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Practice Management/Leadership

Enhancing Patient Outcomes in Rare Myelopathies: Addressing the Psychological Impact of Diagnostic Uncertainty

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 9

    Poster Presenter(s)

  • Hannah Ong, Other

    Medical Student
    Ohio State University College of Medicine
    Columbus, Ohio

    • Co-Author(s)

  • JD

    Jerica Day, Other

    Medical Student
    The Ohio State University College of Medicine
    Columbus, Ohio

  • BB

    Brady Buchanan, MD

    Physician
    Ohio State University College of Medicine
    Columbus, Ohio

  • SG

    Salvador Gomez, MD

    Resident Physician
    Ohio State University Wexner Medical Center, The
    Columbus, Ohio

  • PD

    Philicia Duncan, MD

    Assistant Professor of Clinical Medicine
    Ohio State University Wexner Medical Center, The
    Columbus, Ohio

Disclosure(s):
Hannah Ong, Other: No financial relationships to disclose
Case Diagnosis: A previously healthy 49-year-old female diagnosed with transverse myelitis (TM) of unclear etiology, presenting with progressive lower extremity weakness and significant psychiatric morbidity impacting rehabilitation.

Case Description or Program Description: A 49-year-old woman with Hashimoto’s thyroiditis presented with a 3-week history of progressive lower extremity weakness, leading to immobility. Spinal MRI revealed enhancing lesions in the cervical cord with scattered patchy abnormalities. Despite an exhaustive diagnostic work-up, the etiology remained unclear. A presumptive diagnosis of transverse myelitis (TM) was made, and she was treated with IVIG and steroids. The protracted diagnostic journey during hospitalization resulted in profound psychological distress, including labile mood, fear, anxiety, and self-doubt. This led her to question the reality of her physical symptoms. These mental health symptoms significantly impacted her ability to participate in rehabilitation and all aspects of her care.

Setting: In-patient hospital

Assessment/Results: To combat the patient's emotional distress, the care team prioritized her psychological well-being through open communication, empathetic listening, and emotional validation. This approach not only addressed her distress but also motivated her to persevere with physical therapy and treatment despite minimal immediate improvement.

Discussion (relevance): TM is a rare neurologic syndrome that poses diagnostic difficulties. Patients often present with acute or subacute neurologic deficits, including motor, sensory, or autonomic dysfunction sparing the head and neck. While an evidence-based approach exists to identify causes, a definitive etiology is not always identified. This diagnostic uncertainty is a major stressor, and studies show approximately one-third of TM patients experience psychiatric morbidity [1]. This presents a serious barrier to rehabilitation because mental well-being is vital for engagement and success [2].

Conclusions: Patients with rare, diagnostically complex illnesses represent a population with heightened vulnerability, as physical health is deeply intertwined with mental well-being. This case highlights the impact of dedicated psychological support in fostering resilience, enhancing treatment adherence, and promoting overall well-being, thereby improving patient outcomes.