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Transverse myelitis — RACP Paediatrics MCQ

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ModerateNeurologyTransverse myelitisRACP Paediatrics

A 6-year-old develops acute onset bilateral leg weakness, urinary retention, and a sensory level at T10 over 48 hours. There was a viral illness 1 week ago. MRI spine shows central cord signal abnormality spanning T8-T12 with swelling. CSF shows lymphocytic pleocytosis. What is the most likely diagnosis?

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Correct answer: A — Transverse myelitis

Acute transverse myelitis presents with rapid onset bilateral motor, sensory, and autonomic (bladder/bowel) dysfunction with a defined spinal cord level. MRI shows central cord T2 signal change typically spanning ≥3 segments. Post-viral onset is common. Treatment is high-dose IV methylprednisolone. Plasma exchange may be used for refractory cases. Aquaporin-4 and MOG antibodies should be tested.

Reference: RCH Melbourne – 2023 – Acute Weakness CPG; RACP Paediatric Curriculum – Neurology