Acute Disturbance of Consciousness as the First Clinical Manifestation of an Elderly Patient with Acute Transverse Myelitis

Acute transverse myelitis (ATM) is a rare entity in the elderly. This case report summarizes the clinical features and treatment of an elderly patient with ATM. The aim is to be expected to benefit the diagnosis and treatment of ATM in the elderly. A 68-year-old mail presented with a 5-hour history of acute loss of consciousness and high fever for one day. The examination showed that pin sensation disappeared below the level of the 8th thoracic spinal segment. The patient had paraplegia, muscle hypotonia, urinary incontinence and the disappearance of limb tendon reflexes. Magnetic resonance image (MRI) scan showed extensive increased T2 signal in the spinal cord from medulla oblongata to the first thoracic spine level. The combination treatment was used with 500mg methylprednisone and immunoglobulin (1g/kg) intravenously. On the10 days of hospitalization, the muscle strength of limbs was significantly improved. Methylprednisone was taken orally for one month (80 mg/d) and the amount of oral medications was gradually reduced, maintaining for two months after hospital discharge. After three months from hospital discharge, the patient could walk independently and had no sensory disturbances and urinary incontinence. This case highlights the rare presentation of an elderly patient with ATM which experienced acute disturbance of consciousness as the first clinical manifestation. This case also highlights that the prognosis is better under the acute ATM occurrence in the elderly if treated timely.