Absent F-waves early in a case of transverse myelitis

Abstract

A 29-year-old female presented with acute onset of interscapular pain, followed by weakness of both legs and both hands, and a thoracic sensory level. F-waves in her legs and arms were absent initially, but other conduction studies were normal. An initial spine MRI was normal but a second study 10 days later revealed an enlarged spinal cord with areas of enhancement. Repeat neurophysiologic studies showed return of F-waves in the legs and absent compound muscle action potential (CMAP) in the hands with early denervation on needle examination. An acute intraxial lesion needs to be included in the differential diagnosis of absent F-waves.