Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events
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D R Jeffery1, R N Mandler, L E Davis
1Spinal Cord Injury Service, Veterans Affairs Medical Center, Albuquerque, NM 87108.
Objective:
A study was undertaken to determine whether cases of parainfectious-associated transverse myelitis (TM) and multiple sclerosis-associated TM could be distinguished on the basis of clinical criteria, radiologic features, or cerebrospinal fluid examination. A secondary objective was to determine the incidence of TM in a US population.
Design:
A retrospective analysis of 33 cases was conducted. Cases were classified as being related to parainfectious multiple sclerosis, or spinal cord ischemia, or idiopathic.
Setting:
All cases occurring in the Albuquerque, NM, area from 1960 through 1990 were reviewed. The population base was 500,000.
Outcome Measures:
Clinical presentation, radiologic features, cerebrospinal fluid, recovery of ambulation and bladder function, and recurrence rates were compared.
Results:
Thirty-three patients satisfied study criteria, corresponding to an incidence of 4.6 per million per year. Forty-five percent of these cases were categorized as parainfectious, 21% as associated with multiple sclerosis, 12% as associated with spinal cord ischemia, and 21% as idiopathic. Patients with parainfectious TM suffered from spinal shock more frequently than did those with multiple sclerosis-associated TM. Patients with parainfectious TM showed evidence of spinal cord swelling, whereas patients with multiple sclerosis-associated TM had spinal cord plaques on magnetic resonance images but none showed swelling. Oligoclonal bands were absent in patients with parainfectious TM and present in three of five patients with multiple sclerosis-associated TM.
Conclusions:
Parainfectious TM may be distinguishable from that associated with multiple sclerosis on the basis of presentation, findings on imaging, and the presence of cerebrospinal fluid oligoclonal bands.
Insights
Parainfectious transverse myelitis (TM) can be differentiated from multiple sclerosis-associated TM through clinical presentation, imaging, and cerebrospinal fluid analysis. This study also determined the incidence of TM in a US population.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Medicine
Background:
- Transverse myelitis (TM) is a neurological disorder affecting the spinal cord.
- Differentiating parainfectious TM from multiple sclerosis-associated TM is crucial for accurate diagnosis and treatment.
- The incidence of TM in the United States requires updated epidemiological data.
Purpose of the Study:
- To distinguish parainfectious TM from multiple sclerosis-associated TM using clinical, radiologic, and cerebrospinal fluid (CSF) criteria.
- To determine the incidence of TM in a defined US population.
- To compare clinical outcomes and recurrence rates between different etiologies of TM.
Main Methods:
- Retrospective analysis of 33 TM cases from 1960-1990 in Albuquerque, NM.
- Classification of TM cases into parainfectious, multiple sclerosis-associated, spinal cord ischemia, or idiopathic categories.
- Comparison of clinical presentation, MRI findings, CSF analysis (including oligoclonal bands), and patient recovery.
Main Results:
- An overall TM incidence of 4.6 per million per year was calculated.
- Parainfectious TM (45%) was more frequently associated with spinal shock and spinal cord swelling on MRI.
- Multiple sclerosis-associated TM (21%) showed spinal cord plaques and CSF oligoclonal bands in some cases.
Conclusions:
- Clinical presentation, MRI findings (swelling vs. plaques), and CSF oligoclonal bands can help differentiate parainfectious TM from multiple sclerosis-associated TM.
- The study provides valuable insights into the distinct characteristics of different TM etiologies.
- Updated incidence data for TM in the US population was established.