PURPOSE: To analyze the magnetic resonance (MR) imaging findings in id
iopathic acute transverse myelitis (IATM) in relation to pathologic fi
ndings and MR findings in Guillain-Barre syndrome and ischemia. MATERI
ALS AND METHODS: The cases of 19 patients with IATM seen over a 4-year
period were retrospectively reviewed. Clinical parameters and laborat
ory test findings were recorded for each patient independently of the
MR findings. RESULTS: Ten (53%) patients experienced upper respiratory
infection or vaccination within 4 weeks of symptom onset. The majorit
y (82%) of cases occurred between December and May each year. In seven
of 12 patients who underwent electromyography and nerve conduction ex
aminations, evidence of peripheral nerve injury was seen. On T2-weight
ed axial images, 13 of 18 lesions were depicted with holocord abnormal
signal intensity, seven (39%) had gray matter involvement similar to
that seen in spinal cord ischemia, and three (16%) had isolated white
matter involvement. Enhancement patterns varied. In three (17%) of the
18 lesions, enhancement in the cauda equina was similar to that seen
in Guillain-Barre syndrome. CONCLUSION: IATM may be caused by a small
vessel vasculopathy. MR findings in IATM also occasionally are similar
to those described in Guillain-Barre syndrome and suggest a possible
relationship.