Transverse Myelitis

9-year-old female who presented for worsening upper and lower extremity weakness and paresthesias approximately 2 weeks following an upper respiratory tract infection. There is marked, fusiform enlargement of the cervical and upper thoracic spinal cord on the sagittal T1-weighted images with diffuse cord edema throughout the cervical spinal region. On the diffusion-weighted images, there is prominent diffusion restriction compatible with infarction. These imaging findings, given the stated clinical history and absence of other T2 hyperintense and enhancing lesions within the brain or thoracic spinal region, are classic for transverse myelitis. No gender predilection has been noted. Clinical symptoms are bilateral and include para- or quadriparesis, sensory impairment, and bowel/bladder dysfunction. Both idiopathic and secondary cases have been described. Secondary causes include previous infection, most commonly viral, postvaccination, autoimmune and in the setting of systemic malignancy. Treatment depends on the underlying cause, but immunomodulators, such as steroids, or plasma exchange therapy may be helpful.