Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients
Introduction
Acute transverse myelitis (ATM) is a pathogenetically heterogeneous inflammatory disorder affecting the spinal cord at one or more segments. Clinical symptoms of ATM usually evolve subacutely over hours or days as para- or tetraparesis, a sensory level, or sphincter dysfunction [1], [2], [3]. ATM occurs in association with various viral [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15] and bacterial [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29] infections as well as in systemic autoimmune diseases such as systemic lupus erythematosus (SLE) [30], [31], mixed connective tissue disease [32], scleroderma [33], [34], Sjögren's syndrome [35], rheumatoid arthritis [36], atopic dermatitis [37], primary urticarial vasculitis [38], immune-complex allergic vasculitis [39], and the antiphospholipid antibody syndrome [35], [40]. ATM may also occur in multiple sclerosis (MS) [41], [42], [43], [44], [45], acute disseminated encephalomyelitis (ADEM) [46], and neuromyelitis optica (Devic's syndrome) [47], [48], [49]. Infrequently, ATM is associated with Behcet's disease [50], [51].
Although there is extensive literature on ATM, only few studies have systematically investigated the clinical features and etiologies of ATM [43], [52], [53], [54], [55]. To this end, we retrospectively studied a series of 45 unselected consecutive ATM patients with special regard to the clinical presentation, blood and cerebrospinal fluid (CSF) findings as well as magnetic resonance imaging (MRI) and neurophysiological abnormalities.
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Patients
Forty five unselected consecutive ATM patients diagnosed at the Department of Neurology, University of Bonn, Germany, between January 1997 and December 2000 were retrospectively analyzed. Thirty five patients were females and ten males (mean age 35.8±14.3 years, range 17 to 72 years). Patients with myelopathy related to compression, trauma, spinal or meningeal malignancies, neurological deficits consistent with thrombosis of the anterior spinal artery, arteriovenous malformation, and history of
Clinical findings and etiology of ATM
A sensory level was present in 37/45 (82%) patients and was symmetrical in 22/45 and asymmetrical in 15/45 patients. Motor weakness was observed in 22/45 patients with symmetrical or asymmetrical paraparesis of the lower extremities as the most common finding (8/45 patients). Tetraparesis was present in 5/45, symmetrical or asymmetrical paresis of the upper extremities in 4/45, hemiparesis in 3/45, and asymmetrical paresis of upper and lower extremities in 2/45 patients. Of the 45 patients, 8
Discussion
The aim of this retrospective study was to investigate systematically the clinical features, blood and CSF findings as well as MRI and neurophysiological abnormalities in ATM of various etiologies. We demonstrate that (1) ATM of parainfectious origin is most frequent but the underlying infectious agents are identifiable only in a minority of patients; (2) spinal cord MRI in ATM-MS is predominantly monosegmental and confined to the cervical cord; 3) PNS involvement is frequent in ATM not related
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