The Demographic, Clinical, and Magnetic Resonance Imaging (MRI) Features of Transverse Myelitis in Children

Abstract

The authors collected demographic, clinical, and neuroimaging data prospectively on 38 children with transverse myelitis. One child died during the illness. The female:male ratio was 1.2:1 for children under age 10 years and 2.6:1 over age 10 years. Twenty-eight (74%) reported a prodromal event. Twenty-two patients (58%) had longitudinally extensive transverse myelitis, 9 (24%) had focal lesions, and 5 (13%) had both. Twenty of 33 with brain imaging (61%) had brain lesions; 7 fulfilled McDonald criteria for dissemination in space. Seven of 22 (36%) tested had cerebrospinal fluid oligoclonal banding, 6 of whom had brain lesions. Serum neuromyelitis optica IgG antibodies were absent in all 20 of the children for whom this test was available. At follow-up (mean 3.2 ± 2.0 years), 16% are wheelchair-dependent, 22% have persisting bladder dysfunction, and 13% have been diagnosed with multiple sclerosis.

Recovery From Central Nervous System Acute Demyelination in Children

“…Children with ADEM had the longest hospital stays, whereas children with ON had the shortest hospital stays ( Severe deficits in $1 feature of vision, motor, bladder and bowel function, or cognition were detected at ADS onset in 133 (47.0%) of 283 children, whereas 51 (18.0%) children had $1 moderate deficit, and 79 (27.9%) children had at least 1 mild deficit (Supplemental Fig 3A). Twenty (7.1%) children had a normal examination at study enrollment (days from onset, median [range]: 9 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]); all had at least 1 deficit at onset verified according to records review of their presenting examination.…”

“…We previously described 38 children with TM (none included in the present analysis); 6 (16%) experienced residual motor impairment and 8 (22%) experienced residual bladder impairment. 15 In a European study of 95 children with TM, 28 (30%) experienced a poor outcome (defined as Expanded Disability Status Scale score $4). 16 Of 47 children reported from the Johns Hopkins Myelitis Center, 17 ten (21%) patients required a walker or other support and 22 (50%) of 44 required bladder catheterization.…”

Pediatric transverse myelitis

“…8 Although males are more likely to present with ATM (male:female ratio 1.1-1.6:1), a female preponderance is seen among teenagers in regions at high risk for MS and NMO (United States, Canada, Europe, and parts of Australia). [6][7][8][9][10][11][12] A bimodal age distribution is observed in children under 5 and older than 10 years of age. 3,8,9,[11][12][13] There is no difference in ethnicity prevalence.…”

Risk Factors of Hematomyelia Recurrence and Clinical Outcome in Children with Intradural Spinal Cord Arteriovenous Malformations

“…In other my- elopathies, particularly inflammatory myelopathies in children, younger age at onset and the presence of sphincter involvement were associated with a poorer clinical prognosis. 16,17 Imaging studies revealed that T1 hyposignal and extensive lesions could be MR imaging signs predictive of poorer outcome. In our study, we did not observe any clinical or MR imaging criteria able to distinguish recurrence or more severe ASIA scale apart from younger age, though not significant, suggesting that these factors are less important in hematomyelia in contrast to inflammatory myelopathies.…”