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Acute Myelopathic Multiple Sclerosis
Distinguished From
Acute Transverse Myelitis




Scott T, et al.
Neurology 1998;50:429-33

Abstract

Patients presenting with Asymmetric or Partial Myelopathy are often found to have Multiple Sclerosis.

Acute Transverse Myelitis (ATM), in contrast, is usually a Monophasic illness or recurs at the same Spinal level as the initial attack. It is important in terms of prognosis, and possibly treatment, to distinguish as accurately as possible between these two conditions soon after the onset of symptoms.

In this study, the investigators sought to test the hypothesis that ATM can be distinguished from Myelopathic MS (MMS) by the symmetry of Motor and Sensory Impairments at presentation.

The authors reviewed the records of 20 consecutive patients presenting with ATM, as well as 16 consecutive patients with onset of MS symptoms referable to the Spinal Cord and who eventually fulfilled Poser's Criteria for Clinically Definite MS.

Using discriminant function analysis, the ability of symmetry of Motor and/or Sensory Dysfunction to distinguish between patient groups was evaluated. All ATM patients presented with symptoms of Motor Dysfunction, as did 15 of the 16 MMS patients; all presented with Sensory Symptoms.

According to discriminant function analysis, symmetry of both Sensory and Motor Impairments, when present, is more than 94 percent accurate in distinguishing between ATM and MS. Of the 16 MMS patients, only one had symmetry of both Motor and Sensory symptoms. ATM patients exhibited Symmetric Weakness Uniformly and Symmetric Sensory Loss in all but one patient.

None of the MS patients met criteria for ATM at presentation. None of the ATM patients developed MS over an average follow-up period of 4.5 years. In conclusion, MMS was easily distinguished from ATM in this study.



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