Transverse Myelitis F101

Current RMA Instruments

SOP bulletin for new Instruments

ICD Coding

• ICD-10-AM Code:  G37.3

Brief description

Transverse myelitis (TM) is a rare, acute or subacute, acquired, neuro-immune, spinal cord disorder that is localised to a segment of the spinal cord. It can cause motor, sensory and autonomic dysfunction (weakness, sensory alterations, and bowel or bladder dysfunction).  It is most commonly idiopathic (of unknown cause) but can occur as a post-infectious complication of a variety of infections, or in association with certain drugs and diseases.  A similar clinical picture may be seen with neurological conditions like multiple sclerosis or localised damage to the spinal cord from e.g. trauma, radiation or tumour invasion.  Neuritis in these settings (other neurological disease or local spinal cord pathology) is not covered by this SOP.

Confirming the diagnosis

The diagnosis is made based on the clinical presentation and course, neuroimaging (MRI scan) and lumbar puncture with cerebrospinal fluid analysis.

The relevant medical specialist is a neurologist.

Additional diagnoses covered by SOP

• Nil

Conditions excluded from SOP

• Spinal cord myelits due to multiple sclerosis*, acute disseminated encephalomyelitis^#, or neuromyelitis optica syndrome^#
• Spinal cord myelitis associated with localised spinal cord: trauma; compression (including from spondylosis or other spine pathology); tumour invasion; or radiation damage 
• Spinal cord myelitis associated with intrathecal chemotherapy (SOP for underlying malignancy may apply)

* another SOP applies

^# non-SOP condition

Clinical onset

Symptoms typically develop and progress over the course of hours to a few days and then stabilise.  Symptoms may include rapidly progressing weakness in the limbs, pain and altered sensation below a particular spinal cord level and altered/imapired bladder, bowel and sexual function.

The condition occurs in children and there is a second peak in cases between the ages of 30 and 39.

Clinical worsening

Most patients with TM make at least a partial recovery, which usually begins within one to three months of onset and then continues over an extended period.  Recurrences may occur, particularly if there is an underlying autoimmune disease. Medical (drug) therapy is available and effective, with high dose glucocorticoid therapy typically given as initial therapy.