Objective: To investigate the differential diagnosis of pediatric myelopathy at a specialized myelitis center. Background: Transverse myelitis (TM) is often clinically indistinguishable from other myelopathies. The differentiation between inflammatory (IM) and non-inflammatory myelopathies (NIM) in children is important for proper treatment and prognosis. Design/Methods: Retrospective review of 43 patients Results: Median age was 11 years [IQR 4–15] with a male/female ratio of 1. Clinical, laboratory and imaging findings were consistent with IM in 29 patients (infectious [n=10], idiopathic [n=5], neuromyelitis-optica-spectrum-disorder [NMOSD] [n=2], clinical-isolated-syndrome [n=1], other-inflammatory [n=11]) and NIM in 11 patients (SC ischemia [n=9], metabolic [n=2]). In 3 patients, the etiology was unclear. Most patients achieved their neurological nadir in 5cells/ul) in 24/29 (83%) and elevated protein (>45mg/dl) in 16/29 (55%) patients. In contrast, NIM patients did not have CSF-pleocytosis and only 2/10 (20%) had elevated protein. Overall, SC-MRI lesions were predominantly longitudinally-extensive (n=37/43, 86%), affecting primarily the cervicothoracic-SC. Twelve (28%) cases had SC-enhancing lesions of which 9 presented with IM. 35/43 (81%) patients had received treatment with intravenous steroids. Twelve (28%) patients had complete recovery. NMOSD cases presented as relapsing disease. Conclusions: A third of the cases referred with diagnosis of TM were NIM. A hyperacute temporal profile ( Study Supported by: This research is supported by the Bart McLean Fund for Neuroimmunology Research and the Johns Hopkins Project Restore. Disclosure: Dr. Munoz-Arcos has nothing to disclose. Dr Gordon-Lipkin has nothing to disclose. Dr. Barreras has nothing to disclose. Dr. Castaneda-Valderrama has nothing to disclose. Dr. Mealy has nothing to disclose. Dr. Piedra has nothing to disclose. Dr. Murphy has nothing to disclose. Dr. Levy has nothing to disclose. Dr. Becker has nothing to disclose. Dr. Newsome has nothing to disclose. Dr. Pardo-Villamizar has nothing to disclose.