Transverse Myelitis Diagnosis

Diagnostic Considerations

The American College of Radiology recommends MRI of the spine with thin axial cuts to detect hyperintense lesions in T2, which is essential for diagnosing transverse myelitis 1, 2, 5
The presence of increased deep tendon reflexes (hyperreflexia) is a key finding that distinguishes transverse myelitis from peripheral neuropathies like Guillain-Barré syndrome 3, 2
MOGAD is suggested by conus medullaris involvement at onset, severe and recurrent myelitis, and dependence on steroids with exacerbation upon withdrawal 3, 4
NMOSD is characterized by LETM affecting ≥3 vertebral segments and positive IgG antibodies against aquaporin-4 1, 2, 5
The American College of Radiology suggests that RM of the brain with and without contrast is necessary to evaluate demyelinating lesions 5, 2
Screening for HIV and RPR is recommended as part of the diagnostic workup 1, 2
Vitamin B12 and TSH levels should be checked to rule out metabolic and nutritional causes 1, 2
The Journal of Neuroinflammation recommends using serum as the sample of choice for MOG antibody testing, with cell-based assays (IFT/FACS) as the gold standard 4
Anticuerpos onconeurales in LCR are essential for diagnosing paraneoplastic causes 1
Citología de LCR is crucial in patients with cancer 2

Hyperreflexia should not be confused with areflexia, which is characteristic of Guillain-Barré syndrome 3, 2
LETM in young adults is rarely multiple sclerosis; MOGAD or NMOSD should be considered first 3
The absence of fever does not rule out infectious causes but is typical of MOGAD 3
MRI of the orbits should not be performed alone in cases of acute vision loss; brain imaging should always be included 5