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Myelitis

O Andersen1

  • 1Department of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg, Sweden.

Current Opinion in Neurology
|June 28, 2000
PubMed

Insights

Acute transverse myelitis (ATM) causes vary by severity and patient age, ranging from multiple sclerosis to viral infections. Prompt diagnosis through advanced methods like PCR is crucial for effective treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Acute transverse myelitis (ATM) presents with diverse etiologies, often linked to multiple sclerosis in milder cases and viral infections or vascular disorders in severe presentations.
  • Distinguishing the cause of ATM historically relied on indirect methods, but advancements have improved diagnostic accuracy.
  • Understanding the underlying causes is critical for appropriate management and treatment strategies.

Purpose of the Study:

  • To delineate the various causes of acute transverse myelitis (ATM) based on clinical presentation and imaging findings.
  • To highlight the evolution of diagnostic techniques for identifying infectious and autoimmune etiologies of ATM.
  • To emphasize the importance of a comprehensive differential diagnosis for effective patient outcomes.

Main Methods:

  • Review of clinical presentations, magnetic resonance imaging (MRI) findings, and patient demographics.
  • Application of specific diagnostic tests, including polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) for viral detection.
  • Consideration of serological evidence and identification of pathogens in relevant samples.

Main Results:

  • Moderate ATM with limited MRI lesions is frequently associated with multiple sclerosis.
  • Severe ATM with extensive lesions, particularly in younger individuals, often indicates a viral cause.
  • Older patients with severe ATM may have vascular disorders; post-infectious/vaccinal causes like acute disseminated encephalomyelitis (ADEM) and autoimmune conditions are also significant.
  • Neuromyelitis optica is linked to ADEM or systemic lupus erythematosus.

Conclusions:

  • Accurate diagnosis of ATM relies on considering a broad differential, including viral myelitis, multiple sclerosis, ADEM, neuromyelitis optica, and vascular issues.
  • Modern diagnostic tools, such as PCR, enable specific identification of viral agents.
  • Many ATM causes are treatable with antiviral agents or immunosuppression, underscoring the need for rapid and thorough diagnostic work-up.

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