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Abstract Details

Clinical Criteria To Distinguish Vascular Myelopathy from Transverse Myelitis
MS and Related Diseases
P02 - (-)
117
BACKGROUND: Inflammatory and vascular myelopathies can be difficult to distinguish as they often present with similar clinical and neuroimaging features. After reviewing 400 cases referred to the Johns Hopkins Transverse Myelitis Center (JHTMC) from 2010 to 2012, we excluded those with identifiable myelopathies to focus on the presentation of idiopathic inflammatory and vascular myelopathies.
DESIGN/METHODS: We developed a set of criteria that calculated vascular and inflammatory scores based on MRI and cerebrospinal fluid (CSF) data, vascular risk factors, clinical profile, and response to acute treatment in a set of patients previously diagnosed with idiopathic TM. Patients were included if they had MRI, CSF, and clinical data for review. Patients were excluded if their diagnosis was less likely an idiopathic inflammatory myelopathy or vascular myelopathy. The above criteria were used to produce five versions of a weighted scale, which were applied to 50 patients who fulfilled inclusion/exclusion criteria. Three independent neuroimmunologists from the JHTMC evaluated records of patients to determine if they came to a consensus regarding the diagnosis. Disagreements in diagnoses between raters were discussed by the entire clinical faculty of the JHTMC, where consensus diagnoses were established. The consensus diagnoses were compared to the inflammatory and vascular scores to refine the most accurate scoring system.
RESULTS: The scoring criteria that most accurately captured the expert opinions have been refined for best fit to distinguish the diagnosis of inflammatory versus vascular myelopathy. Preliminary data indicates high inter-rater reliability.
CONCLUSIONS: A classification scale that includes clinical as well as MRI and CSF data may provide a better clinical tool to determine the likelihood of a diagnosis of inflammatory vs. vascular myelopathies. These criteria will be tested prospectively to confirm validity on a larger number of patients.
Authors/Disclosures
Maureen A. Mealy, PhD, RN
PRESENTER 		No disclosure on file
No disclosure on file
Philippe Gailloud, MD (The Johns Hopkins Hospital) Dr. Gailloud has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cerenovus. Dr. Gailloud has received stock or an ownership interest from ArtVentive. The institution of Dr. Gailloud has received research support from Siemens Medical.
Fred D. Lublin, MD, FAAN (Icahn School of Medicine At Mount Sinai) Dr. Lublin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche/Genentech. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurogene. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Lublin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medimmune/Viela Bio/Horizon. Dr. Lublin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Receptos/Celgene/BMS. Dr. Lublin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunic. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Labcorp. Dr. Lublin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuralight. Dr. Lublin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Entelexo. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Lublin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avotres. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Lublin has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Lublin has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for EMD Serono. Dr. Lublin has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for Multiple entities. Dr. Lublin has stock in Avotres. Dr. Lublin has stock in Neuralight. The institution of Dr. Lublin has received research support from Brainstorm. The institution of Dr. Lublin has received research support from biogen. The institution of Dr. Lublin has received research support from NIH.
Daniel Becker, MD (International Neurorehabilitation Institute, Johns Hopkins Hospital) Dr. Becker has nothing to disclose.
Scott D. Newsome, DO, FAAN (Johns Hopkins Hospital) Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Newsome has received research support from Biogen. The institution of Dr. Newsome has received research support from Genentech/Roche. The institution of Dr. Newsome has received research support from Department of Defense. The institution of Dr. Newsome has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Newsome has received research support from National MS Society. The institution of Dr. Newsome has received research support from Lundbeck. The institution of Dr. Newsome has received research support from Sanofi. The institution of Dr. Newsome has received research support from Kyverna Therapeutics. Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving as a Lead PI for Clinical Trial with Roche.
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School) Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.
Carlos A. Pardo-Villamizar, MD (Johns Hopkins U, Med Dept of Neurology) The institution of Dr. Pardo-Villamizar has received research support from National Institutes of Health. The institution of Dr. Pardo-Villamizar has received research support from Bart McLean Fund for Neuroimmunology Research .