Abstract
Objective:
The objective of this study was to observe neurological and functional recovery in patients with acute transverse myelitis (ATM) with inpatient rehabilitation and correlate with magnetic resonance imaging (MRI) changes.
Patients and methods:
The study was conducted with 43 ATM patients (19 males) admitted in the tertiary university research hospital from July 2012 to June 2014. Detailed MRI findings were noted. Neurological status was assessed using the ASIA impairment scale (AIS) and functional recovery was assessed using the Barthel Index score (BI) and Spinal Cord Independence Measure (SCIM).
Results:
Patients showed significant neurological and functional recovery with inpatient rehabilitation using AIS, BI and SCIM scales when admission and discharge scores were compared (P<0.001). Thirty-one patients (72.1%) had rostral level in the cervical region according to MR imaging, but clinically, 17 patients had tetraplegia, whereas 26 patients had lower-limb weakness only. No definitive pattern or correlation was found between level (MRI or clinical) and neurological status (AIS).
Conclusion:
The neurological outcome in patients with ATM cannot be predicted on the basis of imaging findings. There is a great variation in the imaging level and clinical presentation. Patients show significant improvement with inpatient rehabilitation even with poor functional ability in acute and sub-acute phase of illness.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
West TW . Transverse myelitis: a review of presentation, diagnosis and initial treatment. Discov Med 2013; 16: 167–177.
Barnes G, Benjamin S, Bowen JD, Cutter N, de Lateur BJ, Dietrich WD et al. Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59: 499–505.
Schmalstieg WF, Weinshenker BG . Approach to acute or subacute myelopathy. Neurology 2010; 75: S2–S8.
Berman M, Feldman S, Alter M, Zilber N, Kahana E . Acute transverse myelitis: incidence and etiologic considerations. Neurology 1981; 31: 966–971.
Jeffery DR, Mandler RN, Davis LE . Transverse myelitis: Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events. Arch Neurol 1993; 50: 532–535.
Christensen PB, Wermuth L, Hinge HH, Bomers K . Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand 1990; 81: 431–435.
Altrocchi PH . Acute transverse myelopathy. Arch Neurol 1963; 9: 21–29.
Misra UK, Kalita J, Kumar S . A clinical, MRI and neurophysiological study of acute transverse myelitis. J Neurol Sci 1996; 138: 150–156.
Lipton HL, Teasdall RD . Acute transverse myelopathy in adults. A follow-up study. Arch Neurol 1973; 28: 252–257.
Sakakibara R, Hattori T, Yasuda K, Yamanishi T . Micturition disturbance in acute transverse myelitis. Spinal Cord 1996; 34: 481–485.
Ditunno JF Jr, Young W, Donovan WH, Creasey G . The international standards booklet for neurological and functional classification of spinal cord injury. Paraplegia 1994; 32: 70–80.
Mahoney FI, Barthel D . Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 56–61.
Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord 2007; 45: 275–291.
Dawson DM, Potts FM . Acute nontraumatic myelopathies. In: Wilsey RM, Young RR (eds). Neurologic Clinic: Disorders of Spinal Cord Vol 55 WB Sanders company: Philadelphia, PA, USA, 1991, pp 551–603.
Barakos JA, Mark AS, Dillon WP, Norman D . MR imaging of acute transverse myelitis and AIDS myelopathy. J Comput Assist Tomogr 1990; 14: 45–50.
Bitzan M . Rubella myelitis and encephalitis in childhood: a report of two cases with magnetic resonance imaging. Neuropaediatrics 1987; 18: 84–87.
Merine D, Wang H, Kuma AJ, Zinreich SJ, Rosenbaum AE . CT myelography and M.R. imaging of acute transverse myelitis. J Comput Assist Tomogr 1987; 11: 606–608.
Sanders KA, Khandji AG, Mohr JP . Gadolinium MRI in acute transverse myelopathy. Neurology (Minneapolis) 1990; 40: 1614–1616.
Sadowsky CL, Becker D, Bosques G, Dean JM, McDonald JW, Recio A et al. Rehabilitation in transverse myelitis. Continuum (Minneap Minn) 2011; 17: 816–883.
Kaplin AI, Crishnan C, Deshpande DM, Pardo CA, Kerr DA . Diagnosis and management of acute myelopathies. Neurologist 2005; 11: 2–18.
Nakipoglu GF, Ozgirgin N . Urodynamic evaluation and rehabilitation outcomes in transverse myelitis. Neurosciences 2009; 14: 37–40.
Gupta A, Taly AB, Srivastava A, Murali T . Non-traumatic spinal cord lesions: epidemiology, complications, neurological & functional outcome of rehabilitation. Spinal Cord 2009; 47: 307–311.
Debette S, de Sèze J, Pruvo JP, Zephir H, Pasquier F, Leys D, Vermersch P . Long-term outcome of acute and subacute myelopathies. J Neurol 2009; 256: 980–988.
Calvo AC, Mané MartÃnez MA, Palau AA, Escuer JB, Pinel LR, MartÃnez-Yélamos S . Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol 2013; 13: 135.
De Seze J, Stojkovic T, Breteau G, Lucas C, Michon-Pasturel U, Gauvrit JY et al. Acute myelopathies:clinical, laboratory and outcome profiles in 79 cases. Brain 2001; 124: 1509–1521.
Bruna J, MartÃnez-Yélamos S, MartÃnez-Yélamos A, Rubio F, Arbizu T . Idiopathic acute transverse myelitis: a clinical study and prognostic markers in 45 cases. Mult Scler 2006; 12: 169–173.
Boey K-F, Chan ML . Transverse myelopathy in SLE: clinical features and functional outcomes. Lupus 1996; 5: 294–299.
Calis M, Kirnap M, Calis H, Mistik S, Demir H . Rehabilitation results of patients with acute transverse myelitis. Bratislava Lek Listy 2011; 112: 154–156.
Choi K, Lee K, Chung S . Idiopathic transverse myelitis. Am J Neuroradiol 1996; 17: 1151–1160.
Krishnan C, Kaplin A, Deshpande D, Pardo C . Transverse myelitis: pathogenesis, diagnosis and treatment. Front Biosci 2004; 9: 1483–1499.
Alper G, Petropoulou KA, Fitz CR, Kim Y . Idiopathic acute transverse myelitis in children: an analysis and discussion of MRI. Mult Scler 2011; 17: 74–80.
Harzheim M . Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients. J Neurol Sci 2004; 217: 217–223.
Goh C, Desmond PM, Phal PM . MRI in transverse myelitis. J Magn Reson Imaging 2014; 40: 1267–1279.
Mawad ME, Rivera V, Crawford S, Ramirez A, Breitbach W . Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients. Am J Roentgenol 1990; 155: 1303–1307.
Hirono H, Yamadori A, Komiyama M, Yakura H, Yasui T . MRI of spontaneous spinal cord infarction: serial changes in gadolinium-DTPA enhancement. Neuroradiology 1992; 34: 95–97.
Friedman DP, Tartaglino LM, Fisher AR, Flanders AE . MR imaging in the diagnosis of intramedullary spinal cord diseases that involve specific neural pathways or vascular territories. Am J Roentgenol 1995; 165: 515–523.
Fujikawa A, Tsuchiya K, Takeuchi S, Hachiya J . Diffusion weighted MR imaging in acute spinal cord ischemia. Eur J Radiol 2004; 14: 2076–2078.
Stepper F, Lovblad K . Anterior spinal artery stroke demonstrated by echo-planar diffusion weighted imaging. Eur J Radiol 2001; 11: 2607–2610.
Acknowledgements
The study was conducted in the Department of Neurological Rehabilitation, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Gupta, A., Kumar, S. & Taly, A. Neurological and functional recovery in acute transverse myelitis patients with inpatient rehabilitation and magnetic resonance imaging correlates. Spinal Cord 54, 804–808 (2016). https://doi.org/10.1038/sc.2016.23
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2016.23
