[MCQ] Transverse Myelitis

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Transverse Myelitis

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Question 1

Which of the following does not relate well with transverse myelitis ?

A	Inflammatory disorder
B	Acute
C	Subacute
D	Chronic

Question 1 Explanation:

Transverse myelitis is a heterogeneous group of acute or subacute inflammatory disorders with motor, sensory and autonomic (bladder, bowel, and sexual) spinal cord dysfunction.

Question 2

Transverse myelitis syndrome “most often” occurs due to ?

A	Autoimmune phenomenon after infection or vaccination
B	Direct infection
C	Underlying systemic autoimmune disease
D	Acquired demyelinating disease

Question 2 Explanation:

Transverse myelitis syndrome most often occurs as an autoimmune phenomenon after an infection or vaccination or as a result of a direct infection, an underlying systemic autoimmune disease, acquired demyelinating disease (multiple sclerosis) or idiopathic (15 - 30%)

Question 3

In transverse myelitis, most of the recovery occurs over ?

A	First 3 months after the event
B	First 6 months after the event
C	First 12 months after the event
D	First 18 months after the event

Question 3 Explanation:

Most of the recovery in transverse myelitis cases occurs in the first 3 months after the event. Although, improvement may continue for a year or longer.

Question 4

Pathological hallmark of transverse myelitis within the spinal cord is ?

A	Focal collections of neutrophils
B	Focal collections of lymphocytes & monocytes
C	Focal collections of eosinophils
D	Focal collections of basophils

Question 4 Explanation:

In spinal cord, pathological hallmark of transverse myelitis is the presence of focal collections of lymphocytes and monocytes, with varying degrees of demyelination, axonal injury and astroglial and microglial activation.

Question 5

Prognosis in transverse myelitis associated with multiple sclerosis is ?

A	Good
B	Bad
C	Worse
D	Worst

Question 5 Explanation:

Transverse myelitis associated with multiple sclerosis may have a substantial or even complete recovery. Transverse myelitis or neuromyelitis optica associated with other diseases usually have clinically significant residual neurologic deficits.

Question 6

“Spinal shock” consists of all except ?

A	Areflexia
B	Sensory loss
C	Severe weakness
D	Hypotonia

Question 6 Explanation:

“Spinal shock” refers to a combination of severe weakness, hypotonia and areflexia. It is the only recognized predictor of a poor outcome in transverse myelitis.

Question 7

Which of the following best distinguishes myelopathy from cerebral lesions and peripheral neuropathies ?

A	Seizure
B	Sensory level
C	Babinski signs
D	Course of illness

Question 7 Explanation:

A well-defined truncal sensory level, below which the sensation of pain & temperature is altered or lost, distinguishes myelopathy from cerebral lesions & peripheral neuropathies

Question 8

Which of the following is responsible for the Lhermitte’s sign in transverse myelitis ?

A	Demyelination
B	Axonal injury
C	Astroglial activation
D	Microglial activation

Question 8 Explanation:

Demyelination is responsible for the Lhermitte’s sign that refers to the paresthesias that radiate down the spine or limbs with neck flexion. Demyelination is responsible for the paroxysmal tonic spasms i.e.involuntary dystonic contractions of limb or trunk muscles.

Question 9

Which of the following is false about idiopathic transverse myelitis ?

A	No cerebrospinal fluid abnormalities
B	No MRI abnormalities
C	No identifiable underlying cause
D	None of the above

Question 9 Explanation:

Patients with possible idiopathic transverse myelitis have clinical events consistent with transverse myelitis but that are not associated with cerebrospinal fluid abnormalities or abnormalities detected on MRI and that have no identifiable underlying cause.

Question 10

Presentation in transverse myelitis include ?

A	Sensory spinal cord dysfunction
B	Motor spinal cord dysfunction
C	Autonomic spinal cord dysfunction
D	All of the above

Question 10 Explanation:

Diagnostic criteria for transverse myelitis include bilateral (not necessarily symmetric) sensorimotor and autonomic spinal cord dysfunction.

Question 11

In transverse myelitis, clinical deficits progress to nadir between ?

A	4 hours and 7 days after symptom onset
B	4 hours and 14 days after symptom onset
C	4 hours and 21 days after symptom onset
D	4 hours and 28 days after symptom onset

Question 11 Explanation:

Progression to nadir of clinical deficits between 4 hours and 21 days after symptom onset is characteristic of transverse myelitis.

Question 12

Which of the following is true for MRI findings characteristic of myelitis ?

A	More than one intrinsic cord lesions
B	Intrinsic cord lesions span at least two vertebral segments
C	Lesions enhance with intravenous gadolinium
D	All of the above

Question 12 Explanation:

MRI finding of more than one intrinsic cord lesion is characteristic of myelitis. In acute phase, lesions enhance with intravenous gadolinium administration. Lesions in idiopathic transverse myelitis usually span at least two vertebral segments. Normal MRI should prompt a reconsideration of the diagnosis of myelopathy in favor of other disorders of the central or peripheral nervous system.

Question 13

Serum autoantibodies like antinuclear antibody or extractable nuclear antigen are present in ?

A	Multiple sclerosis
B	Neuromyelitis optica
C	Systemic lupus erythematosus
D	All of the above

Question 13 Explanation:

Serum autoantibodies like antinuclear antibody or extractable nuclear antigen may be present in patients with multiple sclerosis or neuromyelitis optica, systemic lupus erythematosus.

Question 14

MRI findings in multiple sclerosis include ?

A	Short lesions spanning less than two vertebral segments
B	Lesions located in the periphery of the cord
C	Concomitant MRI evidence of demyelinating brain lesions
D	All of the above

Question 14 Explanation:

Multiple sclerosis is associated with short lesions, spanning fewer than two vertebral segments, located in the periphery of the cord, affecting mainly white matter (“partial” transverse myelitis), and concomitant MRI evidence of demyelinating brain lesions.

Question 15

Serum autoantibody marker NMO-IgG targets ?

A	Beta2GPI
B	aCL
C	Astrocytic water channel, aquaporin-4
D	Anti-LKM3

Question 15 Explanation:

Neuromyelitis optica is specifically associated with the serum autoantibody marker NMO-IgG, which targets the astrocytic water channel, aquaporin-4.

Question 16

Which of the following is not a monophasic syndrome ?

A	Postinfectious transverse myelitis
B	Postvaccination transverse myelitis
C	Idiopathic transverse myelitis
D	Multiple sclerosis

Question 16 Explanation:

Postinfectious, postvaccination and idiopathic forms of transverse myelitis are usually monophasic syndromes, whereas multiple sclerosis and neuromyelitis optica.spectrum disorders are relapsing diseases that are associated with a high risk of future attacks of transverse myelitis and other neurologic events.

Question 17

What happens to the IgG index in transverse myelitis ?

A	Normal
B	Decreased
C	Increased
D	Any of the above

Question 17 Explanation:

IgG index is a measure of intrathecal synthesis of immunoglobulin and is calculated by the following formula - (CSF IgG ÷ serum IgG) ÷ (CSF albumin ÷ serum albumin).

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See all quizzes of Transverse Myelitis here:

1.Which of the following does not relate well with transverse myelitis ?
A. Inflammatory disorder
B. Acute
C. Subacute
D. Chronic

2. Transverse myelitis syndrome “most often” occurs due to ?
A. Autoimmune phenomenon after infection or vaccination
B. Direct infection
C. Underlying systemic autoimmune disease
D. Acquired demyelinating disease

3. In transverse myelitis, most of the recovery occurs over ?
A. First 3 months after the event
B. First 6 months after the event
C. First 12 months after the event
D. First 18 months after the event

4. Pathological hallmark of transverse myelitis within the spinal
cord is ?
A. Focal collections of neutrophils
B. Focal collections of lymphocytes & monocytes
C. Focal collections of eosinophils
D. Focal collections of basophils

5. Prognosis in transverse myelitis associated with multiple sclerosis
is ?
A. Good
B. Bad
C. Worse
D. Worst

7. “Spinal shock” consists of all except ?
A. Areflexia
B. Sensory loss
C. Severe weakness
D. Hypotonia

9. Which of the following best distinguishes myelopathy from cerebral
lesions and peripheral neuropathies ?
A. Seizure
B. Sensory level
C. Babinski signs
D. Course of illness

10. Which of the following is responsible for the Lhermitte’s sign in
transverse myelitis ?
A. Demyelination
B. Axonal injury
C. Astroglial activation
D. Microglial activation

11. Which of the following is false about idiopathic transverse myelitis ?
A. No cerebrospinal fluid abnormalities
B. No MRI abnormalities
C. No identifiable underlying cause
D. None of the above

12. Presentation in transverse myelitis include ?
A. Sensory spinal cord dysfunction
B. Motor spinal cord dysfunction
C. Autonomic spinal cord dysfunction
D. All of the above

13. In transverse myelitis, clinical deficits progress to nadir between
?
A. 4 hours and 7 days after symptom onset
B. 4 hours and 14 days after symptom onset
C. 4 hours and 21 days after symptom onset
D. 4 hours and 28 days after symptom onset

14. Which of the following is true for MRI findings characteristic of
myelitis ?
A. More than one intrinsic cord lesions
B. Intrinsic cord lesions span at least two vertebral segments
C. Lesions enhance with intravenous gadolinium
D. All of the above

15. Serum autoantibodies like antinuclear antibody or extractable
nuclear antigen are present in ?
A. Multiple sclerosis
B. Neuromyelitis optica
C. Systemic lupus erythematosus
D. All of the above

16. MRI findings in multiple sclerosis include ?
A. Short lesions spanning less than two vertebral segments
B. Lesions located in the periphery of the cord
C. Concomitant MRI evidence of demyelinating brain lesions
D. All of the above

17. MRI findings in Neuromyelitis optica include ?
A. Longitudinally extensive lesions spanning three or more
vertebral segments
B. Symmetric lesions
C. Lesions situated centrally within the cord
D. All of the above

18. Serum autoantibody marker NMO-IgG targets ?
A. Beta2GPI
B. aCL
C. Astrocytic water channel, aquaporin-4
D. Anti-LKM3

19. Which of the following is not a monophasic syndrome ?
A. Postinfectious transverse myelitis
B. Postvaccination transverse myelitis
C. Idiopathic transverse myelitis
D. Multiple sclerosis

20. What happens to the IgG index in transverse myelitis ?
A. Normal
B. Decreased
C. Increased
D. Any of the above

[MCQ] Transverse Myelitis

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Transverse Myelitis

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