Demyelinating Conditions

Question 1

What are the diagnostic criteria for transverse myelitis?

Answer 1

• development of dysfunction attributable to spinal cord
• b/l signs and symptoms (not necessarily symmetric)
• Evidence of spinal cord inflammation (CSF pleocytosis, elevated IgG, or gadolinium enhancement)
• if no inflammatory signs are present at symptom onset, repeat MRI and LP warranted
• Progression to nadir b/t 4hr to 21 days

Question 2

Most common lesion site in transverse myelitis?

Answer 2

Thoracic (although any and all spine segments may be involved)

Question 3

A subset of children with transverse myelitis are also found to have what neuroanatomic issue?

Answer 3

Chiari I malformations

Question 4

3 priorities to diagnosing myelopathy?

Answer 4

1. rule out compressive etiology
2. Determine evidence of cord inflammation
3. Determine extent of demyelination (beyond the cord, or not)

Question 5

Typical MRI spine findings in transverse myelitis?

Answer 5

T1-isointense, T2-hyperintense signals over multiple contiguous segments