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Abstract
Objective To evaluate specific myelopathy diagnoses made in patients with suspected idiopathic transverse myelitis (ITM).
Methods A total of 226 patients 18 years and older were referred to Mayo Clinic Neurology for suspected ITM from December 1, 2010, to December 31, 2015. Electronic medical records were reviewed for detailed clinical presentation and course, laboratory and electrophysiologic investigations, and neuroimaging to determine the etiology. Current diagnostic criteria for ITM and alternative myelopathy diagnoses were applied. All cases where any discrepancy was suspected from the final reported clinical diagnosis were reviewed by each author and a consensus final diagnosis was made.
Results The diagnostic criteria for ITM were met in 41 of 226 patients (18.1%). In 158 patients (69.9%), an alternative specific myelopathy diagnosis was made: multiple sclerosis or clinically isolated syndrome, 75; vascular myelopathy, 41; neurosarcoidosis, 12; neuromyelitis optica spectrum disorder, 12; myelin oligodendrocyte glycoprotein myelopathy, 5; neoplastic, 4; compressive, 3; nutritional, 3; infectious, 2; and other, 2. A myelopathy was not confirmed in 27 patients. Time from symptom onset to final clinical diagnosis in patients without ITM was a median of 9 months (range 0–288). Fifty-five patients (24%) required treatment changes according to their final clinical diagnosis.
Conclusions The majority of patients with suspected ITM have an alternative specific myelopathy diagnosis. A presumptive diagnosis of ITM can lead to premature diagnostic conclusions affecting patient treatment.
Glossary
- ACE=
- angiotensin-converting enzyme;
- ADEM=
- acute disseminated encephalomyelitis;
- AQP4=
- aquaporin-4;
- ASIA=
- American Spinal Injury Association;
- CIS=
- clinically isolated syndrome of demyelination;
- DAVF=
- dural arteriovenous fistula;
- EDSS=
- Expanded Disability Status Scale;
- IgG=
- immunoglobulin G;
- ITM=
- idiopathic transverse myelitis;
- MOG=
- myelin oligodendrocyte glycoprotein;
- MS=
- multiple sclerosis;
- NMOSD=
- neuromyelitis optica spectrum disorders;
- PPMS=
- primary progressive multiple sclerosis;
- QREADS=
- Quick Query Radiographs and Photographs Electronic Analysis and Display Station;
- RRMS=
- relapsing-remitting multiple sclerosis;
- SCI=
- spinal cord infarction;
- TE=
- echo time;
- TR=
- repetition time;
- VGCC=
- voltage-gated calcium channel;
- VZV=
- varicella-zoster virus
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 51
- Received May 8, 2017.
- Accepted in final form September 7, 2017.
- Copyright © 2017 American Academy of Neurology
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