Summary

• Heterogeneous focal inflammatory disorder of the spinal cord characterised by acute or subacute development of motor weakness, sensory impairment, and autonomic dysfunction.
• Causes motor weakness, a sensory impairment below the lesions, and bowel and bladder dysfunction.
• Clinical characteristics and MRI of the spinal cord classify transverse myelitis (TM) into acute partial or longitudinally extensive variants.
• Confirmed by LP demonstrating increased WBC count and absence of infection, with or without spinal cord MRI revealing a cord lesion that enhances after gadolinium administration.
• In the setting of a characteristic brain MRI, the acute partial variant suggests high future risk of developing multiple sclerosis (MS).
• In the setting of neuromyelitis optica-IgG auto-antibody seropositivity, the longitudinally extensive variant suggests a neuromyelitis optica spectrum disorder.
• Therapy for acute symptoms includes intravenous corticosteroids or plasmapheresis.
• Preventive therapies include immunomodulatory drugs for acute partial TM at high risk for MS. Immunosuppressive therapies are used for longitudinally extensive TM at high risk for recurrent myelitis or neuromyelitis optica.