Treatment of acute transverse myelitis and its early complications

Acute transverse myelitis (ATM) has many potential etiologies, but a significant proportion of cases are categorized as idiopathic despite thorough evaluation. Clinical presentation of ATM typically includes some combination of motor weakness, sensory symptoms, and bowel and bladder dysfunction. Prompt recognition, even before a final etiologic diagnosis is reached, is critical to initiating early therapeutic intervention to reduce the harmful effects of inflammation. Acute therapeutic options for ATM include corticosteroids, plasma exchange, IV immunoglobulin, and chemotherapeutic agents such as cyclophosphamide. In some instances, combinations of these therapies are used. This article examines the therapeutic approach to ATM and its various acute clinical manifestations.