Study design <p>Single case report.</p> Objective <p>We present a case of Tetraplegia due to Transverse Myelitis/ADEM with excellent rehabilitation outcome.</p> Setting <p>National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, United Kingdom.</p> Case report <p>An 8-year-old girl presented with a severe acute neurological decline, initially involving a chest infection, four-limb paralysis, and deteriorating consciousness, which required intubation and mechanical ventilation. She was diagnosed with Transverse Myelitis/Acute Disseminated Encephalomyelitis (ADEM). MRI imaging of the brain and spine revealed significant T2 signal changes in the brainstem, as well as in the cervical spine (C2–C5).</p> <p>Her rehabilitation focused on achieving independence in activities of daily living, with wheelchair assistance for mobility and support for transfer activities. This ongoing rehabilitation, conducted on both an inpatient and outpatient basis for a period of 8 years, led to remarkable progress. The patient showed significant neurological recovery, ultimately reaching an AIS-E classification, indicating complete recovery of motor and sensory function.</p> Conclusion <p>Spinal injury resulting from Transverse Myelitis can lead to widespread paralysis; however, prompt diagnosis and early specialist rehabilitation are crucial in promoting functional recovery and improving outcomes for affected individuals. The suggested “two-year” window for recovery in the adult population would appear to be extended in the paediatric population.</p>