Patient handout

Acute Transverse Myelitis

PRODUCTION

1. Your condition

This handout is for acute transverse myelitis. Your care team identified this based on: bilateral motor + sensory deficit referable to single spinal cord level (tmcwg 2002 pmid 12236201).

Other reasons your team may use this plan: sensory level (clear demarcation between normal and abnormal sensation) — tmcwg 2002 cardinal feature; bowel / bladder dysfunction (retention, incontinence, urgency) — autonomic involvement; cord pathology; back pain at the level of the cord lesion (inflammatory radicular pain).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
methylprednisolone	1 g IV daily × 3-5 d (typically 5 d)	IV	daily × 3-5 d	First-line for acute TM; reduces inflammation; ONTT-scaffolding (extension from optic neuritis trial); same pulse used for MS flare (ms-flare engine — Beh 2013 PMID 23186897 review)
prednisone	1250 mg PO daily × 3-5 d (then taper)	PO	daily	Oral methylprednisolone-equivalent 1250 mg/day non-inferior to IV for MS flare (Le Page Lancet 2015); reasonable for mild TM with reliable PO + outpatient infusion

Plan: TM acute Rx — high-dose steroid + PLEX for refractory + cyclophosphamide / rituximab for autoimmune + antibiotic for infectious + supportive (TMCWG 2002 PMID 12236201; ApolyDS Magaña 2011 PMID 10589540)

3. When to call your provider

Contact your care team if any of the following happen:

New weakness / sensory level / vision loss / bowel-bladder change → ED + STAT MRI (recurrence)
New infection during immunosuppression → urgent visit + abx
Pressure ulcer stage 2+ → wound care + nutrition
Severe depression / suicidality → urgent psych
Severe spasticity / baclofen withdrawal symptoms → ED
DVT signs → ED

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Idiopathic transverse myelitis — TMCWG 2002 criteria (bilateral cord signs + sensory level + inflammation evidence MRI gad or CSF + max severity 4 h-21 d + EXCLUDE compressive) without identified etiology (TMCWG 2002 PMID 12236201; Beh 2013 PMID 23186897)
NMOSD transverse myelitis — AQP4-IgG positive + longitudinally extensive ≥3 vertebral segments + female predominant 9:1 (Wingerchuk 2015 PMID 26092914); different DMT (eculizumab / satralizumab / inebilizumab / rituximab) — NOT MS DMT(life-threatening)
MOGAD transverse myelitis — MOG-IgG positive (live cell-based assay) + often bilateral simultaneous optic neuritis + brain / cortical encephalitis features (Banwell 2023 PMID 36706773); many monophasic but some relapsing → rituximab / azathioprine / mycophenolate / IVIG
Sarcoid-associated transverse myelitis — elevated CSF / serum ACE + gallium scan + biopsy granulomas; longitudinally extensive cord lesion common; steroid + methotrexate / TNF inhibitor maintenance
SLE transverse myelitis — ANA + dsDNA positive + part of SLE flare (5% of SLE develop TM); SLE engine drives cyclophosphamide / rituximab — TM engine drives cord workup + steroid pulse + PLEX (route to rheum.sle-flare.core.v1)(life-threatening)
Sjögren transverse myelitis — SS-A/SS-B positive + Schirmer test + lip biopsy; rituximab + steroid; rheum consult
Paraneoplastic transverse myelitis — anti-CRMP5 / anti-amphiphysin / anti-Hu / anti-Ma2 positive; underlying cancer (small cell lung, breast, ovary, thymoma); CT chest/abdomen/pelvis + PET cancer workup
Spinal cord infarct — anterior cord syndrome (bilateral motor + pain/temp loss with preserved dorsal column proprioception/vibration); sudden onset (<4 h to peak); vascular RFs (atherosclerosis, AAA repair, hypotension, hypercoagulable, fibrocartilage embolism); STAT MRI cord; route to neuro.ischaemic-stroke.v1(life-threatening)
Chronic dural arteriovenous fistula — progressive over weeks-months; older male predominant (M:F 4:1); STAT spinal angiography → embolization or surgical disconnection; NOT a steroid-responsive entity

5. Follow-up

Rehab 6-12 mo (PT / OT / SLP); NMOSD / MOGAD DMT initiation if AQP4+/MOG+ (route to ms-flare engine for regimen scaffolding); MS clinic q3 mo if MRI brain demyelinating lesions; autoimmune clinic if SLE / Sjögren / sarcoid; recurrent TM warning (NMOSD 60% in 1 y untreated; Wingerchuk 2015 PMID 26092914); bladder mgmt + bowel regimen + spasticity Rx + pressure ulcer surveillance + sexual function counseling + psych follow-up

6. Sources

Guideline: 2002 Transverse Myelitis Consortium Working Group (TMCWG) Clinical Criteria + 2015 Wingerchuk NMOSD Diagnostic Criteria + 2023 Banwell MOGAD Diagnostic Criteria + 2011 ApolyDS Magaña PLEX Class I AAN + CDC Lyme Borreliosis + Pidcock 2007 Post-Infectious TM + Beh 2013 TM Review Neurol Clin