Transverse myelitis: quick hits

25 Jul

BASICS

segmental spinal cord injury caused by acute inflammation

RARE (1-5 cases per million)

Most are idiopathic, presumably result from an autoimmune process

up to half have a preceding infection

can also occur in multiple sclerosis (MS) and can be the presenting demyelinating event

also associated with connective tissue diseases (e.g. lupus, Sjogren’s, scleroderma, RA, etc).

 

inflammation of TM is generally restricted to one or two segments, usually in the thoracic cord.

 

SYMPTOMS:

Symptoms typically develop rapidly over several hours (~37 percent worsen maximally within 24 hours)

Typically bilateral, producing weakness and sensory disturbance below the level

 

In addition to diminished sensation, pain and tingling are common and frequently include a tight banding or girdle-like sensation around the trunk, which may be very sensitive to touch.

Back and radicular pain are also common.

Bowel and bladder dysfunction, reflective of autonomic involvement, also occur.

 

Diagnosis:

MRI

Cerebrospinal fluid (CSF)

  • elevated protein level (usually 100 to 120 mg/100 mL)
  • moderate lymphocytosis (usually <100 /mm3).
  • Glucose levels are normal.
  • Oligoclonal bands are usually not present in isolated TM, and when present suggest a higher risk of subsequent MS.

 

TREATMENT OPTIONS:

often treated with corticosteroids, though there is limited evidence

other immunosuppressive drugs

 

Most patients have at least a partial recovery, after 1-3 months

Some degree of persistent disability is common (~ 40%)

Significant recovery is unlikely if there is no improvement by three months.

a small percentage may suffer a recurrence.

 

Submitted by J. Stanton.

 

References: uptodate.com; picture

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