Transverse Myelitis with Acute Inflammatory Polyradiculoneuropathy

Abstract

A 15-year-old previously healthy female presented with lower extremity weakness and numbness, demonstrating imaging and laboratory characteristics diagnostic of both acute transverse myelitis (TM) and acute inflammatory demyelinating polyradiculopathy (AIDP). AIDP typically presents as a distinct clinical entity limited to the peripheral nervous system and nerve roots, but has been reported in association with central demyelinating syndromes including transverse myelitis. The signs and symptoms of the two syndromes may mimic one another and should always be considered in the differential diagnosis. Thus, careful investigation and a high index of suspicion are necessary to thoroughly exclude the coexistence of peripheral and central demyelination. When the conditions do co-occur, systemic inflammatory disease or infection should be considered and thoroughly investigated, as treatment must be directed toward any such underlying disease. In the rare case where no associated disease is identified, the treatment plan should independently consider recommendations for each demyelinating condition. Outcomes of AIDP versus central demyelinating syndromes vary considerably depending upon various prognostic factors, and it remains unclear how such prognosis translates to those cases with co-occurrence.