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Clinical course and long-term prognosis of acute transverse myelopathy
P B Christensen1, L Wermuth, H H Hinge
1Department of Neurology, Aalborg Hospital, Aarhus, Denmark.
Abstract:
The clinical characteristics and course of acute transverse myelopathy (ATM) was studied. One patient developed multiple sclerosis. In 1 patient ATM was caused by tumour-cell embolization of the intramedullar vessels; 30 aged 12-74 years (median 36 years) had ATM of unknown course, of these, 13 had symptoms of a preceding viral-like infection, 18 had back-pain and 10 signs of spinal shock. The time from onset of ATM to maximum deficit varied from less than 1 h to 20 days. The thoracic region was the most common level of cord damage. Follow-up was possible in 29 cases; 2 died (2 and 8 months after onset), of the surviving 27 (follow-up 1-13 years, median 6 years) one third had a good outcome, one third a fair, while one third remained paraplegic, incontinent with severe sensory deficits. Back-pain and signs of spinal shock indicated a poor outcome.
Insights
Acute transverse myelopathy (ATM) impacts individuals of various ages, with outcomes ranging from full recovery to permanent paralysis. Pre-existing back pain or spinal shock symptoms suggest a poorer prognosis in ATM patients.
Area of Science:
- Neurology
- Clinical Medicine
- Neuroimmunology
Background:
- Acute transverse myelopathy (ATM) is a rare neurological disorder.
- Understanding the clinical characteristics and prognosis of ATM is crucial for patient management.
- Etiologies of ATM can be diverse, including infections and neoplastic processes.
Purpose of the Study:
- To investigate the clinical features and long-term outcomes of patients with acute transverse myelopathy.
- To identify factors associated with a poor prognosis in ATM.
- To explore potential triggers and complications of ATM.
Main Methods:
- Retrospective case series analysis of patients diagnosed with ATM.
- Data collection included clinical presentation, time to maximum deficit, affected spinal cord level, and etiological factors.
- Longitudinal follow-up assessments evaluated functional recovery, neurological deficits, and mortality.
Main Results:
- The study included 30 patients with ATM of unknown cause, aged 12-74 years (median 36).
- Commonly reported preceding symptoms included viral-like infections (13 patients) and back pain (18 patients).
- One-third of survivors experienced good recovery, one-third fair recovery, and one-third remained with significant neurological deficits, including paraplegia and incontinence.
Conclusions:
- Acute transverse myelopathy presents with variable clinical courses and outcomes.
- The presence of back pain and spinal shock at onset are indicators of a poor prognosis.
- ATM can rarely be a presenting sign of multiple sclerosis or arise from tumor-related emboli.