[Acute transverse myelopathy: inflammatory or ischemic?]

Area of Science:

• Neurology
• Neuroimmunology
• Neuroradiology

Context:

• Acute transverse myelopathy (ATM) is a neurological disorder characterized by rapid onset of motor and sensory deficits.
• Distinguishing between different etiologies of ATM, such as ischemia, inflammation, and infection, is critical for patient management.
• Spinal cord compression must be urgently excluded via MRI.

Purpose:

• To outline the diagnostic features and differential diagnosis of acute transverse myelopathy.
• To highlight key clinical and imaging findings for various causes of ATM.
• To emphasize the importance of cerebrospinal fluid analysis and specific diagnostic criteria.

Summary:

• ATM typically involves rapid paraparesis/tetraparesis, bilateral sensory loss with a rostral border, and bladder dysfunction.
• Ischemic ATM presents suddenly with symptoms in the anterior spinal artery territory, requiring identification of a specific cause.
• Inflammatory ATM, often linked to multiple sclerosis or neuromyelitis optica, shows characteristic MRI lesions and cerebrospinal fluid findings. Infectious causes may follow viral illness or vaccination, resembling acute disseminated encephalomyelitis.

Impact:

• Accurate diagnosis of ATM etiology guides appropriate treatment strategies.
• Distinguishing between conditions like multiple sclerosis and acute disseminated encephalomyelitis impacts prognosis and therapeutic decisions.
• Early and precise diagnosis improves patient outcomes by enabling timely and targeted interventions.