Acute transverse myelitis is inflammatory disease that affects both sides of the spinal cord. It is a rare disease that is commonly idiopathic, but when an etiology is found, it is commonly due to an acute infection, post-infection, post-vaccination or associated with autoimmune diseases such as lupus. Patients present typically with an acute or subacute onset (hours to days) of motor, sensory and/or autonomic dysfunction of the nervous system. Motor symptoms include rapidly progressing paraparesis that commonly involves the upper extremities, with flaccidity initially, followed by spasticity. Most patients have sensory level symptoms as well, including pain, dysesthesia, and paresthesia, although paresthesia are uncommon in children. Autonomic symptoms are related bowel, bladder and sexual dysfunction.
Brain MRI with and without gadolinium is useful to help rule out spinal cord compressions and brain lesions that are suggestive of other diseases, such as multiple sclerosis. On T2-weighted imaging, patients may have bright periventricular white matter lesions; multiple sclerosis develops in approximately 50% of patients who have these, and in 5% who do not. Other studies have shown that patients presenting with partial myelitis initially and have cranial abnormalities showing lesions typical for multiple sclerosis, have a 60-90% chance of transitioning to MS over 3-5 years. However, patients with a normal MRI have a 10-30% rate of developing MS in that same time frame.
References:
1. Meyer P, Leboucq N, Molinari N, Roubertie A, Carneiro M, Walther-Louvier U, Cuntz-Shadfar D, Leydet J, Cheminal R, Cambonie G, Echenne B, Rondouin G, Deiva K, Mikaeloff Y, Rivier F. Partial acute transverse myelitis is a predictor of multiple sclerosis in children. Mult Scler. 2014;20:1485–93.
3. https://radiopaedia.org/articles/transverse-myelitis