Journal Volume 5 - January 2011
Article 2
This article originally appeared in The New England Journal of Medicine 363:6 564-72. August 5, 2010 Transverse MyelitisElliot M. Frohman, M.D., Ph.D., and Dean M. Wingerchuk, M.D. N Engl J Med 2010; 363:564-572August 5, 2010 This article has no abstract; the first 100 words appear below. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage An otherwise healthy 28-year-old woman presents to the emergency department with progressive weakness that began 3 days earlier. She reports difficulty walking, numbness in the body below her breasts, and urinary urgency, and she notes that neck flexion triggers an electrical sensation that radiates to the coccyx. Physical examination reveals moderate paraparesis with hyperreflexia, a left extensor plantar response, impairment of vibratory and proprioceptive sensation, and a sensory level at T6. Magnetic resonance imaging (MRI) reveals a lower cervical cord lesion that enhances after gadolinium administration, a finding that is consistent with transverse myelitis. How should she be further . . . An audio version of this article is available at NEJM.org. Dr. Frohman reports receiving speaking fees from Biogen Idec, Teva Neuroscience, Bayer, and Novartis and consulting fees from Biogen Idec, Teva Neuroscience, Abbott, and Genzyme; and Dr. Wingerchuk, receiving research support from Alexion, Genzyme, Genentech, Organon (now part of Merck), and the National Multiple Sclerosis Society and consulting fees from Novartis, Teva Neuroscience, VLST, and the Guthy–Jackson Charitable Foundation. No other potential conflict of interest relevant to this article was reported. |