Transverse myelitis - Comparison with spinal cord presentations of multiple sclerosis

We delineated the clinical and laboratory features that help distinguish acute myelopathic MS (MMS) from acute transverse myelitis (ATM), specifically testing the hypothesis that the symmetry of motor and sensory impairments at presentation can reliably distinguish between ATM and MMS. We reviewed 20 consecutive patients with ATM and 16 patients with MMS. Clinical criteria were used to assign patients to the ATM group. Patients assigned to the MMS group had onset of MS symptoms referable to the spinal cord and eventually fulfilled Poser's criteria for MS. The relative contribution of the symmetry of both motor and sensory symptoms for the accurate identification of ATM versus MMS was evaluated using a discriminant function analysis. Fifteen of 16 MMS patients and all 20 ATM patients presented with symptoms of motor dysfunction. Additionally, all patients in both groups presented with sensory complaints. MMS patients had asymmetric motor or sensory symptoms in all but one patient, whereas ATM patients exhibited symmetric weakness uniformly and symmetric sensory loss in all but one patient (statistically significant). None of the MS patients met criteria for ATM at presentation. None of the ATM patients developed MS over an average follow-up period of 4.5 years. In conclusion, MMS was easily distinguished from ATM in this study.