Synopsis
Approach acute spinal-cord inflammation as a time-critical syndrome: localise the lesion, exclude compression and vascular disease, identify its cause and protect respiratory, bladder and mobility function.
- Transverse myelitis describes an inflammatory spinal-cord syndrome, not a final aetiological diagnosis; it may be idiopathic, post-infectious or part of MS, NMOSD, MOGAD, systemic autoimmunity, infection or malignancy.
- Typical deficits evolve over hours to days and combine bilateral motor, sensory and autonomic dysfunction attributable to a spinal level, although asymmetry is common early.
- Urgent MRI of the whole spine with contrast is required to exclude compression, epidural infection, tumour, vascular malformation and other structural emergencies before immunotherapy is assumed appropriate.
Key red flags
Weakness and sensory symptoms progress over hours or days, with a band-like truncal boundary and new bladder, bowel or sexual dysfunction. Bilateral findings below one anatomical level are strongly localising.
Investigation priorities
Confirm intramedullary disease and immediately identify compression, abscess, haemorrhage, tumour or a vascular structural lesion.
Management branches
An acute or subacute bilateral sensorimotor syndrome with autonomic disturbance is identified.
- Perform ABCDE, document sacral and segmental neurology, check respiratory mechanics for cervical disease, scan the bladder and use the emergency spinal-compression pathway when red flags are present.
- Obtain urgent contrast MRI of the whole spine, involving spinal surgery, oncology or infection teams immediately if compression, abscess, haemorrhage or instability appears.
Key medicines
Intravenous methylprednisoloneSpecialist protocols commonly use 1 g once daily for three to five days in adults.
Therapeutic plasma exchangeA typical rescue course comprises five to seven specialist exchanges, adjusted to response and local policy.