Differential Diagnosis for Acute Transverse Myelitis

Demyelinating and Inflammatory Disorders

The American Academy of Neurology recommends distinguishing multiple sclerosis from acute transverse myelitis based on dissemination in time and space on MRI, with lesions typically shorter than 3 vertebral segments 1, 2, 3
The National Institute of Neurological Disorders and Stroke suggests that neuromyelitis optica spectrum disorder is characterized by longitudinally extensive transverse myelitis affecting ≥3 contiguous vertebral segments, positive aquaporin-4 IgG antibody, and specific MRI patterns including dorsal medulla/area postrema lesions 4, 5
The American College of Rheumatology notes that sarcoidosis is a systemic granulomatous disease with CNS involvement that can cause acute transverse myelitis 2, 7

The Centers for Disease Control and Prevention states that HIV-associated myelitis is a direct viral infection or metabolic disturbance in AIDS patients 9, 7
The World Health Organization recommends considering HTLV-1 myelopathy as a chronic progressive myelitis from direct spinal cord infection 1, 2, 9

The American Heart Association notes that spinal cord infarction is an acute ischemic injury to the spinal cord 9, 7
The American College of Cardiology suggests that vasculitis is an inflammatory vessel disease affecting spinal cord perfusion 9, 7

The North American Spine Society recommends urgent exclusion of spinal cord compression from tumor, abscess, or herniated disc 9, 7

The National Institutes of Health states that vitamin B12 deficiency causes subacute combined degeneration of the spinal cord 9, 7
The American Thyroid Association notes that thyroid disorders, such as hyperthyroidism and hypothyroidism, can cause acute transverse myelitis 9, 7

The Occupational Safety and Health Administration recommends considering organophosphate poisoning as a common toxic cause, particularly in agricultural regions 9, 7, 8
The National Institute of Environmental Health Sciences suggests that heavy metal poisoning, such as lead, thallium, and arsenic, can cause acute transverse myelitis 9, 7

The National Institute of Neurological Disorders and Stroke notes that paraneoplastic syndromes can cause cerebellar ataxia or myelopathy associated with malignancy, often with elevated CSF IgG 1, 2, 9
The American Academy of Neurology recommends considering critical illness polyneuropathy in intensive care settings 9, 7