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Transverse myelitis--a review of the presentation, diagnosis, and initial management
1Lou Ruvo Center for Brain Health and the Mellen Center for Multiple Sclerosis Treatment and Research Neurological Institute, Department of Neurology, Cleveland Clinic, Las Vegas, Nevada 89106, USA.
Abstract:
Myelitis is a rare neurological disorder of the spinal cord that is caused by inflammation and can have devastating neurologic effects with up to two-thirds of patients having a moderate to severe degree of residual disability. Symptoms typically develop over hours or days and then worsen over a matter of days to weeks. Patients can present with sensory alteration, weakness, and autonomic dysfunction including bowel and bladder problems, temperature dysregulation, or even bouts of hypertension. Evaluation for compressive etiologies must be a priority as compressive myelopathy and transverse myelitis are often clinically indistinguishable and emergent surgical intervention is indicated in such cases. However, if neuroimaging and CSF studies indicate inflammation within the central nervous system, then a work-up for myelitis must include autoimmune, inflammatory, and infectious etiologies. Acute management of these patients is dictated by which etiology is suspected and rapid initiation of that treatment portends a more favorable patient outcome. This review will discuss a practical clinical approach to the diagnosis and acute management of patients with myelitis including clinical symptoms, the role of neuroimaging, and the utility of both CSF and serological studies in the management of these patients.
Insights
Myelitis, a spinal cord inflammation, causes significant disability. Early diagnosis and prompt treatment based on suspected causes like autoimmune or infectious factors are crucial for better patient outcomes.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Myelitis is a rare neurological disorder characterized by spinal cord inflammation.
- It can lead to severe, lasting neurological deficits in up to two-thirds of patients.
- Symptoms develop rapidly and include sensory, motor, and autonomic dysfunction.
Purpose of the Study:
- To outline a clinical approach for diagnosing and managing myelitis.
- To emphasize the importance of differentiating inflammatory myelitis from compressive etiologies.
- To review diagnostic tools including neuroimaging, CSF, and serological studies.
Main Methods:
- Clinical review of myelitis diagnosis and management.
- Discussion of diagnostic priorities, including ruling out compressive causes.
- Emphasis on etiological work-up (autoimmune, inflammatory, infectious).
Main Results:
- Prompt diagnosis and etiology-specific treatment are key to favorable outcomes.
- Neuroimaging and CSF analysis are vital in identifying central nervous system inflammation.
- Distinguishing myelitis from compressive myelopathy requires urgent evaluation.
Conclusions:
- A systematic approach to diagnosis and acute management of myelitis is essential.
- Identifying the underlying cause (autoimmune, infectious, inflammatory) guides treatment decisions.
- Timely intervention significantly impacts patient prognosis and functional recovery.
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