TY - JOUR
T1 - Evaluation of idiopathic transverse myelitis revealing specific myelopathy diagnoses
AU - Zalewski, Nicholas L.
AU - Flanagan, Eoin P.
AU - Keegan, B. Mark
N1 - Publisher Copyright:
© 2017 American Academy of Neurology.
PY - 2018/1/9
Y1 - 2018/1/9
N2 - Objective To evaluate specific myelopathy diagnoses made in patients with suspected idiopathic transverse myelitis (ITM). Methods A total of 226 patients 18 years and older were referred to Mayo Clinic Neurology for suspected ITM from December 1, 2010, to December 31, 2015. Electronic medical records were reviewed for detailed clinical presentation and course, laboratory and electrophysiologic investigations, and neuroimaging to determine the etiology. Current diagnostic criteria for ITM and alternative myelopathy diagnoses were applied. All cases where any discrepancy was suspected from the final reported clinical diagnosis were reviewed by each author and a consensus final diagnosis was made. Results The diagnostic criteria for ITM were met in 41 of 226 patients (18.1%). In 158 patients (69.9%), an alternative specific myelopathy diagnosis was made: multiple sclerosis or clinically isolated syndrome, 75; vascular myelopathy, 41; neurosarcoidosis, 12; neuromyelitis optica spectrum disorder, 12; myelin oligodendrocyte glycoprotein myelopathy, 5; neoplastic, 4; compressive, 3; nutritional, 3; infectious, 2; and other, 2. A myelopathy was not confirmed in 27 patients. Time from symptom onset to final clinical diagnosis in patients without ITM was a median of 9 months (range 0-288). Fifty-five patients (24%) required treatment changes according to their final clinical diagnosis. Conclusions The majority of patients with suspected ITM have an alternative specific myelopathy diagnosis. A presumptive diagnosis of ITM can lead to premature diagnostic conclusions affecting patient treatment.
AB - Objective To evaluate specific myelopathy diagnoses made in patients with suspected idiopathic transverse myelitis (ITM). Methods A total of 226 patients 18 years and older were referred to Mayo Clinic Neurology for suspected ITM from December 1, 2010, to December 31, 2015. Electronic medical records were reviewed for detailed clinical presentation and course, laboratory and electrophysiologic investigations, and neuroimaging to determine the etiology. Current diagnostic criteria for ITM and alternative myelopathy diagnoses were applied. All cases where any discrepancy was suspected from the final reported clinical diagnosis were reviewed by each author and a consensus final diagnosis was made. Results The diagnostic criteria for ITM were met in 41 of 226 patients (18.1%). In 158 patients (69.9%), an alternative specific myelopathy diagnosis was made: multiple sclerosis or clinically isolated syndrome, 75; vascular myelopathy, 41; neurosarcoidosis, 12; neuromyelitis optica spectrum disorder, 12; myelin oligodendrocyte glycoprotein myelopathy, 5; neoplastic, 4; compressive, 3; nutritional, 3; infectious, 2; and other, 2. A myelopathy was not confirmed in 27 patients. Time from symptom onset to final clinical diagnosis in patients without ITM was a median of 9 months (range 0-288). Fifty-five patients (24%) required treatment changes according to their final clinical diagnosis. Conclusions The majority of patients with suspected ITM have an alternative specific myelopathy diagnosis. A presumptive diagnosis of ITM can lead to premature diagnostic conclusions affecting patient treatment.
UR - http://www.scopus.com/inward/record.url?scp=85044058519&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044058519&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000004796
DO - 10.1212/WNL.0000000000004796
M3 - Article
C2 - 29247071
AN - SCOPUS:85044058519
SN - 0028-3878
VL - 90
SP - e96-e102
JO - Neurology
JF - Neurology
IS - 2
ER -