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Journal of the Korean Child Neurology Society 2008;16(1):50-61.
Published online May 30, 2008.
Clinical Characteristics of Acute Transverse Myelitis in Childhood.
Bo Lyun Lee, Kye Hyang Lee, Jeehun Lee, Jung Mi Chun, Ho Young Lee, So Hee Chung, Ji Hye Kim, Munhyang Lee
1Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea. mhlee0429@gmail.com
2Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
3Department of Pediatrics, School of Medicine, Catholic University of Daegu, Korea.
4Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Korea.
5Dr. Park's Pediatric Clinic, Korea.
6Hae Maleun Pediatric Clinic, Korea.
Abstract
PURPOSE
We performed this study to investigate clinical and radiological features, CSF findings, clinical courses and prognostic factors of acute transverse myelitis(ATM) in pediatric patients. METHODS: A retrospective review of the medical records was performed for 15 patients with ATM under the age of 16 years from January 1997 to January 2007. RESULTS: The mean age at onset was 9.3+/-4.4 years, and the male to female ratio was 1.5:1. During the initial phase, the common presenting symptoms were back pain, abdominal pain, leg pain and weakness. Motor deficits progressed in all patients and urinary difficulty was found in 13 patients(86.7%). CSF leukocytosis was found in four patients and protein was elevated in nine patients among the 12 patients who underwent CSF study. On spine MRI, high signal intensity in T2-weighted image was mainly identified at the cervicothoracic level in 11 patients(73.3 %). According to Paines scale, 11 patients(73.3%) had normal or good outcomes. Favorable outcomes were associated with shorter duration of maximal neurologic deficits, an early recovery, and shorter interval to independent walking. In this study, we described two patients suffering from relapsing myelits without any association with a systemic disease. One patient was diagnosed as idiopathic recurrent transverse myelitis(IRTM) and the other was re-diagnosed as multiple sclerosis(MS). CONCLUSION: The prognosis of ATM in childhood is better than that reported for adults. The clinical symptoms and the extent of lesions in MRI were not correlated with outcomes. However earlier recovery was significantly associated with favorable outcomes.
Key Words: Transverse myelitis, Prognostic factor, Multiple sclerosis, Childhood, Relapsing myelitis


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