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Transverse Myelitis Overview

Transverse myelitis is a neurological disorder caused by inflammation across both sides of one segment of the spinal cord, resulting in demyelination. It can affect both adults and children and has no single known cause, with potential etiologies including viral or bacterial infection, autoimmune conditions, neoplasms, toxins, and idiopathic cases. Symptoms vary depending on the level of injury but commonly include leg weakness, sensory changes, and urinary/bowel dysfunction. Diagnosis involves MRI, CSF analysis, and ruling out other conditions. Treatment focuses on underlying causes and corticosteroids, with prognosis varying from full to no recovery.

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391 views19 pages

Transverse Myelitis Overview

Transverse myelitis is a neurological disorder caused by inflammation across both sides of one segment of the spinal cord, resulting in demyelination. It can affect both adults and children and has no single known cause, with potential etiologies including viral or bacterial infection, autoimmune conditions, neoplasms, toxins, and idiopathic cases. Symptoms vary depending on the level of injury but commonly include leg weakness, sensory changes, and urinary/bowel dysfunction. Diagnosis involves MRI, CSF analysis, and ruling out other conditions. Treatment focuses on underlying causes and corticosteroids, with prognosis varying from full to no recovery.

Uploaded by

Anonymous YHQmN8a01
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We take content rights seriously. If you suspect this is your content, claim it here.
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TRANSVERSE

MYELITIS
TERMS

• MYELITIS Spinal cord


• NEURITIS Axon
• RADICULITIS Root
• POLIOMYELITIS Gray matter
• LEUKOMYELITIS White matter
• TRANSVERSE MYELITIS Whole cross sectional
• MENINGOMYELITIS Meninges & spinal cord
• MENINGORADICULITIS Meningeal & root
• PACHYMENINGITIS Spinal dura
• EPIDURAL SPINAL ABSCESS Epidural space
• GRANULOMA Subdural space
DEFINITION

• Neurological disorder caused by inflammation


affects gray and white matter across both sides
of one level, or segment, of the spinal cord
• a demyelinating (loss of the fatty tissue around the nerves)
disorder of the spinal cord.
• a clinical syndrome , Not a true disease
• Also called acute transverse myelopathy
EPIDEMIOLOGY

• Adults and children (peak 10-19 years and 30-39 years)


• Both genders, all races
• Is not inherited
• Incidence : UK 300, US 1400
SITE OF ENTRY
• Respiratory tract
• Gastrointestinal tract : poliovirus
• Subcutaneous tissue
• Peripheral nerves
-antegrade
-retrograde transport : rabies, polio

PREDILECTION
• Thoracic cord
• Cervical cord
ETIOLOGY

• INFECTION : - Viral, Bacterial, Fungal, Parasitic,

• AUTOIMMUNE :
- PERIINFECTION (Measles, varicella, rabies, typhoid)
- POSTINFECTION
- POSTVACCINAL (Rubella, Diphteria, Polio)
• MULTIPLE SCLEROSIS
• NEOPLASTIC (paracarcinomatosis necrosis)
• TOXIC (secondary to heroin inj.)
• VASCULAR (Vascular insufficiency)
• DEGENERATIVE (irradiation)
• IDIOPATHIC
INFECTIONS
HERPES ENTEROVIRUS RETROVIRUS
EBV Coxsackie HTLV -I and II
VCV Echovirus HIV
CMV Hepatitis
HSV Rubella OTHERS
HHV6 Measles Influenza
Herpes B Mumps West Nile
Polio Rabies

BACTERIA FUNGAL PARASITIC


Lyme Cryptococcal Schistosomiasis
Mycoplasma Toxoplasmosis
Yersinia Cysticercosis
Catscratch Toxocariasis
Syphilis Gnathostoma
Tuberculosis Angiostrongyllus
• EBV : mononucleosis, prognosis good
• VZV : reactivation of shingles
• CMV : immunocompromise (AIDS)
• HSV : aggressive with necrosis of spinal cord
associated with encephalopathy
• HHV6 : rare, relation to multiple sclerosis
• Herpes B : expossure to monkey
SYMPTOMS & SIGNS

• Acute (hours yo several days)


• Subacute (over 1-2 weeks)
• Chronic ( > 6 weeks)

• Leg weakness
• Sensory level disturbance (ascending paresthesia)
• Urinary bladder & bowel dysfunction
• Back pain (interscapular region)
PATHOLOGY

• Necrosis of the cord (center)


• Posterior nerve root
• Posterior root ganglion
DIAGNOSIS

• Imaging (MRI) : - negative


- mild swelling of the cord
• Myelography ± subarachnoid block
• CSF : - elevation protein
- pleocytosis (monocytes)
• Elevated IgG level
• Causa : - PCR : proteins of viral DNA
- serology
- culture CSF
DIFFERENTIAL DIAGNOSIS

• GUILLAIN-BARRE SYNDROME
• ANTERIOR SPINAL ARTERY OCLUSION
• ACUTE CORD COMPRESSION
• EPIDURAL ABSCESS, HEMATOMA
• TUMOR
• ACUTE MENINGOVASCULAR SYPHILIS
• MYCOPLASMAL INFECTION
• MULTIPLE SCLEROSIS
TREATMENT

• No efective cure
• Depend on underlying cause (infection, connect. tissue)

• MS, idiopathic, postvaccinial, post infection :


- Methylprednisolone, 250-500 mg/12 hours, 3-7 days, follow
- Prednison oral, 60-80 mg/day, 7 days
tapp. 10mg/ 4days
- Dexamethasone : 10mg iv, follow 6 x 4-6mg/days

• Physiotherapy
PROGNOSIS

• Recovery :
2-12 weeks  good
3-6 months  poor

• 1/3 full recovery : walk normally, minimal paresthesia


1/3 fair recovery : spastic gait, sensory dysf, incontinence
1/3 no recovery : wellchair - bedridden

• Majority only one episode


some (MS, SLE) recover than relapse

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