From the Guidelines
Transient myelitis is characterized by acute or subacute weakness or sensory changes that are bilateral, often accompanied by increased deep tendon reflexes, as defined in the American Society of Clinical Oncology clinical practice guideline 1. The diagnosis of transient myelitis involves a comprehensive neurological examination, and clinical symptoms typically include rapid onset of muscle weakness and sensory changes. Some key points to consider in the diagnosis and clinical symptoms of transient myelitis include:
- Acute or subacute onset of symptoms
- Bilateral weakness or sensory changes
- Increased deep tendon reflexes
- Possible autonomic dysfunction The clinical presentation of transient myelitis can vary, but it is essential to recognize the condition promptly to initiate appropriate management and investigate for underlying causes, as suggested by the guideline 1. In terms of management, the focus is on reducing inflammation and managing symptoms, although the specific treatment approach may vary depending on the underlying cause and individual patient factors. It is crucial to conduct a thorough evaluation, including MRI of the spine and blood tests, to rule out other conditions and determine the best course of action, as implied by the definition of transverse myelitis in the guideline 1.
From the Research
Clinical Symptoms of Transient Myelitis
- Symptoms typically develop over hours or days and then worsen over a matter of days to weeks 2
- Patients can present with sensory alteration, weakness, and autonomic dysfunction including bowel and bladder problems, temperature dysregulation, or even bouts of hypertension 2
- Clinical presentation of acute transverse myelitis (ATM) typically includes some combination of motor weakness, sensory symptoms, and bowel and bladder dysfunction 3
Diagnosis of Transient Myelitis
- Evaluation for compressive etiologies must be a priority as compressive myelopathy and transverse myelitis are often clinically indistinguishable and emergent surgical intervention is indicated in such cases 2
- If neuroimaging and CSF studies indicate inflammation within the central nervous system, then a work-up for myelitis must include autoimmune, inflammatory, and infectious etiologies 2
- Prompt recognition, even before a final etiologic diagnosis is reached, is critical to initiating early therapeutic intervention to reduce the harmful effects of inflammation 3
Treatment Options for Transient Myelitis
- Acute therapeutic options for ATM include corticosteroids, plasma exchange, IV immunoglobulin, and chemotherapeutic agents such as cyclophosphamide 3
- Some studies suggest that plasma exchange or cyclophosphamide may be beneficial in certain cases 4
- High-dose intravenous steroid therapy may also have a beneficial effect in some patients 5
- However, other studies have found no beneficial role of methyl prednisolone in the outcome of ATM 6