Inflammatory condition/syndrome over several spinal segments of white and grey matter of spinal cord – can occur at any level, but most commonly in thoracic region. Onset can be at any age, but peaks at 10-19 years and >40 years. M=F.
Can be primary (up to 40%; believed to be abnormal activation of immune system) or secondary from a complication of other diseases – multiple sclerosis; vasculitis; viral (coxsackie, herpes zoster, Epstein-Barr); postinfectious (chickenpox, measles, postvaccination smallpox); SLE
Most start with a flu like illness; back pain; weakness and parathesias in legs – usually begins as numbness, tingling or ‘pins and needles’ in toes; generalised discomfort. Dramatic with flaccid paraplegia – develops over a few hours to a few days. Tendon reflexes initially depressed, later hyperactive. Bladder control is almost always eventually affected. Sensory changes below level of lesion, but proprioception and vibration often not affected.
Prognosis for recovery is usually good – can be partial or complete. Corticosteroids (usually high dose IV); bed rest; prevent ulcers and infection; physiotherapy; management of bladder and bowel function; baclofen for spasticity