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@EoinFlanagan14 work has changed our approach to myelopathies, this @ContinuumAAN is a testimony to his remarkable contributions to our field. I am honored to share our recent review on #myelitis
1/6 @MayoClinicNeuro https://twitter.com/continuumaan/status/1357808477280886784
1/6 @MayoClinicNeuro https://twitter.com/continuumaan/status/1357808477280886784
@nzalewski2 has shown ~70% of patients with a diagnosis of "idiopathic transverse myelitis" have an alternative specific cause of myelopathy found after a thorough workup!
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-The term "transverse myelitis" is used as a synonym for inflammatory myelopathy leading to confusion and misdiagnosis
-Many causes cause inflammation of a segment of the cord on cross section
-Ab testing, CSF and radiologic discriminators are more useful!
3/7
-Many causes cause inflammation of a segment of the cord on cross section
-Ab testing, CSF and radiologic discriminators are more useful!
3/7
-The time from onset to maximal neurologic deficit is the most important feature to determine when evaluating a myelopathy as it helps narrow the differential diagnosis.
-Hyperacute:minutes <12 h(typical of infarct), acute/subacute (1 to 21 days), chronic progressive beyond 21
-Hyperacute:minutes <12 h(typical of infarct), acute/subacute (1 to 21 days), chronic progressive beyond 21
- Most inflammatory myelopathies are subacute
-Progressive clinical course and persistent enhancement on imaging are flags
consider : AV fistula, neoplasm or other non inflammatory causes. 5/7
-Progressive clinical course and persistent enhancement on imaging are flags
consider : AV fistula, neoplasm or other non inflammatory causes. 5/7
The majority of inflammatory myelitis episodes will be accompanied by an elevated CSF white blood cell count, and its absence should at least raise consideration of alternative etiologies (eg, vascular myelopathies) 6/7
For this review we made illustrative figures that I hope you will find very helpful for your clinical practice!
Recognizing radiographic patterns is crucial to accurately identify the etiology as @rafidmustafa recently showed here : https://bit.ly/39o5wrg
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Recognizing radiographic patterns is crucial to accurately identify the etiology as @rafidmustafa recently showed here : https://bit.ly/39o5wrg
7/7
