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BRIEF COMMUNICATIONS: J. de Seze, C. Lanctin, C. Lebrun, I. Malikova, C. Papeix, S. Wiertlewski, J. Pelletier, O. Gout, C. Clerc, C. Moreau, G. Defer, G. Edan, F. Dubas, and P. Vermersch Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria Neurology 2005; 65: 1950-1953 [Abstract] [Full text] [PDF]

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Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria

Yasuo Iwasaki, Ken Ikeda   (18 April 2006)

Reply from the author

Jerome de seze   (18 April 2006)

Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria 18 April 2006
Yasuo Iwasaki, Toho University Omori Hospital 6-11-1,Omorinishi,Ota-ku,Tokyo, Ken Ikeda Send Correspondence to journal: Re: Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria yaso{at}med.toho-u.ac.jp Yasuo Iwasaki, et al.	We read interest the recent article by de Seze et al concerning acute transverse myelitis(ATM). [1] It is difficult to reach a correct diagnosis in patients who develop ATM. We observed five patients, all over sixty years old, with possible ATM according to criteria because all cases had normal cell counts in their CSF. In addition, they all had responsible regions in the thoracic cord and MRI extended to more than two vertebral lesions. They received IV corticosteroid with no improvement. Our five patients could not walk. In de Seze et al's series, their ages at onset were all below 40. They pointed out that there was no difference in terms of gender, clinical examination, MRI, and laboratory findings in the prognosis. However, T2-weighted hypersignal disappeared after treatment which indicated improvement of edema. Our series indicates that younger onset in possible ATM is not good in its prognosis. References 1.de Seze J, Lanctin C, Lebrum C, et al. Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria. Neurology 2005;65:1950-1953. Disclosure: The authors report no conflicts of interest.
Reply from the author 18 April 2006
Jerome de seze, Department of Neurology Hopital Civil de Strasbourg, CHRU de Strasbourg, 1 Place de L'hôpital, 67091 Strasbourg Cedex Send Correspondence to journal: Re: Reply from the author jerome.de.seze{at}chru-strasbourg.fr Jerome de seze	We thank Dr. Iwasaki for these interesting comments. We agree that the possible idiopathic acute transverse myelitis (ATM) group is confusing. It represents about one third of the patients and this subgroup should be better analyzed in future prospective studies. However, we can not rule out these patients especially if the diagnostic work-up is delayed after the first symptoms. In these cases, gadolinium enhancement and increased cell count in CSF may be absent. It is necessary, as proposed by the consortium, to exclude possible ATM patients with possible spinal cord infarct. This diagnosis is frequently difficult to assess. Spinal cord infarct patients may be closely similar to the five patients described by Dr. Iwasaki (i.e., age > 60, MRI extended to more than 2 vertebral levels, normal CSF, no improvement after corticosteroid treatment). Arterial territory involvement is sometimes difficult to confirm on MRI and difficult to be sure that these patients are not spinal cord infarct. Disclosure: The author reports no conflicts of interest.