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An approach to the diagnosis of acute transverse myelitis.

Authors
  • Jacob, Anu1
  • Weinshenker, Brian G
  • 1 Division of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
Seminars in neurology
Publication Date
Feb 01, 2008
Volume
28
Issue
1
Pages
105–120
Identifiers
DOI: 10.1055/s-2007-1019132
PMID: 18256991
Source
Medline
License
Unknown

Abstract

The differential diagnosis of acute inflammatory transverse myelitis (ATM) is broad. Therefore, physicians must be aware of the many potential etiologies for acute myelopathy, and should pursue an ordered, efficient, and cost-effective approach to the diagnosis based on the patient's clinical history, examination, and magnetic resonance imaging (MRI) findings. Clinical, immunological, and radiological findings of non-compressive myelopathies are reviewed, as are how these findings can be used to distinguish between demyelinating, infectious, other inflammatory, vascular, neoplastic, and paraneoplastic etiologies. We also review predictors of further episodes of ATM in patients with demyelinating disorders. We discuss the diagnostic clues and pitfalls of the not uncommon clinical scenario of a presumed "myelopathy with normal MRI." Finally, we suggest an algorithm for the diagnosis and management of acute myelopathies.

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