Idiopathic Cervical Transverse Myelitis Presenting Predominantly With Lower Limb Weakness and Autonomic Dysfunction: A Report of a Rare Case

TL;DR

A 40-year-old woman with cervical transverse myelitis showed lower limb weakness and bladder issues, improved after steroid treatment, highlighting the need for early diagnosis.

Contribution

Presents a rare idiopathic cervical transverse myelitis case with atypical features and successful treatment response.

Findings

MRI showed C3-C6 spinal cord lesions consistent with transverse myelitis.

Patient improved significantly after high-dose corticosteroids and physiotherapy.

No infectious or autoimmune cause was identified, leading to idiopathic diagnosis.

Abstract

Transverse myelitis (TM) is a rare neuroinflammatory disorder that can lead to significant morbidity if not promptly diagnosed and treated. We report the case of a 40-year-old female who presented with progressive bilateral lower limb weakness and urinary incontinence over a two-month period. Neurological examination revealed upper motor neuron signs and a defined sensory level, raising suspicion of a spinal cord pathology. MRI of the cervicothoracic spine showed T2- and Short Tau Inversion Recovery (STIR)-weighted hyperintense lesions extending from C3 to C6, with mild cord expansion, suggestive of an inflammatory demyelinating process consistent with transverse myelitis. An extensive laboratory evaluation was unremarkable, and differential diagnoses such as multiple sclerosis, neuromyelitis optica, and sarcoidosis were excluded. Cerebrospinal fluid (CSF) analysis was not performed, representing a diagnostic limitation. With no identifiable infectious or autoimmune etiology, a diagnosis of idiopathic cervical transverse myelitis was made. The patient received high-dose intravenous corticosteroids followed by structured physiotherapy, resulting in marked clinical improvement within one week. This case underscores the importance of early recognition and intervention in atypical TM presentations, especially those involving the cervical spine, and demonstrates the potential for favorable outcomes with timely, individualized treatment.

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