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Spine
Diagnosis
Infection and Inflammatory Disorders
Inflammatory and Autoimmune Disorders
Idiopathic Acute Transverse Myelitis
Idiopathic Acute Transverse Myelitis
Jeffrey S. Ross, MD; Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Idiopathic acute transverse myelitis (IATM)

              • Synonyms

                • Idiopathic transverse myelopathy

              • Definitions

                • Inflammatory disorder involving both halves of spinal cord, resulting in bilateral motor, sensory, and autonomic dysfunction
                  • Diagnosis of exclusion, since 80% of patients have identifiable disease

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Chitnis T: Pediatric central nervous system demyelinating diseases. Continuum (Minneap Minn). 25(3):793-814, 2019
                                          2. Wang C et al: Clinical approach to pediatric transverse myelitis, neuromyelitis optica spectrum disorder and acute flaccid myelitis. Children (Basel). 6(5), 2019
                                          3. Zalewski NL et al: Evaluation of idiopathic transverse myelitis revealing specific myelopathy diagnoses. Neurology. 90(2):e96-102, 2018
                                          4. Cree BA: Acute inflammatory myelopathies. Handb Clin Neurol. 122:613-67, 2014
                                          5. Goh C et al: MRI in transverse myelitis. J Magn Reson Imaging. 40(6):1267-79, 2014
                                          6. Cobo Calvo A et al: Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol. 13:135, 2013
                                          7. Kitley J et al: Longitudinally extensive transverse myelitis with and without aquaporin 4 antibodies. JAMA Neurol. 70(11):1375-81, 2013
                                          8. West TW et al: Acute transverse myelitis: demyelinating, inflammatory, and infectious myelopathies. Semin Neurol. 32(2):97-113, 2012
                                          9. Pandit L: Transverse myelitis spectrum disorders. Neurol India. 57(2):126-33, 2009
                                          10. Scott TF et al: Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically definite multiple sclerosis. Mult Scler. 11(4):373-7, 2005
                                          11. Andronikou S et al: MRI findings in acute idiopathic transverse myelopathy in children. Pediatr Radiol. 33(9):624-9, 2003
                                          12. Banit DM et al: Recurrent transverse myelitis after lumbar spine surgery: a case report. Spine. 28(9):E165-8, 2003
                                          13. Kim KK: Idiopathic recurrent transverse myelitis. Arch Neurol. 60(9):1290-4, 2003
                                          14. Kerr DA et al: Immunopathogenesis of acute transverse myelitis. Curr Opin Neurol. 15(3):339-47, 2002
                                          15. Transverse Myelitis Consortium Working Group: proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 59(4):499-505, 2002
                                          16. Scotti G et al: Diagnosis and differential diagnosis of acute transverse myelopathy. The role of neuroradiological investigations and review of the literature. Neurol Sci. 22 Suppl 2:S69-73, 2001
                                          17. Misra UK et al: Role of MRI in acute transverse myelitis. Neurol India. 47(4):253-4, 1999
                                          18. Murthy JM et al: Acute transverse myelitis: MR characteristics. Neurol India. 47(4):290-3, 1999
                                          19. Isoda H et al: MR imaging of acute transverse myelitis (myelopathy). Radiat Med. 16(3):179-86, 1998
                                          20. Choi KH et al: Idiopathic transverse myelitis: MR characteristics. AJNR Am J Neuroradiol. 17(6):1151-60, 1996
                                          21. Misra UK et al: A clinical, MRI and neurophysiological study of acute transverse myelitis. J Neurol Sci. 138(1-2):150-6, 1996
                                          22. Tartaglino LM et al: Idiopathic acute transverse myelitis: MR imaging findings. Radiology. 201(3):661-9, 1996
                                          23. Campi A et al: Acute transverse myelopathy: spinal and cranial MR study with clinical follow-up. AJNR Am J Neuroradiol. 16(1):115-23, 1995
                                          24. Jeffery DR et al: Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events. Arch Neurol. 50(5):532-5, 1993
                                          25. Kelley CE et al: Acute transverse myelitis in the emergency department: a case report and review of the literature. J Emerg Med. 9(6):417-20, 1991
                                          26. Christensen PB et al: Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand. 81(5):431-5, 1990
                                          27. Dunne K et al: Acute transverse myelopathy in childhood. Dev Med Child Neurol. 28(2):198-204, 1986
                                          28. Berman M et al: Acute transverse myelitis: incidence and etiologic considerations. Neurology. 31(8):966-71, 1981
                                          29. Lipton HL et al: Acute transverse myelopathy in adults. A follow-up study. Arch Neurol. 28(4):252-7, 1973
                                          30. Altrocchi PH: Acute transverse myelopathy. Arch Neurol. 9:111-9, 1963
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Idiopathic acute transverse myelitis (IATM)

                                                      • Synonyms

                                                        • Idiopathic transverse myelopathy

                                                      • Definitions

                                                        • Inflammatory disorder involving both halves of spinal cord, resulting in bilateral motor, sensory, and autonomic dysfunction
                                                          • Diagnosis of exclusion, since 80% of patients have identifiable disease

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nonvascular Interventions

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Chitnis T: Pediatric central nervous system demyelinating diseases. Continuum (Minneap Minn). 25(3):793-814, 2019
                                                                                  2. Wang C et al: Clinical approach to pediatric transverse myelitis, neuromyelitis optica spectrum disorder and acute flaccid myelitis. Children (Basel). 6(5), 2019
                                                                                  3. Zalewski NL et al: Evaluation of idiopathic transverse myelitis revealing specific myelopathy diagnoses. Neurology. 90(2):e96-102, 2018
                                                                                  4. Cree BA: Acute inflammatory myelopathies. Handb Clin Neurol. 122:613-67, 2014
                                                                                  5. Goh C et al: MRI in transverse myelitis. J Magn Reson Imaging. 40(6):1267-79, 2014
                                                                                  6. Cobo Calvo A et al: Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol. 13:135, 2013
                                                                                  7. Kitley J et al: Longitudinally extensive transverse myelitis with and without aquaporin 4 antibodies. JAMA Neurol. 70(11):1375-81, 2013
                                                                                  8. West TW et al: Acute transverse myelitis: demyelinating, inflammatory, and infectious myelopathies. Semin Neurol. 32(2):97-113, 2012
                                                                                  9. Pandit L: Transverse myelitis spectrum disorders. Neurol India. 57(2):126-33, 2009
                                                                                  10. Scott TF et al: Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically definite multiple sclerosis. Mult Scler. 11(4):373-7, 2005
                                                                                  11. Andronikou S et al: MRI findings in acute idiopathic transverse myelopathy in children. Pediatr Radiol. 33(9):624-9, 2003
                                                                                  12. Banit DM et al: Recurrent transverse myelitis after lumbar spine surgery: a case report. Spine. 28(9):E165-8, 2003
                                                                                  13. Kim KK: Idiopathic recurrent transverse myelitis. Arch Neurol. 60(9):1290-4, 2003
                                                                                  14. Kerr DA et al: Immunopathogenesis of acute transverse myelitis. Curr Opin Neurol. 15(3):339-47, 2002
                                                                                  15. Transverse Myelitis Consortium Working Group: proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 59(4):499-505, 2002
                                                                                  16. Scotti G et al: Diagnosis and differential diagnosis of acute transverse myelopathy. The role of neuroradiological investigations and review of the literature. Neurol Sci. 22 Suppl 2:S69-73, 2001
                                                                                  17. Misra UK et al: Role of MRI in acute transverse myelitis. Neurol India. 47(4):253-4, 1999
                                                                                  18. Murthy JM et al: Acute transverse myelitis: MR characteristics. Neurol India. 47(4):290-3, 1999
                                                                                  19. Isoda H et al: MR imaging of acute transverse myelitis (myelopathy). Radiat Med. 16(3):179-86, 1998
                                                                                  20. Choi KH et al: Idiopathic transverse myelitis: MR characteristics. AJNR Am J Neuroradiol. 17(6):1151-60, 1996
                                                                                  21. Misra UK et al: A clinical, MRI and neurophysiological study of acute transverse myelitis. J Neurol Sci. 138(1-2):150-6, 1996
                                                                                  22. Tartaglino LM et al: Idiopathic acute transverse myelitis: MR imaging findings. Radiology. 201(3):661-9, 1996
                                                                                  23. Campi A et al: Acute transverse myelopathy: spinal and cranial MR study with clinical follow-up. AJNR Am J Neuroradiol. 16(1):115-23, 1995
                                                                                  24. Jeffery DR et al: Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events. Arch Neurol. 50(5):532-5, 1993
                                                                                  25. Kelley CE et al: Acute transverse myelitis in the emergency department: a case report and review of the literature. J Emerg Med. 9(6):417-20, 1991
                                                                                  26. Christensen PB et al: Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand. 81(5):431-5, 1990
                                                                                  27. Dunne K et al: Acute transverse myelopathy in childhood. Dev Med Child Neurol. 28(2):198-204, 1986
                                                                                  28. Berman M et al: Acute transverse myelitis: incidence and etiologic considerations. Neurology. 31(8):966-71, 1981
                                                                                  29. Lipton HL et al: Acute transverse myelopathy in adults. A follow-up study. Arch Neurol. 28(4):252-7, 1973
                                                                                  30. Altrocchi PH: Acute transverse myelopathy. Arch Neurol. 9:111-9, 1963