Mealy M (1), Munoz L (1), Barreras P (1), Garcia M (1,2), Becker D (3), Newsome S (4), Gailloud P (5), Levy M (6), Pardo-Villamizar C (7)
1. Johns Hopkins University School of Medicine
2. Universidad De Los Andes
3. International Neurorehabilitation Institute, Johns Hopkins Hospital
4. Johns Hopkins Hospital
5. The Johns Hopkins Hospital
6. Johns Hopkins University
7. Johns Hopkins University, Med Dept of Neurology
Presentation at the 2018 American Academy of Neurology Annual Meeting, Los Angeles, CA
Objective: To retrospectively investigate the spectrum of diagnoses in patients who presented with presumed transverse myelitis (TM) seen at a specialized center dedicated to TM care.
Background: TM is an inflammatory neurologic disorder that causes damage to motor and sensory tracts of the spinal cord. The cause of TM is variable and often never discovered. Patients may experience any combination of weakness, altered sensation, bowel and bladder dysfunction and dysautonomia. Non-immunologic myelopathies may cause a similar clinical presentation. As such, investigation is paramount to ensure appropriate treatment.
Design/Methods: We conducted a retrospective analysis of new patients referred to the Johns Hopkins TM Center (JHTMC) between 2010 and 2017. We reviewed the clinical/temporal profile, neuroimaging and laboratory assessment to establish a final diagnosis.
Results: One thousand patients were included in this analysis (66% White/Caucasian descent; 60% female), of which 62% were confirmed to have an inflammatory cause for their myelopathy, of which 35% was idiopathic. An additional 41% was attributable to an underlying disease such as multiple sclerosis or neuromyelitis optica spectrum disorder. However, 24% of patients who were initially diagnosed with TM were found to have non-inflammatory causes of myelopathy, including vascular abnormalities (38%) and compressive myelopathy (24%). Ten percent of cases had inadequate initial evaluations or follow-up, and a final diagnosis could not be established.
Conclusions: One quarter of patients initially referred to the JHTMC for the diagnosis of TM were found to have a non- myelopathic cause for their symptoms. Furthermore, of those with inflammatory TM, 41% had an underlying disease for which long-term immunotherapy was warranted. This analysis of a large cohort of patients suggests that a more detailed analysis at acute presentation is necessary to ensure patients receive adequate and timely treatment of the underlying cause of myelopathic symptoms towards the effort of improving patient outcomes.