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Transverse myelitis

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


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
    • 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, February, 2015 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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