Transverse myelitis — SCE Neurology MCQ

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HardCNS inflammationTransverse myelitisSCE Neurology

A patient develops a severe longitudinally extensive thoracic myelitis over 36 hours. MRI brain is normal and there is no compressive lesion. Which investigation set is most important before assigning idiopathic transverse myelitis?

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Correct answer: D — CSF with serum AQP4-IgG and MOG-IgG assays

The best answer is “CSF with serum AQP4-IgG and MOG-IgG assays”. A long cord lesion can reflect infection, NMOSD, MOGAD, sarcoid or other inflammation; CSF characterises the inflammatory process and validated serum antibody assays identify relapsing disorders requiring distinct acute and preventive treatment. “Routine nerve-conduction and electromyographic studies” is less appropriate because peripheral conduction testing does not evaluate an intrinsic spinal-cord lesion “Carotid Doppler with extracranial flow-velocity measurement” is less appropriate because carotid imaging does not address thoracic myelitis “Acetylcholine-receptor and MuSK antibody testing” is less appropriate because junctional antibodies do not explain a sensory level and sphincter dysfunction “Skin biopsy for phosphorylated alpha-synuclein deposition” is less appropriate because cutaneous synuclein testing is unrelated to acute inflammatory cord disease

Reference: NEMOS recommendations: attack therapy and long-term management of NMOSD. https://pmc.ncbi.nlm.nih.gov/articles/PMC10770020/ International MOGAD diagnostic criteria. https://pubmed.ncbi.nlm.nih.gov/36706773/