Differential diagnosis in acute inflammatory myelitis

Area of Science:

• Neuroimmunology
• Neurology
• Diagnostic Medicine

Background:

• Differentiating inflammatory causes of acute transverse myelitis (ATM) presents diagnostic challenges.
• Accurate etiological diagnosis is crucial for targeted therapeutic interventions.

Purpose of the Study:

• To identify clinical, imaging, and laboratory findings that best aid in confirming ATM etiology.
• To enhance the diagnostic accuracy for various causes of acute transverse myelitis.

Main Methods:

• Retrospective analysis of clinical history, MRI, CSF, and serum tests in 172 ATM patients.
• Univariate and multivariate logistic regression analyses were employed to assess contributing factors.

Main Results:

• Distinct patterns emerged for multiple sclerosis (MS), idiopathic myelitis (IM), systemic-antibody-associated myelitis (SAb-M), and neuromyelitis optica spectrum disorders (NMOSD).
• Brain demyelinating lesions and oligoclonal bands (OCB) in CSF indicated MS risk.
• Longitudinally extended (LE) spinal cord lesions and brain lesions were associated with NMOSD and ATM recurrence.

Conclusions:

• Spinal cord and brain MRI findings, combined with CSF and serum tests, can clarify ATM etiology.
• This integrated diagnostic approach facilitates earlier and more precise diagnoses, enabling specific therapies for uncertain cases.