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DEFINITIONS AND EPIDEMIOLOGY

Acute transverse myelopathy is a clinical syndrome consisting of progressive symptoms and signs reflecting sensory, motor, or autonomic dysfunction attributable to the spinal cord. This syndrome can be caused by a heterogeneous group of disorders, including acute transverse myelitis. Definitions of acute transverse myelitis (ATM) vary significantly in the literature.1,2 To address this nonuniformity, the criteria proposed by the Transverse Myelitis Consortium Working Group3 (Table 21-1) should be used to establish the diagnosis and guide the differential diagnosis and workup. The diagnosis of ATM can be further refined by determining whether there is partial or complete involvement of the spinal cord in the axial plane. Complete acute transverse myelitis is characterized by moderate to severe symmetric symptoms, whereas partial acute transverse myelitis is marked by milder, asymmetric symptoms.4 A distinct but overlapping condition, acute flaccid myelitis (AFM), came to the fore after an outbreak of cases in the United States in 2014. This diagnosis is appropriate for patients with acute onset of focal limb weakness and a spinal cord lesion largely restricted to gray matter on magnetic resonance imaging (MRI).5

TABLE 21-1Transverse Myelitis Consortium Working Group Diagnostic Criteria

Acute transverse myelitis can be associated with more diffuse central nervous system (CNS) demyelinating disorders, systemic autoimmune disorders, or specific associated infections. Idiopathic acute transverse myelitis is associated with a nonspecific ...

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