Diagnosing Transverse Myelitis (TM)

How is transverse myelitis diagnosed?

A very good clinical interview to outline the evolution of symptoms as well as a careful neurological examination is always needed to characterize the clinical profile of the patient suspected to have TM. In addition to the clinical evaluation, two common tests following the onset of suspicious symptoms are used as a first step to diagnose TM:

Magnetic resonance imaging (MRI) of the spinal cord: The most reliable neuroimaging technique to evaluate the structure of the spinal cord is the MRI. MRI of the spinal cord without and with paramagnetic contrast (e.g., gadolinium) may facilitate the visualization of cord lesions, swelling of the spinal cord, a signal abnormality in the cord identified by contrast enhancement (which can indicate inflammation) or no abnormality at all.

Lumbar puncture (spinal tap): A spinal tap allows a sample of cerebrospinal fluid (CSF) to be removed to determine the degree of inflammation present. Analysis of the cellular content of CSF will determine the amount of white blood cells that may accumulate in the fluid, a measure that may serve as a good indicator of the magnitude of inflammation.

In addition to the neuroimaging of the spinal cord and CSF studies, blood/serological studies frequently help in ruling out the presence of systemic disorders such as rheumatologic diseases (e.g., Sjogren’s disease or systemic lupus erythematous), infectious or metabolic disorders. It is important to note that while both of the above procedures facilitate a diagnosis, the results do not predict a patient’s outcome from transverse myelitis.