When should I consider referring a patient with transverse myelitis to a specialist for further evaluation?

You should consider referring a patient with suspected transverse myelitis to a specialist for further evaluation, particularly a consultant neurologist or a specialist under their supervision, if you suspect a neurological condition such as multiple sclerosis (MS) ⁵.

Immediate or Urgent Referral Criteria:

• Refer immediately adults with rapidly (within 4 weeks) progressive symmetrical limb weakness for neurological assessment and assessment of bulbar and respiratory function ⁶.
• Refer immediately if there is breathlessness at rest or when lying flat ⁶.
• Refer urgently if there is any evidence of swallowing impairment ⁶.
• Contact the consultant neurologist directly if you think a person needs to be seen urgently ⁵.
• If there is a neurological abnormality attributable to spinal cord injury, perform MRI after CT ⁷. For confirmed spinal cord injury, the trauma team leader should immediately contact the specialist neurosurgical or spinal surgeon on call ⁷.
• For people with a spinal cord injury, ensure ongoing contact with the regional specialist spinal cord injury centre and refer using the national spinal injuries database within 24 hours of diagnosis ⁸.

Other Referral Considerations:

• Before referring a person suspected of having MS, confirm that this is a neurological episode by taking a history, undertaking a physical examination, and excluding alternative, more common diagnoses ⁵.
• Seek specialist advice if spinal cord injury affects areas of physical function including bowel, bladder, and sexual function ⁸.