Transverse Myelitis
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
Clinical features:
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.
Treatment:
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
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