Editing Transverse myelitis (section)

==Diagnosis==
[[File:Transverse Myelitis.PNG|thumb|Axial [[Magnetic resonance imaging#T1 and T2|T2 MRI]] of cervical spine demonstrating normal cord signal (green circle) and increased T2 signal in the central cord (red circle).]]

===Diagnostic criteria===
In 2002, the Transverse Myelitis Consortium Working Group proposed the following diagnostic criteria for idiopathic acute transverse myelitis:<ref name="WorkingGroup2002">{{Cite journal |vauthors=((Transverse Myelitis Consortium Working Group)) |date=August 2002 |title=Proposed diagnostic criteria and nosology of acute transverse myelitis |journal=Neurology |volume=59 |issue=4 |pages=499–505 |doi=10.1212/WNL.59.4.499 |pmid=12236201}}</ref>
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* '''Inclusion criteria'''
** Motor, sensory or autonomic dysfunction attributable to spinal cord
** Signs and symptoms on both sides of the body (not necessarily symmetrical)
** Clearly defined sensory level
** Signs of inflammation ([[pleocytosis]] of the [[cerebrospinal fluid]], or elevated [[immunoglobulin G]], or evidence of inflammation on [[gadolinium]]-enhanced (MRI) Magnetic resonance imaging)
** Peak of this condition can occur anytime between 4 hours to 21 days after onset
* '''Exclusion criteria'''
** Irradiation of the spine (e.g., [[radiotherapy]]) in the last 10 years
** Evidence of thrombosis of the [[anterior spinal artery]]
** Evidence of extra-axial compression on neuroimaging
** Evidence of [[arteriovenous malformation]] (abnormal flow voids on surface of spine)
** Evidence of [[connective tissue disease]], e.g. [[sarcoidosis]], [[Behçet's disease]], [[Sjögren's syndrome]], [[systemic lupus erythematosus]] or [[mixed connective tissue disease]]
** Evidence of [[optic neuritis]] (diagnostic of [[neuromyelitis optica]] (NMO))
** Evidence of infection ([[syphilis]], [[Lyme disease]], [[Human immunodeficiency virus]], [[Human T-lymphotropic virus 1]], [[mycoplasma]], [[Herpes simplex virus]], [[Varicella-zoster virus]], [[Epstein-Barr virus]], [[cytomegalovirus]], [[Human herpesvirus 6]] or [[enterovirus]]es)
** Evidence of [[multiple sclerosis]] (abnormalities detected on MRI and presence of oligoclonal antibodies in [[cerebrospinal fluid]] (CSF))
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===Investigations===
Individuals who develop TM are typically transferred to a [[neurologist]] who can urgently investigate the patient in a hospital. If [[breathing]] is affected, particularly in upper spinal cord lesions, methods of [[Mechanical ventilation|artificial ventilation]] must be on hand before and during the transfer procedure. The patient should also be [[catheter]]ized to test for and, if necessary, drain an over-distended [[urinary bladder|bladder]]. A [[lumbar puncture]] can be performed after the MRI or at the time of  [[Computed tomography|CT]] [[myelography]]. [[Corticosteroid]]s are often given in high doses when symptoms begin with the hope that the degree of inflammation and swelling of the spinal cord will be lessened, but whether this is truly effective is still debated.<ref name="gar" />

===Differential diagnosis===
The [[differential diagnosis]] of acute TM includes [[demyelination|demyelinating]] disorders, such as [[multiple sclerosis]] and [[neuromyelitis optica]], infections, such as herpes zoster and herpes simplex virus, and other types of [[inflammation|inflammatory]] disorders, such as [[systemic lupus erythematosus]] and [[neurosarcoidosis]]. It is important to also rule out an acute cause of compression on the spinal cord.<ref>{{Cite journal |vauthors=Jacob A, Weinshenker BG |date=February 2008 |title=An approach to the diagnosis of acute transverse myelitis |journal=Seminars in Neurology |volume=28 |issue=1 |pages=105–120 |doi=10.1055/s-2007-1019132 |pmid=18256991 |doi-access=free}}</ref>