Acute Transverse Myelopathy in Childhood

Dunne, Katie; Hopkins, I. J.; Shield, Lloyd K.

doi:10.1111/j.1469-8749.1986.tb03855.x

Cited by 95 publications

(49 citation statements)

References 6 publications

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“…Thirty-one percent of patients recovered completely, minimal sequelae were present in 25%, and mild to severe sequelae were present in 44% (Defresne et al, 2003). A poor prognosis was associated with paraplegia and a nadir was reached within 24 hours (suggestive of vascular compromise), similar to the observations from other case series (Dunne et al, 1986;De Goede et al, 2010). This series found that use of high-dose corticosteroids was associated with a favorable outcome.…”

Section: Outcomes and Treatmentsupporting

confidence: 84%

“…Two patients had recurrent ATM, and one child developed SLE, NMO, and MS. The age of onset had a bimodal distribution, with 15/47 (38%) children presenting before the age of 3 and 23/47 (49%) children presenting in adolescence, similar to prior observations from another case series (Dunne et al, 1986). At nadir, 80% of children were paraplegic and required catheterization.…”

Section: Observations From Case Seriessupporting

confidence: 83%

“…However, 38% were afflicted by chronic bladder dysfunction. The second pediatric ATM case series found an overall good prognosis in the majority of cases (12/21) (Dunne et al, 1986). A poor outcome in 5 patients was associated with severe deficits evolving over 3 hours, suggestive of spinal cord ischemia, although without the expected sparing of dorsal column sensory function.…”

Section: Outcomes and Treatmentmentioning

confidence: 97%

“…The second published case series of pediatric ATM was a single-center retrospective case series and described the clinical characteristics of 21 children with acute transverse myelopathy (Dunne et al, 1986). Compressive, traumatic, and radiation-induced etiologies were excluded.…”

Section: Observations From Case Seriesmentioning

confidence: 99%

“…A consistent feature associated with a poor prognosis of pediatric myelopathy is acute onset (Dunne et al, 1986;Defresne et al, 2003;De Goede et al, 2010). A case series of 5 adolescent patients who presented with rapid myelopathy with maximum deficit between 10 minutes and 6 hours also experienced poor recovery (Wilmshurst et al, 1999).…”

Section: Acute Myelopathymentioning

confidence: 99%

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Acute inflammatory myelopathies

Cree

2014

Handbook of Clinical Neurology

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Section: Outcomes and Treatmentsupporting

confidence: 84%

Section: Observations From Case Seriessupporting

confidence: 83%

Section: Outcomes and Treatmentmentioning

confidence: 97%

Section: Observations From Case Seriesmentioning

confidence: 99%

Section: Acute Myelopathymentioning

confidence: 99%

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Acute inflammatory myelopathies

Cree

2014

Handbook of Clinical Neurology

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Idiopathic Recurrent Transverse Myelitis

Kim

2003

Arch Neurol

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Objective: To determine whether idiopathic recurrent transverse myelitis (RTM) can be distinguished from multiple sclerosis-associated RTM (MSRTM) on the basis of clinical manifestations of myelopathy, or findings from magentic resonance imaging or cerebrospinal fluid examination.Design: A retrospective analysis of 37 cases was conducted. Patients were classified as having idiopathic RTM on the basis of recurrent myelitis confirmed by clinical manifestations of myelopathy and magnetic resonance imaging findings. On review patients with idiopathic RTM had normal cranial magnetic resonance imagings and did not demonstrate paraclinical evidence of spatial dissemination beyond the spinal cord of the disease process. Patients were classified as having MSRTM on the basis of criteria of Poser et al for clinically definite multiple sclerosis involving the central nervous system. Fifteen patients met study criteria for idiopathic RTM. Twenty-two patients had MSRTM. Result: Idiopathic RTM occurred preponderantly in male patients and presented more often with acute transverse myelitis than did MSRTM. More than 2 relapses occurred in 6 cases (40%) of idiopathic RTM. The involved segments of spinal cord on T2-weighted images were not significantly different in idiopathic RTM and MSRTM, with enhancing lesions mostly in the posterior columns, and the spinothalamic and spinocerebellar tracts of white matter. Additionally, almost all patients with idiopathic RTM had normal cerebrospinal fluid indexes. Conclusion:Idiopathic RTM might be a disease entity distinct from MSRTM, differing in its male preponderance, absence of oligoclonal bands, frequent multiple relapses, and frequent presentation as acute transverse myelitis.Arch Neurol. 2003;60:1290-1294 R ECURRENT TRANSVERSE myelitis (RTM) usually heralds or is accompanied by lesions producing dysfunction elsewhere in the central nervous system and almost always signifies the presence of multiple sclerosis (MS).1-4 A series of 3 cases of RTM in patients who never developed other evidence of MS or collagen vascular disease and had no abnormalities on magnetic resonance imagings (MRIs) of the brain suggested that RTM may be a disorder distinct from MS.5 Recurrent transverse myelitis as an independent entity, with neither abnormal cranial MRI nor oligoclonal bands (OCBs) in cerebrospinal fluid (CSF), is an interesting topic in terms of the causative factors and therapeutic considerations. Further studies in which the criteria for an idiopathic RTM of unknown origin are clearly defined and that include longterm follow-up are needed to distinguish idiopathic RTM from MS-associated RTM (MSRTM). In this study, the medical records of 15 patients with idiopathic RTM who were followed up for longer than 5 years after their first attack of myelitis were reviewed for clinical manifestations, specific spinal MRI findings, and CSF study results to verify a novel disease entity distinguished from clinically definite myelopathic MS. METHODSThe medical records of 15 consecutive patients (12 men and ...

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Ascending myelitis after intensive chemotherapy and radiation therapy in children with cranial parameningeal sarcoma

Raney

Tefft

Heyn

et al. 1992

Cancer

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In 1977, a program of early, wide‐field radiation therapy (RT) to the central nervous system and repeated lumbar intrathecal (IT) medications along with systemic chemotherapy was begun by the Intergroup Rhabdomyosarcoma Study (IRS) for patients younger than 21 years of age with cranial parameningeal sarcoma and a high risk of meningeal extension. From 1977 until 1987, 149 eligible patients with high‐risk cranial parameningeal sarcoma were enrolled in IRS trials. None had evidence of lower extremity or sphincter impairment at diagnosis. Five of the 149 (3.4%) had ascending myelitis at 5.5 to 9 months after the initiation of therapy, with loss of sphincter control and inability to walk; this progressed to severe flaccid quadriparesis and necessitated longterm ventilatory support in 4. All five had received vincristine, dactinomycin, cyclophosphamide, and doxorubicin; four also had received cisplatin and three also had received etoposide. All patients received 4770 to 5500 cGy to the primary tumor, and four patients received 3000 cGy of cranial RT. Three patients received cervical RT and two received spinal RT. The patients also received four to seven courses of IT methotrexate, hydrocortisone, and cytosine arabinoside. Three patients died: one after local tumor recurrence with central nervous system extension and two without known recurrence. In one of the latter patients, the results of an autopsy showed necrosis of the cervical spinal cord and caudal medulla. Although the exact cause of this complication is unclear, no additional cases have been reported to the IRS since the protocol was revised in 1987 to reduce the doses of the IT drugs and to limit them to four courses each. Cancer 1992; 69:1498‐1506.

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Acute Transverse Myelopathy in Childhood

Cited by 95 publications

References 6 publications

Acute inflammatory myelopathies

Acute inflammatory myelopathies

Idiopathic Recurrent Transverse Myelitis

Ascending myelitis after intensive chemotherapy and radiation therapy in children with cranial parameningeal sarcoma

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