Describe briefly the clinical features, differential diagnosis, initial diagnostic tests and treatments for a patient with suspected acute transverse myelitis.
Clinical Features: [3 marks]
Acute transverse myelitis is a clinical syndrome characterised clinically by rapid onset and progression of motor, sensory and autonomic dysfunction as a result of acute inflammation involving gray and white matter at one or adjacent levels in the spinal cord.
Differentials (i.e. diagnoses other than those specifically associated with ATM);
[2 marks for any 4 of below]
Note: Must include imaging (either CT scan or MRI) and CSF examination in this section to score full marks.
Specific Treatments to be initiated; [3 marks]
– should be commenced awaiting definitive diagnosis
This question is a welcome evolution of Question 3 from the second paper of 2018, where (again) the trainees were asked to compare Guillaine-Barre syndrome to another lower motor neuron disease.
Initial diagnostic tests
Beh, Shin C., et al. "Transverse myelitis." Neurologic clinics 31.1 (2013): 79-138.
Waters, Patrick, et al. "Aquaporin-4 antibodies in neuromyelitis optica and longitudinally extensive transverse myelitis." Archives of neurology 65.7 (2008): 913-919.