Comprehensive Evaluation of Acute Transverse Myelitis Spectrum Disorders: A Retrospective Analysis of 52 Patients

Abstract

Objective: Acute transverse myelitis (ATM) is defined as focal inflammation of the spinal cord, which may be idiopathic or secondary to an infection or systemic disease without cord compression. In this study, we aimed to evaluate the clinical, radiological, and etiological findings of patients who were diagnosed with ATM. Materials and Methods: Fifty-two patients who were diagnosed with ATM in our clinic between January 2015 and June 2022 and continued regular followup were included in the study. Demographic data, results of the serum and cerebrospinal fluid (CSF) analyses, and spinal imaging features of the patients were retrospectively recorded. Patients were divided into two groups according to their etiology: idiopathic ATM (iATM) and secondary ATM (sATM). Results: A total of 52 patients, of whom 36 (69.2%) were women and 16 (30.8%) were men, were included in the study. The mean age of the patients was 40.27 +- 14.44 years, and the mean follow-up period was 2.68 +- 1.93 years. Of the 52 patients, 37 (71.1%) were evaluated as sATM and 15(28.9%) as iATM. A total of 24 (46.4%) patients were diagnosed with multiple sclerosis, and one patient (1.9%) was diagnosed with ATM due to infection. There was no statistically significant difference in clinical findings between the iATM and sATM groups. There was also no significant difference between the groups in the CSF analysis. Although three patients had aquaporin-4 antibody positivity, oligodendrocyte glycoprotein antibody was positive in only one patient. Cervical region involvement (most commonly between C4 and C6) was observed in 41 (78%) patients. Longitudinal extensive myelitis was seen in 43.2% of the sATM group and 26.7% of the iATM group, but there was no significant statistical difference between them. Six (11.5%) patients required admittance to the intensive care unit and one (1.9%) required mechanical ventilation. One patient died from pneumonia 6 months after being discharged from the hospital. Conclusion: ATM is a rare neurological disorder that has a high risk of morbidity. Therefore, differential diagnosis and rapid treatment, arranged according to the underlying process, play important roles in the recovery period.

Keywords

• transverse myelitis
• spinal cord diseases
• multiple sclerosis
• neuromyelitis optica spectrum diseases