Evaluation should consist of contrast-enhanced MRI of the entire spine Imaging of the brain is also suggested to evaluate for lesions suggestive of multiple sclerosis CSF evaluation should be obtained, including cell count and testing for oligoclonal bands Serum testing for neuromyelitis optica IgG antibodies is now recommended Presence of these antibodies can aid in determining the etiology as well as risk of recurrence Treatment of transverse myelitis is supportive, and some degree of recovery occurs in approximately 80% of cases All children with this syndrome should be hospitalized Although there are no controlled trials of their efficacy, there is a consensus supporting the use of systemic corticosteroids Currently, there is moderate evidence to support the use of plasma exchange in patients who have failed corticosteroid therapy; however, there is insufficient evidence to support the use of IV immunoglobulin Acute spinal cord compression in children is usually caused by trauma, infection, or cancer Spinal trauma may lead to contusion or concussion of the cord with hemorrhage, edema, and local mass effect, or may lead to development of a spinal epidural hematoma Mass lesions may cause damage by direct compression of spinal cord tissues or, secondarily, by interference with the tenuous arterial (or, less commonly, venous) blood flow to the spinal cord, with resultant spinal cord infarction Parenchymal injury usually presents acutely, but an epidural hematoma may develop over several days after the antecedent trauma Epidural abscess is the most common infectious cause of spinal cord compression It is usually caused by hematogenous spread of bacteria, with Staphylococcus aureus being the most common pathogen Neoplastic causes include both primary intraspinal tumors (ependymoma and astrocytoma) and extrinsic lesions such as neuroblastoma or lymphoma Traumatic and infectious spinal lesions are usually accompanied by relatively acute onset of local back pain, which is exacerbated by direct percussion of the area Pain from an infectious cause occasionally may precede other symptoms for days With tumors, however, there may be weakness in the absence of pain Patients with epidural abscess often have systemic signs of infections such as fever, headache, vomiting, and, perhaps, neck stiffness Bony tenderness in such a patient may indicate vertebral osteomyelitis or discitis, which can also present with weakness, although usually less severe than is seen with actual spinal cord involvement Diagnosis is confirmed by emergency neuroimaging, with precautions to immobilize patients with potentially unstable lesions Plain spine films are useful