Use the injury-to-treatment interval to decide whether steroid therapy is still within the acute spinal cord injury window and counsel realistically about prognosis. Document the lesion level and the management step it implies.

High-dose steroids are most effective when started within three to eight hours of acute spinal cord injury; Functional motor recovery after acute spinal cord injury is limited; Anterior spinal artery infarction causes dissociated sensory loss; Autoimmune and rheumatologic disease can recur as transverse myelitis; Timing of treatment strongly influences neurologic outcome