Transversal myelitis
Signs & Symptoms
Acute or subacute neurological signs/symptoms of motor/sensory/autonomic origin
Most patients have sensitivity problems; 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 …)
- lactate
- Autoimmune serology: anti-MOG, anti-aquaporin-4 IgG, ANF
- Copper levels in the blood
- TSH, B12
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
Abbrevations
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
