Abstract
Acute transverse myelitis (ATM) is a pathogenetically heterogeneous inflammatory disorder
of the spinal cord. Therefore, the identification of clinical and paraclinical features
providing clues of the underlying etiologies is needed. The clinical presentation,
blood and cerebrospinal fluid (CSF) findings as well as magnetic resonance imaging
(MRI) and neurophysiological features were retrospectively analyzed in 45 unselected
consecutive patients with ATM. Parainfectious ATM was diagnosed in 38% of patients.
The underlying infectious agent, however, was identified only in a minority of patients.
In 36% of patients, the etiology remained uncertain (“idiopathic” ATM) and in 22%
ATM was the first manifestation of possible multiple sclerosis (ATM-MS) according
to recently published diagnostic criteria. Spinal cord MRI showed signal alterations
in 96% of the patients. In ATM-MS, monosegmental involvement of the spinal cord was
most frequent while spinal cord involvement of two or more segments was more common
in ATM of other etiologies. Of particular note, neurophysiological examinations showed
evidence of peripheral nervous system (PNS) involvement in 27% of patients with ATM
but not in patients with ATM-MS. Therefore, neurophysiological evidence of PNS involvement
may provide additional discriminatory features between ATM-MS and ATM of other etiologies.
Keywords
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Article info
Publication history
Accepted:
October 22,
2003
Received in revised form:
October 21,
2003
Received:
April 10,
2003
Identification
Copyright
© 2003 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
