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Transverse myelitis
Up ADEM Brain abscess Brain death Cerebral oedema Cerebral tumours CIPNM CVT CVA Coma Cord compression Encephalitis Guillain Barre syn. ICH Meningitis Myasthenia gravis Periodic paralysis Nerve lesions SAH Status epilepticus Subdural empyema SjO2 Tick paralysis Transverse myelitis Weakness

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Epidemiology

  • more common in adults than in children

Aetiology

2 main groups

  • postinfectious inflammatory demyelinating myelopathies
  • viral infection

Clinical features

  • pain at site of lesion followed by:
  • leg weakness
    • progressive
    • clinical picture of spinal shock (rare in acute cord lesions due to multiple sclerosis)
  • sensory symptoms
  • sphincter involvement
    • usually difficulty in emptying bladder (cf difficulty in filling bladder seen in multiple sclerosis)

Investigations

  • CSF
    • moderate increase in mononuclear cells (more than in multiple sclerosis but less than in acute necrotizing myelitis)
    • raised protein. May be oligoclonal bands on electrophoresis
    • normal glucose
  • Radiology
    • swelling of spinal cord

Diagnosis

Diagnostic criteria for acute transverse myelitis

  • acute disturbance of motor function and continence
  • maximal disturbance within 4 weeks of onset
  • bilateral segmental sensory loss
  • absence of medullary compression or systemic (extraneural) disease
  • consistent MRI and neurophysiological findings
 

©Charles Gomersall, May, 2008 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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