Remarks about “a pediatric patient of hemorrhagic acute transverse myelitis”

We have read with significant interest the case report ‘‘A pediatric patient of hemorrhagic acute transverse myelitis”, by Fukuoka and colleagues, concerning the presence of spinal hemorrhage in cases of transverse acute myelitis [1]. This situation is rare and knowing it is useful for clinical practice. The paper by Fukuoka and colleagues shows the usefulness of instrumental and laboratory findings to guide the diagnostic process. Clinical evaluation is essential for diagnosis, treatment and rehabilitation but the association with the other examinations often is a necessary support, especially in atypical cases. A multidimensional evaluation of patients, like described by the authors, is essential, even when the symptoms and signs are mainly neurologic. The case especially shows the high importance of objective evaluations, with parameter quantifications, limitedly possible with the use of the sole clinical exam. With this approach, reduction of diagnostic mistakes may be possible, with timesaving and correct treatment planning. Considering the clinical picture of the presented patient, we would like to suggest the application of additional instrumental evaluations in similar cases. In particular, muscle weakness is investigable by electromyography and, associated with the use of ultrasound, it may help the distinction between central and peripheral neurological dysfunction. Nerve ultrasound is able to evaluate dimensions and morphological alterations of nerves [2]. Another relevant clinical problem of the case was walking difficulty. The use of computed motion analysis provides objective and reliable results for gait assessment and ground reaction platforms permits the evaluation of the forces interacting during gait [3]. Finally, specific instruments should be used for autonomic dysfunctions, like the use of sudomotor tests [4]. The application of the listed (and other) tests is not only important to demonstrate with objective methods what we can suppose by an exclusive clinical evaluation