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Transverse Myelitis


Step 1: View clinicals

A 4 year old boy presents with weakness in his upper and lower limbs for 24 hours. He had experienced an upper respiratory tract infection 10 days before, which lasted for 1 day. His medical history is unremarkable, and development is age appropriate. All immunizations are up to date, with no recent vaccinations.

Step 2: Order all relevant investigations

Lumbar Puncture

Appearance: clear WBC: 24 (0 - 5) 67% lymphocytes Protein: 84 mg/dl (18-58) Glucose: 55 mg/dL (<300) Gram stain and culture: Negative Ziehl-Neelsen stain for acid fast bacilli: Negative CSF sample sent for serologic testing.

MRI Spine & Brain

The MRI of the spine shows visible swelling of the C5-6 segments, with T2 hyperintensity. There is abnormal Gd-DTPA enhancement of the affected segments alone, with no enhancement of the dura mater and spinal roots. The MRI of the brain appears completely normal.

NCS Lower Limbs

The nerve conduction study reveals normal peripheral nerve velocities. F-waves were obtainable.

Serum CPK

Serum CPK: 50 IU/L (38-174)

Step 3: Select appropriate management

IV Ceftriaxone
IV Methylprednisolone
Neurosurgical Referral

Score: ★★☆