MOGAD Transverse Myelitis Clinical Characteristics

Motor Manifestations

Bilateral weakness develops rapidly over hours to days, most commonly progressing to maximal severity within 10 days of symptom onset, characterized by spastic paralysis with hyperreflexia, distinguishing it from lower motor neuron disorders like Guillain-Barré syndrome which presents with flaccid paralysis 1
Incomplete, painful tetraparesis may occur when cervical cord segments are involved 2

Sensory level corresponding to the spinal cord lesion location 1
Lower limb pain is common, particularly when the conus medullaris and cauda equina are affected 2

Bladder dysfunction is nearly universal, occurring in virtually all patients with transverse myelitis, with urinary retention being a common manifestation requiring evaluation 1
Bowel dysfunction and constipation frequently accompany bladder symptoms 1
Severe erectile and sphincter disturbance may occur, particularly with conus medullaris involvement, which is especially suggestive of MOG-EM 2, 3

Longitudinally extensive transverse myelitis (LETM) affecting ≥3 vertebral segments is common in MOGAD, occurring in 44-52% of patients during their disease course 3
In pediatric MOG-EM patients, LETM is present at disease onset in 80% of cases 3
Conus medullaris involvement at disease onset is particularly suggestive of MOGAD 3
Severe and recurrent myelitis episodes, even when non-longitudinally extensive, should raise suspicion for MOGAD 2

Steroid-responsive symptoms with flaring after tapering or discontinuation of corticosteroids is characteristic of MOGAD 2, 4, 5
Good response to plasma exchange (PEX) when steroids are insufficient 2

Bilateral optic neuritis occurring simultaneously or sequentially with myelitis 2, 4, 5
Brainstem involvement extending from the spinal cord lesion 2
ADEM-like presentation with large white matter lesions, disturbance of consciousness, and involvement of the entire spinal cord 2
Absence of oligoclonal bands in CSF (87-88% of MOG-EM patients) 3
CSF pleocytosis with lymphomonocytic cells and neutrophils (up to 10%), with negative oligoclonal bands 2, 4

The presence of increased deep tendon reflexes is the key distinguishing feature from conditions causing flaccid paralysis like Guillain-Barré syndrome 1
Multiple sclerosis rarely if ever presents with LETM; when LETM is present, alternative diagnoses like MOGAD or NMOSD should be strongly considered 3
Fever is typically absent in MOGAD transverse myelitis, unlike infectious causes 6