Transversal myelitis

Signs & Symptoms

Acute or subacute neurological signs/symptoms of motor/sensory/autonomic origin

Most patients have sensitivity problems; 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 …)
    • lactate
  • Autoimmune serology: anti-MOG, anti-aquaporin-4 IgG, ANF
  • Copper levels in the blood
  • TSH, B12


  • 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

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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