Transversal myelitis

Signs & Symptoms

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

Evaluation

• 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

Management

• 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