Idiopathic acute transverse myelitis in a middle-aged woman with progression to nadir in less than one hour

We report a case of a middle-aged woman, normally fit and well, presenting with acute onset neurological deficit with progression to nadir in <1 hour. Initial MRI spine showed no significant abnormality, although second MRI spine showed abnormal signal in three to four segments with no compressive lesion. CT aortic angiography excluded vascular or ischaemic abnormality. We made a diagnosis of idiopathic acute transverse myelitis (ATM). She was treated with steroids and made significant progress improving from T11 ASIA A paraplegia to T11 ASIA C paraplegia by the time of discharge. Awareness of idiopathic ATM presenting hyperacutely with initial MRI spine being normal is important for prompt diagnosis and management.