Transverse myelitis

Clinical vignette
Article section 4 of 16.  Previous  Next

By Anthony T Reder MD

A 30-year-old marathon runner and commodities broker developed a minor “cold,” and 10 days later noticed tingling in the middle of his trunk. The tingling was soon followed by paresthesias in his feet and then loss of sensation from below the mid-thoracic level with a 4 cm hyperesthetic band above. In conjunction, he developed profound weakness of both legs and urinary retention. He had no symptoms above the thoracic level. MRI scan of the brain was normal, but a spinal cord MRI showed swelling and diffuse abnormal T2 signal from the T-5 to the T-10 level. Spinal fluid had protein of 113 mg/100 ml, glucose of 66 mg/100 ml, 65 lymphocytes/mm3, and no oligoclonal bands. He refused therapy with glucocorticoids.

The symptoms lasted for 3 weeks and then began to resolve. Over the next 2 years, muscle strength gradually returned. He reported that improvements in a given muscle group were often heralded by muscle cramping and aches. At 2 years, sensation and bladder function was essentially normal, and he was running 4 miles per day.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited