When should I consider referring a patient with transverse myelitis to a specialist for further evaluation?

You should consider referring a patient with suspected transverse myelitis to a specialist for further evaluation, particularly a consultant neurologist or a specialist under their supervision, if you suspect a neurological condition such as multiple sclerosis (MS) NICE NG220.

Immediate or Urgent Referral Criteria:

• Refer immediately adults with rapidly (within 4 weeks) progressive symmetrical limb weakness for neurological assessment and assessment of bulbar and respiratory function NICE NG127.
• Refer immediately if there is breathlessness at rest or when lying flat NICE NG127.
• Refer urgently if there is any evidence of swallowing impairment NICE NG127.
• Contact the consultant neurologist directly if you think a person needs to be seen urgently NICE NG220.
• If there is a neurological abnormality attributable to spinal cord injury, perform MRI after CT NICE NG41. For confirmed spinal cord injury, the trauma team leader should immediately contact the specialist neurosurgical or spinal surgeon on call NICE NG41.
• For people with a spinal cord injury, ensure ongoing contact with the regional specialist spinal cord injury centre and refer using the national spinal injuries database within 24 hours of diagnosis NICE NG211.

Other Referral Considerations:

• Before referring a person suspected of having MS, confirm that this is a neurological episode by taking a history, undertaking a physical examination, and excluding alternative, more common diagnoses NICE NG220.
• Seek specialist advice if spinal cord injury affects areas of physical function including bowel, bladder, and sexual function NICE NG211.