Overview
Acute transverse myelopathy involves sudden neurological dysfunction due to spinal cord injury or compression, often leading to motor and sensory deficits below the level of the lesion 1.Diagnosis
Clinical Presentation: Sudden onset of motor, sensory, or autonomic dysfunction 1.
Imaging: MRI is essential for identifying compressive lesions such as tumors or hematomas 1.
Lumbar Puncture: May be considered to rule out infectious causes, though less relevant for compressive etiologies 1.
Electromyography/Nerve Conduction Studies: Useful for assessing the extent of spinal cord involvement 1.Management
Surgical Intervention: Early surgical decompression is crucial for recovery, particularly in compressive lesions like neurilemmomas 1.
Medical Management: Supportive care including pain management, spasticity control (e.g., baclofen), and prevention of complications 1.
Rehabilitation: Early initiation of physical and occupational therapy to maximize functional recovery 1.Special Populations
Elderly: Early surgical intervention remains critical despite age, as seen in the case of a 74-year-old patient 1.Key Recommendations
Early Surgical Decompression: Essential for patients with compressive etiologies like spinal subdural hematoma or neurilemmoma to improve neurological outcomes 1 (Evidence: Strong).
Imaging Confirmation: MRI should be performed promptly to identify the underlying cause of transverse myelopathy 1 (Evidence: Strong).
Supportive Care: Implement comprehensive supportive care including pain management and rehabilitation strategies post-decompression 1 (Evidence: Moderate).References
1 Smith RA. Spinal subdural hematoma, neurilemmoma, and acute transverse myelopathy. Surgical neurology 1985. link90208-3)