TRANSVERSE MYELITIS - RETROSPECTIVE ANALYSIS OF 33 CASES, WITH DIFFERENTIATION OF CASES ASSOCIATED WITH MULTIPLE-SCLEROSIS AND PARAINFECTIOUS EVENTS

Objective.-A study was undertaken to determine whether cases of parain fectious-associated transverse myelitis (TM) and multiple sclerosis-as sociated TM could be distinguished on the basis of clinical criteria, radiologic features, or cerebrospinal fluid examination. A secondary o bjective was to determine the incidence of TM in a US population. Desi gn.-A retrospective analysis of 33 cases was conducted. Cases were cla ssified as being related to parainfectious multiple sclerosis, or spin al cord ischemia, or idiopathic. Setting.-All cases occurring in the A lbuquerque, NM, area from 1960 through 1990 were reviewed. The populat ion base was 500 000. Outcome Measures.-Clinical presentation, radiolo gic features, cerebrospinal fluid, recovery of ambulation and bladder function, and recurrence rates were compared. Results.-Thirty-three pa tients satisfied study criteria, corresponding to an incidence of 4.6 per million per year. Forty-five percent of these cases were categoriz ed as parainfectious, 21 % as associated with multiple sclerosis, 12 % as associated with spinal cord ischemia, and 21 % as idiopathic. Pati ents with parainfectious TM suffered from spinal shock more frequently than did those with multiple sclerosis-associated TM. Patients with p arainfectious TM showed evidence of spinal cord swelling, whereas pati ents with multiple sclerosis-associated TM had spinal cord plaques on magnetic resonance images but none showed swelling. Oligoclonal bands were absent in patients with parainfectious TM and present in three of five patients with multiple sclerosis-associated TM. Conclusions.-Par ainfectious TM may be distinguishable from that associated with multip le sclerosis on the basis of presentation, findings on imaging, and th e presence of cerebrospinal fluid oligoclonal bands.