Clinical manifestations, laboratory findings, management, and course of nine children diagnosed with acute transverse myelitis (ATM) between 1993 and 1996 are reported from the Children’s University Hospital, Wurzburg, Germany. Spinal cord functions, including sensation, motor activity, and sphincter control, were affected in differing degrees, and neurologic symptoms and signs were often preceded by non-specific fever, nausea, and muscle pain. The peak of the illness and paraplegia was generally seen within 10 days and no later than 4 weeks. The thoracic spinal cord was principally involved in 80% of cases. Initially, tone and reflexes were decreased, and later, paralyses were associated with spasticity and hyperreflexia. CSF pleocytosis and/or elevated protein levels occurred in 4 patients. Peripheral nerve conduction velocity was normal, but muscle action potential amplitudes were decreased. An infectious causative agent was found in only 2 cases, with increasing antibody titers against echovirus 25 in one and Borrelia in one other. A para-, postinfective, postvaccinal myelitis was suspected in 7 cases. A review of the literature found bacterial, parasitic, and systemic lupus collagen disease as rare causes of ATM. A 3-day high-dose IV steroid pulse therapy (20 mg/kg/day prednisone) offered the most promising response in therapy. MRI excluded tumors, abscess, and vascular malformation. Multiple sclerosis, Guillain-Barre syndrome, and spinal cord infarction were more difficult to exclude. Of 6 patients followed up, 1 had a good recovery and 5 had a fair outcome. [1]

COMMENT. Diagnostic criteria for acute transverse myelitis include: 1) acute paraplegia and sphincter disturbance with maximum impairment within 4 weeks; 2) bilateral segmental sensory impairment; 3) exclusion of spinal cord compression or systemic neurologic disease; and 4) consistent MRI and laboratory EMG findings. Prognosis is variable and residual sequelae are common.