

  https://scholars.duke.edu/publication/1116786

  Longitudinally extensive transverse myelitis (LETM), characterized by spinal cord inflammation extending three or more vertebral segments in length, may be caused by a multitude of disorders. […] The objective of this review is to highlight the wide range of disorders that may cause LETM and to emphasize the need to carefully consider all potential etiologies in the assessment of LETM. […] In particular, we focus on the salient clinical, laboratory, and radiographic features of these various disorders, which help them to be differentiated from one another.

• #2 Transverse Myelitis (TM) | Diagnosis | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/transverse-myelitis/diagnosis/

  Lumbar puncture is used to look for surrogate markers of inflammation in the cerebrospinal fluid (CSF). These include elevated white cell counts, elevated protein or other markers such as oligoclonal bands. While these markers are supportive of TM, it should be noted that they are not present in all individuals. […] A series of blood tests are often recommended for patients with spinal cord disorder suspicious for TM. This commonly includes testing for aquaporin-4 and myelin oligodendrocyte glycoprotein (MOG) antibodies, in addition to tests associated with systemic autoimmune disorders such as systemic lupus erythematosus (SLE) and Sjgrens syndrome. If sarcoidosis is suspected based upon history and imaging characteristics, a CT of the chest may be considered to look for lung findings. Other common ordered tests include HIV, syphilis, vitamin B12 and copper levels.

• #2 Transverse Myelitis (TM) | Diagnosis | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/transverse-myelitis/diagnosis/

  An MRI of the brain is often performed to screen for lesions suggestive of a demyelinating disorder such as MS, NMOSD, or MOG antibody disease. In patients with imaging features of TM that are consistent with MS, brain imaging may be repeated over time to see if characteristic MS lesions develop. […] If none of the tests are suggestive of a specific cause, a diagnosis of idiopathic transverse myelitis can be made. […] Even after comprehensive medical evaluation, there remains a significant proportion of individuals with spinal cord inflammation that is without a clear identifiable cause. This is a condition called idiopathic transverse myelitis. When a healthcare provider diagnoses someone with transverse myelitis, they are typically referring to idiopathic TM. Even among those labeled as having idiopathic TM, it is likely that there are multiple yet-to-be-identified causes for this inflammation.

• #2 Transverse Myelitis: What It Is and How It’s Connected to MS

  https://www.healthline.com/health/multiple-sclerosis/transverse-myelitis

  Transverse myelitis is spinal cord inflammation causing damage to the covering of nerve cell fibers. […] Prompt diagnosis and treatment may help recovery. […] The National Institute of Neurological Disorders and Stroke recommends that anyone with transverse myelitis or partial myelitis gets checked for MS. […] A doctor usually orders a magnetic resonance imaging (MRI) scan to diagnose transverse myelitis. An MRI of your spinal cord will show if there is inflammation. This will help the doctor determine whether your pain is from a slipped disc or another condition like MS. […] Tests the doctor might perform include: an MRI of your spine, an MRI of your brain, a lumbar puncture, or spinal tap, to test the fluid surrounding your spinal cord, blood tests for specific antibodies and diseases like HIV. […] The doctor may ask for your medical and family history. A neurological exam is also required to diagnose transverse myelitis and MS. […] Waiting to get treatment is dangerous. The sooner you are treated after symptoms appear, the better your chance of recovery.

• #3 Transverse Myelitis | Living With Paralysis | Reeve Foundation

  https://www.christopherreeve.org/todays-care/living-with-paralysis/health/causes-of-paralysis/transverse-myelitis/

  Transverse myelitis (TM) is a subgroup category in a larger diagnostic grouping called neuromyelitis optica spectrum disorder (NMOSD) which also includes neuromyelitis optica, a paralysis of the optic nerve. […] Diagnosing TM can be difficult. First emergency conditions must be eliminated. The following assessments and tests are used to make a TM diagnosis. […] A history and physical examination are completed. It is important to describe all your symptoms to your healthcare provider if you think they are TM symptoms or not. This should include when symptoms occur, and if you had symptoms in the past which have now resolved. […] Your provider will perform an extensive neurological examination which includes assessment of your central nervous system (CNS) as well as the nerves and muscles of your body. Physical examination will include an assessment of all the nerves and joints of your body and testing the sensation of your body using a sharp object for pin prick touch and a cotton tip for light touch.

• #3 Comprehensive Evaluation of Acute Transverse Myelitis Spectrum Disorders: A Retrospective Analysis of 52 Patients | 2023, Volume 29 – Issue 4 | Turkish Journal of Neurology

  https://tjn.org.tr/full-text/8/eng

  Acute transverse myelitis (ATM) is defined as focal inflammation of the spinal cord, which may be idiopathic or secondary to an infection or systemic disease without cord compression. […] Definitive diagnosis of myelitis is based on clinical findings and confirmation of inflammation through laboratory and imaging studies. […] The diagnosis of iATM can be made based on the clinical, laboratory, and imaging findings, and other causes are excluded. […] A CSF examination is extremely important to determine the etiology of ATM. […] OCB analysis shows a narrow range of electrophoretic dissociation of certain Igs in the CSF. […] The presence of OCB indicates that there is an inflammatory process in the brain and spinal cord. […] OCBs can be detected in the CSF of most patients with ATM.

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