Isolated recurrent idiopathic transverse myelitis

Abstract

Background Idiopathic transverse myelitis (TM) is most commonly due to immune-mediated inflammatory demyelination of the spinal cord as a parainfectious phenomenon. Known causes of recurrent TM include connective tissue diseases such as lupus, multiple sclerosis and Devic’s disease and antiphospholipid antibody syndrome. Isolated recurrent idiopathic TM is rare and exact etiology and predictive factors for recurrence are uncertain. Methods All patients with transverse myelitis managed in our hospital from 1998 to 2001 were studied. Those with multiple sclerosis, Devic’s disease, lupus and other known causes of TM were excluded. Clinical, biochemical and radiological features were analyzed. All patients were followed up for at least 2 years. Results A total of 16 patients with idiopathic TM were studied. Four patients had recurrent attacks with interval of 1 to 4 months between attacks while the other 12 patients had one attack only. All patients with recurrent TM were female while 5 of the 12 with single attacks were men. All patients with recurrent TM had MRI documented signal changes affecting 3 or more vertebral segments longitudinally with cord swelling while only 2 of the 12 with single attack had such extensive lesion and just 1 had cord swelling. All the recurrent cases were negative for oligoclonal band in cerebrospinal fluid while 50% of the single-attack group harbored oligoclonal band. Neurological recovery was unfavourable for the recurrent group while most of the non-recurrent patients could walk independently. Conclusion Idiopathic recurrent transverse myelitis seems to be characterized by a female predominance, longitudinally extensive cord lesion with swelling, absence of oligoclonal band and poor prognosis. An autoimmune basis should be considered.