Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- idade entre 10-19 ou 30-39 anos
- fraqueza motora
- parestesias ou perda sensorial
- sintomas vesicais: polaciúria, urgência, incontinência ou retenção urinária
- sintomas intestinais: incontinência ou constipação
- sinal de L'Hermitte
- Sinal de McArdle
- espasmos tônicos paroxísticos
- sinais do neurônio motor superior: hiper-reflexia, sinal de Babinski positivo, espasticidade dos membros
- perda sensorial/nível sensorial
- dispneia/dificuldade respiratória
Other diagnostic factors
- dorsalgia
- dor no tronco/membros
- arreflexia/hiporreflexia
- soluços
- náuseas/vômitos
Risk factors
- doença infecciosa precedente
- vacinação recente
- sexo feminino
- história de trauma físico recente
- injeção na coluna vertebral
Diagnostic tests
1st tests to order
- ressonância nuclear magnética (RNM) da medula espinhal
- ressonância nuclear magnética (RNM) cranioencefálica
- autoanticorpos anti-aquaporina-4 e autoanticorpos anti-glicoproteína mielina-oligodendrócito séricos
- celularidade do líquido cefalorraquidiano, diferencial de celularidade, nível de proteínas, índice de imunoglobulina G (IgG) e bandas oligoclonais
- coloração de Gram, culturas (bacteriana, fúngica e para tuberculose) e esfregaço com tinta nanquim no líquido cefalorraquidiano
- líquido cefalorraquidiano, reação em cadeia da polimerase para detecção de vírus do herpes simples (HSV)-1, HSV-2, vírus da varicela-zóster (VZV), Borrelia burgdorferi (doença de Lyme), citomegalovírus (CMV), vírus Epstein-Barr (EBV) e vírus do Nilo Ocidental
- exame Venereal Disease Research Laboratory do líquido cefalorraquidiano
- fator antinuclear sérico, DNA de fita dupla
- antígeno nuclear extraível (incluindo autoanticorpos SSA e SSB)
- autoanticorpos paraneoplásicos séricos ou no líquido cefalorraquidiano
- outros autoanticorpos neurais
Tests to consider
- enzima conversora de angiotensina sérica e do líquido cefalorraquidiano
- radiografia torácica
- tomografia computadorizada (TC) corporal (tórax, abdome e pelve)
- PET do corpo inteiro
- citometria de fluxo e citologia do líquido cefalorraquidiano
- sorologia para vírus do herpes simples (HSV) -1, HSV-2, vírus da varicela-zóster, citomegalovírus, vírus Epstein-Barr e vírus do Nilo Ocidental
- urinálise
- anticorpos antivírus da imunodeficiência humana (anti-HIV)
- potencial evocado visual
- tomografia de coerência óptica
- tentativa terapêutica com corticosteroide
- biópsia da medula espinhal
Treatment algorithm
deficits neurológicos agudos
mielite transversa (MT) idiopática
com risco de esclerose múltipla (EM) (lesões desmielinizantes típicas na ressonância nuclear magnética [RNM])
soropositivo para autoanticorpos anti-aquaporina-4 (AQP4)
soropositivo para autoanticorpos IgG anti-glicoproteína mielina-oligodendrócito
Contributors
Authors
Cristina Valencia-Sanchez, MD, PhD
Department of Neurology
Mayo Clinic
Scottsdale
AZ
Disclosures
CVS declares that she has served on an advisory board for TG Therapeutics.
Acknowledgements
Dr Cristina Valencia-Sanchez would like to gratefully acknowledge Dr Dean Wingerchuk, the previous contributor to this topic. DMW has received compensation from MedImmune for service on a clinical trial adjudication committee, from Caladrius for consulting services, and research support paid to Mayo Clinic from Alexion and TerumoBCT. DMW is an author of a number of references cited in this topic.
Peer reviewers
Alireza Minagar, MD
Assistant Professor of Neurology
LSU Health Sciences Center
Shreveport
LA
Disclosures
AM declares that he has no competing interests.
Cory Toth, BSc, MD, FRCP(C)
Assistant Professor of Neurosciences
Hotchkiss Brain Institute
University of Calgary
Alberta
Canada
Disclosures
CT declares that he has no competing interests.
Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCP
Consultant Neurologist
Clinical Director of Neurosciences
Department of Neurology
Queen's Hospital
Romford
UK
Disclosures
AC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002 Aug 27;59(4):499-505. Abstract
Expert Panel on Neurological Imaging, Agarwal V, Shah LM, et al. ACR appropriateness criteria® myelopathy: 2021 update. J Am Coll Radiol. 2021 May;18(5s):S73-82.Full text Abstract
Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis. Neurology. 2018 Apr 24;90(17):777-88.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Mielopatia compressiva
- Mielite infecciosa (por exemplo, tuberculose)
- Oclusão da artéria espinhal anterior
More DifferentialsGuidelines
- ACR appropriateness criteria: myelopathy
- Practice guideline: disease modifying therapies in adults with multiple sclerosis
More GuidelinesPatient information
Esclerose múltipla
More Patient information
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