Diagnostic criteria for transverse myelitis

Inclusion criteria

Exclusion criteria

Development of sensory, motor, or autonomic dysfunction attributable to the spinal cord
Bilateral signs and/or symptoms (though not necessarily symmetric)
Clearly defined sensory level
Exclusion of extra-axial compressive etiology by neuroimaging (MRI or myelography; CT of spine not adequate)
Inflammation within the spinal cord demonstrated by CSF pleocytosis or elevated IgG index or gadolinium enhancement. If none of the inflammatory criteria is met at symptom onset, repeat MRI and lumbar puncture evaluation between 2 and 7 days following symptom onset meet criteria
Progression to nadir between 4 hours and 21 days following the onset of symptoms (if patient awakens with symptoms, symptoms must become more pronounced from point of awakening)

History of previous radiation to the spine within the last 10 years
Clear arterial distribution clinical deficit consistent with thrombosis of the anterior spinal artery
Abnormal flow voids on the surface of the spinal cord consistent with AVM
Serologic or clinical evidence of connective tissue disease (sarcoidosis, Behçet syndrome, Sjögren's disease, SLE, mixed connective tissue disorder, etc.)^*
CNS manifestations of syphilis, Lyme disease, HIV, HTLV-1, Mycoplasma, other viral infection (eg, HSV-1, HSV-2, VZV, EBV, CMV, HHV-6, enteroviruses)^*
Brain MRI abnormalities suggestive of MS^*
History of clinically apparent optic neuritis^*

AVM: arteriovenous malformation; CMV: cytomegalovirus; CNS: central nervous system; CSF: cerebrospinal fluid; CT: computed tomography; EBV: Epstein-Barr virus; HHV: human herpes virus; HSV: herpes simplex virus; HTLV-1: human T cell lymphotropic virus-1; IgG: immunoglobulin G; MRI: magnetic resonance imaging; MS: multiple sclerosis; SLE systemic lupus erythematosus; VZV: varicella zoster virus.

* Do not exclude disease-associated acute transverse myelitis.

From: Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59:499. DOI: 10.1212/wnl.59.4.499. Copyright © 2002 American Academy of Neurology. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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Diagnostic criteria for transverse myelitis