Identification of specific causes of myelopathy in a large cohort of patients initially diagnosed with transverse myelitis

Identifying the etiologic diagnosis in patients presenting with myelopathy is essential in order to guide appropriate treatment and follow-up. We set out to examine the etiologic diagnosis after comprehensive clinical evaluation and diagnostic work-up in a large cohort of patients referred to our sp...

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Bibliographic Details
Published in:Journal of the neurological sciences 2022-11, Vol.442, p.120425-120425, Article 120425
Main Authors: Murphy, Olwen C, Barreras, Paula, Villabona-Rueda, Andres, Mealy, Maureen, Pardo, Carlos A
Format: Article
Language:English
Subjects:
Diagnosis, Differential
Humans
Infarction - complications
Magnetic Resonance Imaging
Male
Myelitis - complications
Myelitis - etiology
Myelitis, Transverse - complications
Myelitis, Transverse - etiology
Retrospective Studies
Spinal Cord - diagnostic imaging
Spinal Cord Diseases - diagnosis
Spinal Cord Diseases - etiology
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Summary:Identifying the etiologic diagnosis in patients presenting with myelopathy is essential in order to guide appropriate treatment and follow-up. We set out to examine the etiologic diagnosis after comprehensive clinical evaluation and diagnostic work-up in a large cohort of patients referred to our specialized myelopathy clinic, and to explore the demographic profiles and symptomatic evolution of specific etiologic diagnoses. In this retrospective study of patients referred to the Johns Hopkins Myelitis and Myelopathy Center between 2006 and 2021 for evaluation of "transverse myelitis", the final etiologic diagnosis determined after comprehensive evaluation in each patient was reviewed and validated. Demographic characteristics and temporal profile of symptom evolution were recorded. Of 1193 included patients, 772 (65%) were determined to have an inflammatory myelopathy and 421 (35%) were determined to have a non-inflammatory myelopathy. Multiple sclerosis/clinically isolated syndrome (n = 221, 29%) and idiopathic myelitis (n = 149, 19%) were the most frequent inflammatory diagnoses, while spinal cord infarction (n = 197, 47%) and structural causes of myelopathy (n = 108, 26%) were the most frequent non-inflammatory diagnoses. Compared to patients with inflammatory myelopathies, patients with non-inflammatory myelopathies were more likely to be older, male and experience chronic symptom evolution (p 
ISSN:0022-510X
1878-5883
DOI:10.1016/j.jns.2022.120425