To identify factors that predict the final diagnosis of clinical phenotype after an initial attack of transverse myelitis (TM).

This is a retrospective analysis of patients presenting to University Hospitals Cleveland Medical Center after an initial, isolated attack of TM. Final clinical phenotypes were: idiopathic TM, multiple sclerosis (MS) or high risk clinically isolated syndrome (CIS), positive AQP-4 or double seronegative neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), or secondary TM (e.g. neurosarcoidosis, SLE). Demographic, clinical, radiologic, and laboratorial data were collected and analyzed. Categorical variables were compared using Pearson χ2 or Fisher's exact test, and continuous variables were compared using independent t-test.

One hundred and fifteen patients met the inclusion criteria. The final phenotypes were MS (10, 8.6%), idiopathic TM (59, 51.3%), MOGAD (10, 8.6%) AQP-4 positive NMOSD (13,11.3%), seronegative NMOSD (9, 7.8%), and secondary TM (14, 12.1%). African American race, comorbid autoimmune diseases, longitudinally extensive transverse myelitis (LETM), paraplegia, steroids unresponsiveness and the need for plasmapheresis were associated with NMOSD, white race, short segment myelitis and isolated sensory symptoms were associated with MS, LETM, steroid responsiveness was associated with MOGAD.

A careful evaluation of patient demographics, clinical response, radiologic and laboratory data, and exam findings may all play a role in predicting the final clinical phenotype after an initial TM presentation. Utilizing early predictors in clinical practice could better inform prognosis and management decisions.