Original Article
Spinal Cord (2009) 47, 312–317; doi:10.1038/sc.2008.143; published online 18 November 2008
Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings
J Sellner1,2, N Lüthi1, W M M Schüpbach1, A Gebhardt1, O Findling1, G Schroth3, H P Mattle1 and K Nedeltchev1,4
- 1Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 2Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
- 3Department of Interventional and Diagnostic Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 4Department of Neurology, Stadtspital Triemli, Zürich, Switzerland
Correspondence: Dr J Sellner, Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 München, Germany. E-mail: sellner@lrz.tum.de
Received 23 April 2008; Revised 10 October 2008; Accepted 12 October 2008; Published online 18 November 2008.
Abstract
Study design:
Retrospective 9-year survey.
Objectives:
Clinical presentation of acute myelitis syndromes is variable, and neuroimaging and laboratory findings are not specific enough to establish the diagnosis with certainty. We evaluated the spectrum clinical features and paraclinical findings encountered during diagnostic workup and aiding the diagnosis.
Setting:
Department of Neurology, Inselspital Bern, Switzerland.
Material:
Charts and magnetic resonance imaging (MRI) of 63 patients discharged with the diagnosis of acute transverse myelitis.
Results:
The diagnosis was supported by abnormal MRI and cerebrospinal fluid (CSF) findings in 52 patients (82.5%) and suspected in the remaining either because of a spinal cord MRI lesion suggestive of myelitis (n=5), or abnormal CSF findings (n=4), or electrophysiological evidence of a spinal cord dysfunction (n=2). Clinical impairment was mild (ASIA D) in the majority. All patients had sensory disturbances, whereas motor deficit and autonomic dysfunction were less frequent. Neurological levels were mainly located in cervical or thoracic dermatomes. Spinal cord lesions were visualized by MRI in 90.4% of the patients and distributed either in the cervical or thoracic cord, or both. Multiple lesions were present in more than half of the patients, and lateral, centromedullary and posterior locations were most common. A high percentage of multiple sclerosis (MS)-typical brain lesions and CSF findings suggested a substantial number of MS-related myelitis in our cohort.
Conclusion:
The diagnostic workup of acute myelitis discloses a broad spectrum of CSF or MRI findings, and may be associated with diagnostic uncertainty due to lack of specific CSF or MRI features, or pathological findings.
Keywords:
spinal cord, transverse myelitis, examination, neuroimaging, diagnosis
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