Disclosures: Melanie N. Wilson, MD: Nothing to disclose

Case Description: 54-year-old female presents to the Emergency Center with abdominal cramping wrapping around the back, right leg weakness, and left leg paraesthesias, stating she came into the Emergency Center walking, but within hours could not get up from a chair. Magnetic resonance imaging of lumbar/thoracic spine, and brain, was unremarkable. Within days, she developed bilateral leg paraesthesias from T4 down, decreased temperature sensation with normal vibration sense, bilateral leg paralysis with areflexia and positive Babinskis, urinary retention and bowel incontinence. Of note, she presented to a different Emergency Center 2 days prior to current admission with abdominal cramping, nausea, and diarrhea. This admission, a lumbar puncture revealed elevated IgG. She received intravenous immunoglobulin and intravenous steroids without improvement. Electromyogram of bilateral legs on day 4 showed active denervation in the right flexor digitorum longus muscle. Magnetic resonance imaging on day 10 revealed new cord signal abnormality from T4 to T8 involving the anterior spinal cord suspicious for anterior infarct, but with more posterior cord involvement inferiorly. She transferred to the Inpatient Rehabilitation Unit requiring maximal assistance with bed mobility and transfers.

Setting: Tertiary Care Hospital

Patient: 54-year-old Caucasian female

Assessment/Results: The patient was placed on a bowel program and learned how to self catheterize. She developed some voluntary muscle contraction in the left leg, however was discharged at wheelchair level. She continued with outpatient therapy and 7 months post-insult, is independent with all transfers and ambulating with minimal assistance with Lofstrand crutches with a left ankle-foot-orthosis and right knee-ankle-foot orthosis.

Discussion: There are only 1-4 new cases of transverse myelitis per million people per year, and it may be exceeding difficult to differentiate from anterior cord infarct.

Conclusion: Transverse myelitis can present initially as anterior cord infarct, however high index of suspicion and thorough diagnostic work up can identify the appropriate diagnosis.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transverse-myelitis-presenting-as-acute-anterior-spinal-cord-infarct-a-case-report/