2026 American Academy of Neurology Abstract Website

Objective:

To describe a rare case of fulminant transverse myelitis with hemorrhagic transformation following influenza B infection and to discuss diagnostic and management challenges associated with longitudinally extensive transverse myelitis (LETM).

Background:

Fulminant transverse myelitis with hemorrhagic transformation is a rare and devastating condition that can result in significant neurological morbidity, even in young and otherwise healthy individuals. Viral infections have been implicated as potential triggers; however, the underlying mechanisms are poorly understood.

Design/Methods:

Not applicable

Results:

We present a case of a previously healthy 41-year-old patient who developed rapidly progressive lower extremity paralysis and sensory loss within 24 hours following an influenza B infection. The illness was complicated by myocarditis requiring extracorporeal membrane oxygenation (ECMO). Magnetic resonance imaging of the spine, which was delayed by three days due to ECMO support, demonstrated T2 signal abnormalities extending from C5 to the conus. Subsequent imaging demonstrated hemorrhagic conversion with T1 hyperintensity within the spinal cord from level T7/T8 to T10. Cerebrospinal fluid analysis revealed minimally elevated IgG. Despite aggressive treatment with high-dose steroids, plasmapheresis, and intravenous immunoglobulin (IVIG), neurological recovery was minimal, with only trace hip movement and limited vibratory sensation six weeks from symptom onset.

Conclusions:

Although viral infections are a known trigger of hemorrhagic LETM, this patient’s etiology of paraplegia is called into question given the possibility of a spinal cord infarct related to ECMO. Given the scarcity of reported cases and interplay of potential etiologies, further research is necessary to improve diagnostic accuracy and guide more effective treatment strategies.