A clinical, MRI and neurophysiological study of acute transverse myelitis

Abstract

There is paucity of studies correlating the MRI and evoked potential changes in acute transverse myelitis (ATM). We studied ten patients with ATM (age range 14-57 years; 8 men, 2 women) who were subjected to clinical, MRI and neurophysiological evaluation. The latter included median and tibial somatosensory evoked potentials (SEP), motor evoked potentials (MEP) to upper and lower limbs and concentric needle EMG. The outcome was defined on the basis of three month Barthel Index score. All the patients had pronounced lower limb and three had upper limb weakness. Magnetic resonance imaging scans revealed diffuse to hypointense lesions in T₁, which became hyperintense in T₂ in all except one patient, who had patchy hyperintense lesions in both T₁ and T₂ sequences suggesting haemorrhage. The signal changes extended at least three segments above the sensory level. Tibial SEP and central motor conduction time to tibialis anterior (CMCT-TA) were abnormal in nine patients each. Median SEP was normal in all, but CMCT to abductor digiti minimi (CMCT-ADM) was abnormal in four patients. The extent of MRI signal alterations and CMCT-TA correlated with the outcome. Seven patients had a poor outcome, in them MRI changes extended 10 spinal segments or more. In these patients, MEP on lumbar stimulation was either unrecordable or of low amplitude and extensive fibrillations were present in the lower limb muscles. From this study, we conclude that in ATM, extensive MRI changes, unrecordable MEP to lower limbs especially on lumbar stimulation and evidence of denervation in leg muscles seem to predict a poor outcome.