Evidence map›Paper›PMID 29196574›Full record

ArticleNeurology2018

Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy.

Paula Barreras, Kathryn C Fitzgerald, Maureen A Mealy, Jorge A Jimenez, Daniel Becker, Scott D Newsome, Michael Levy, Philippe Gailloud, Carlos A Pardo

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 2 pooled it
5.2field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 2 syntheses or guidelines pooled it, 103 citations in OpenAlex.

  1. Thrombolysis in spinal cord infarction: Case report and systematic review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Pooled it
  2. Pooled it
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  6. Observational
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  8. A case report of acute idiopathic longitudinal extensive transverse myelitis.Turkish journal of physical medicine and rehabilitation · 2025
    Article
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  15. Immune-Mediated Myelopathies.Continuum (Minneapolis, Minn.) · 2024
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Paula BarrerasFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Kathryn C FitzgeraldFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Maureen A MealyFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Jorge A JimenezFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Daniel BeckerFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Scott D NewsomeFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Michael LevyFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Philippe GailloudFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD.
Carlos A PardoFrom the Department of Neurology (P.B., K.C.F., M.A.M., D.B., S.D.N., M.L., C.A.P.) and Division of Interventional Neuroradiology (P.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Universidad de Antioquia (J.A.J.); Neuroclinica (J.A.J.), Medellin, Colombia; and International Neurorehabilitation Institute (D.B.), Lutherville, MD. cpardov1@jhmi.edu.
Instituto Neurológico de Colombia · COUniversidad de Antioquia · CO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the predictive value of the initial clinical and paraclinical features in the differentiation of inflammatory myelopathies from other causes of myelopathy in patients with initial diagnosis of transverse myelitis (TM).

methodsWe analyzed the clinical presentation, spinal cord MRI, and CSF features in a cohort of 457 patients referred to a specialized myelopathy center with the presumptive diagnosis of TM. After evaluation, the myelopathies were classified as inflammatory, ischemic/stroke, arteriovenous malformations/fistulas, spondylotic, or other. A multivariable logistic regression model was used to determine characteristics associated with the final diagnosis and predictors that would improve classification accuracy.

resultsOut of 457 patients referred as TM, only 247 (54%) were confirmed as inflammatory; the remaining 46% were diagnosed as vascular (20%), spondylotic (8%), or other myelopathy (18%). Our predictive model identified the temporal profile of symptom presentation (hyperacute <6 hours, acute 6-48 hours, subacute 48 hours-21 days, chronic >21 days), initial motor examination, and MRI lesion distribution as characteristics that improve the correct classification rate of myelopathies from 67% to 87% (multinomial area under the curve increased from 0.32 to 0.67), compared to only considering CSF pleocytosis and MRI gadolinium enhancement. Of all predictors, the temporal profile of symptoms contributed the most to the increased discriminatory power.

conclusionsThe temporal profile of symptoms serves as a clinical biomarker in the differential diagnosis of TM. The establishment of a definite diagnosis in TM requires a critical analysis of the MRI and CSF characteristics to rule out non-inflammatory causes of myelopathy. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients presenting with myelopathy, temporal profile of symptoms, initial motor examination, and MRI lesion distribution distinguish those with inflammatory myelopathies from those with other causes of myelopathy.

Indexed as

AdultAgedBiomarkersCohort StudiesDiagnosis, DifferentialDisease ProgressionFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedMyelitis, TransverseNeurologic ExaminationRetrospective StudiesSpinal CordSpinal Cord DiseasesBiomarkers

Identifiers

PMID29196574
PMCPMC5754646
OpenAlexW2772130406

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.