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Epidemiology
- Depends on aetiology
- Idiopathic or postinfectious transverse myelitis:
- 1.3-8 cases per million per year
- Age: bimodal peak at 10-19 years and 30-39 years but may occur at any
age
- If acquired demyelinating causes are included incidence increases to
24.6 per million per year
Aetiology
- Viral infection eg herpes simplex, CMV, varicella zoster, HIV, syphilis,
Lyme disease
- Systemic autoimmune or connective tissue disease eg SLE, Sjogren's
syndrome
- Post-infectious or post vaccination eg acute disseminated
encephalomyelitis
- Acquired demyelinating disease eg multiple sclerosis, neuromyelitis
optica (Devic's disease)
Clinical features
- motor weakness
- sensory abnormalities referable to spinal cord
- sensory level usually present
- bladder or bowel disfunction
- typically evolves orver hours to days and reaches a nadir within 3 weeks
- neuropathic pain
- aching, deep pain in midline or
- dermatomal pain
- radicular or lancinating or sensation of burning or itching
- gives clue to anatomical level of lesion
- 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
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
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