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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 (ATM). Definitions of ATM have varied significantly in the literature.1,2 To address this nonuniformity, the criteria proposed by the Transverse Myelitis Consortium Working Group3 (Table 18–1) 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 ATM is characterized by moderate to severe symmetric symptoms, while partial ATM is marked by milder, asymmetric symptoms.4
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ATM can be associated with more diffuse central nervous system (CNS) demyelinating disorders, systemic autoimmune disorders, or specific associated infections. Idiopathic ATM is associated with a nonspecific preceding infection or no apparent cause and constitutes the most common subgroup of pediatric ATM.
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Idiopathic ATM afflicts approximately 1.34 persons per million.5 In the pediatric age group, patients present at a mean age of 8 years with an equal gender ratio.1,2,4,6–9 Approximately 280 cases of ATM occur in pediatric patients in the United States ...