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Transverse myelitis

Case contributed by Assoc Prof Frank Gaillard

Presentation

A few weeks of unsteadiness and right lower limb weakness.

Patient Data

Age: 20 years
Gender: Male
MRI

The lower thoracic cord from T10 to T12 is expanded and demonstrates an ill-defined T2 hyperintensity in two segments. At the level of the upper portion of T10 there is a ventral and then almost complete but mainly right-sided expansion and T2 signal change. It is isointense on T1. This ends at the lower half of the T11 vertebral body but there is a second area of involvement behind the T12  vertebral body extending down to the conus at the T12/L1 disc level. No contrast enhancement is present.

The abnormality involves the intramedullary cord with no abnormality of the extra dural space. No flow-voids or vascular anomalies are noted. No blood products are present within or outside the cord.There is an incidental hemangioma in the vertebral body of T6. 

Annotated image

increased T2 signal and mild swelling (blue arrows) involves most of the conus, more patchy towards the tip. No contrast enhancement. No syrinx or hemorrhage. 

Case Discussion

CSF electrophoresis shows oligoclonal banding. Corresponding bands were not detected in the serum.

Examination of the brain demonstrates no features to suggest prior demyelination, although on further questioning the patient describes an episode of lower limb sensory disturbance which may represent a prior episode of demyelination. 

Overall features are fairly typical of transverse myelitis, and the patient has been followed both clinically and with MRI. He has recovered and remains well. 

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