Distinguishing Transverse Myelitis from CIDP

Key Clinical Distinguishing Features

The American Academy of Neurology recommends distinguishing transverse myelitis from CIDP based on the presence or absence of hyperreflexia, with transverse myelitis presenting with spastic paralysis and increased deep tendon reflexes due to upper motor neuron involvement, and CIDP presenting with flaccid paralysis and areflexia due to peripheral nerve demyelination 1, 2
Transverse myelitis is characterized by bilateral weakness with hyperreflexia and spastic paralysis, indicating upper motor neuron pathology, whereas CIDP is characterized by symmetric weakness with areflexia or hyporeflexia and flaccid paralysis, indicating peripheral nerve involvement 1, 2, 3

The American College of Radiology recommends MRI of the spine with thin axial cuts through suspected lesion areas to detect T2 hyperintense lesions, which is essential for transverse myelitis diagnosis 4, 2
MRI of the brain with and without contrast is recommended to evaluate for demyelinating lesions and assess dissemination in space 5, 2

The National Institute of Neurological Disorders and Stroke recommends methylprednisolone 1 g IV daily for 3-5 days for moderate to severe transverse myelitis, and considers IVIG 2 g/kg over 5 days 4
The American Academy of Neurology recommends plasma exchange for transverse myelitis when steroids are insufficient, particularly in MOGAD 1
The European Federation of Neurological Societies recommends first-line treatments for CIDP, including intravenous immunoglobulin, subcutaneous immunoglobulin, corticosteroids, or plasma exchange 3

The American Academy of Neurology warns against confusing hyperreflexia with areflexia, as this single finding distinguishes upper motor neuron (transverse myelitis) from peripheral nerve (CIDP) pathology 1, 2
The Multiple Sclerosis International Federation notes that longitudinally extensive transverse myelitis (LETM) in young adults is rarely multiple sclerosis, and MOGAD or NMOSD should be considered first 6, 2