Transversal myelitis

Signs & Symptoms

  • Acute or subacute neurological signs/symptoms of motor/sensory/autonomic origin
  • Most have sensory symptoms
  • Often bilateral symptoms


  • Always MRI to exclude compression
  • Lumbar puncture after brain imaging: analysis of CSF for white blood cell analysis (ideally including flowcytometry analysis), proteinorraghy, glucose level, presence for neoplastic cells
  • infectious workup (incl. viral and bacterial analysis in CSF and blood according to local practice (incl. viral and bacterial analysis in CSF and blood: eg varicella, hepatitis E, HSV1, HSV2, VZV, EBV, syphilis, HIV, CMV …):
  • Blood analysis for: lactate, copper levels in the blood, TSH, B12
  • Autoimmune serology: anti-MOG, anti-aquaporin-4 IgG, ANF


  • IV 500mg-1gr methylprednisolone during 3-5 days followed by oral steroid tapering
  • Plasmapheresis might be indicated if no response to corticoid therapy upon 1 week of treatment
  • ICU admission should be considered if autonomic instability
  • Neurological consult


ANF: Anti Nuclear Factor
Anti-MOG Ab: Anti Myelin Oligodendrocyte Glycoprotein Antibody
CMV: Cytomegalovirus
CSF: Cerebrospinal fluid
EBV: Epstein-Barr Virus
EEG: Electro EncephaloGram
HSV: Herpes Zoster Virus
ICPi: Immune Checkpoint Blockade Inhibition
ICU: Intensive Care Unit
HIV: Human Immunedeficiency Virus
MRI: Magnetic Resonance Imaging
PCR: Polymerase Chain Reaction
VZV: Varicella Zoster Virus