UMEM Educational Pearls

Title: Must transverse myelitis be symmetrical?

Category: Neurology

Keywords: weakness, sensory symptoms, MRI, LP (PubMed Search)

Posted: 9/26/2018 by Danya Khoujah, MBBS
Click here to contact Danya Khoujah, MBBS

Although transverse myelitis classically presents with bilateral and symmetric symptoms, it may be “partial” - symptoms would be asymmetric, or specific only to particular anatomic tracts.
In patients with risk factors (e.g. recent infection, history of autoimmune disease or cancer) and subacute ascending weakness/sensory symptoms, perform a thorough neurological exam, and obtain a gadolinium-enhanced MRI of the entire spine and/or lumbar puncture if you suspect transverse myelitis. 

References

Frohman EM, Wingerchuk DM. Clinical practice. Transverse myelitis. N Engl J Med. 2010;363(6):564-572.

de Seze J, Lanctin C, Lebrun C, et al. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology. 2005;65(12):1950-1953.