Diagnosis and treatment of pediatric acute transverse myelitis.

Acute transverse myelitis is a rare, focal immune-mediated disease that affects the sensory and motor pathways of the spinal cord. It is characterized by a sudden clinical onset of neurological motor dysfunction associated with sensory loss and autonomic disturbances. The following tetrad of symptoms has been classically described in acute transverse myelitis (ATM): 1) weakness in the arms/legs; 2) sensory symptoms such as numbness or tingling; 3) pain and discomfort; and 4) bladder dysfunction and/or bowel motility problems. The etiology of ATM is diverse and includes infectious, post-infectious, vascular, collagen/autoimmune, neoplastic, and paraneoplastic causes. Clinical interview and careful neurological examination are essential in making an ATM diagnosis. In addition to the clinical evaluation, magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) testing are common diagnostic tools used as a first step in diagnosis. Children with ATM undergo different therapeutic modalities such as corticosteroids, plasma exchange (PLEX), intravenous immunoglobulin (IVIG), cytotoxic drugs, and other immunomodulatory agents; however, the use of steroids followed by PLEX is the most widely accepted treatment regimen. ATM is commonly a monophasic illDiagnosis and Treatment of Pediatric Acute Transverse Myelitis