Transverse Myelitis in Naloxone Reversible Acute Respiratory Failure—A Case Report

Transverse myelitis (TM) is a rare inflammatory myelopathy presenting as bilateral neurologic deficit localized to the spinal cord. The patient had a witnessed loss of consciousness with initiation of immediate bystander CPR. Paramedics on scene noted apnea and cyanosis on their arrival. The patient’s combination of rapid improvement with MRI findings concerning for inflammatory process could be explained by reversible systemic hypoxia imposed on subacute, high spinal cord myelitis.

• 1
  MRI revealed increased signal throughout the spinal cord from C-1 to the conus medullaris with mild expansion consistent with transverse myelitis.
• 2
  Urine drug screening was negative including screen for opiate, tetrahydrocannabinol, phencyclidine. Of note, the drug screen performed at this facility was not sensitive for synthetic opioids such as oxycodone and fentanyl.
• 3
  The patient’s combination of rapid improvement with MRI findings concerning for inflammatory process could be explained by reversible systemic hypoxia imposed on subacute, high spinal cord myelitis.