Transverse myelitis

Transverse myelitis is an inflammatory disorder affecting the spinal cord, resulting in varying degrees of muscle weakness, sensory disturbances, and autonomic dysfunction. The condition can be caused by various factors, including infections, autoimmune diseases, vaccinations, and spinal cord injuries.

Transverse Myelitis

Signs and symptoms

The symptoms of transverse myelitis can vary greatly between individuals and may develop rapidly over hours to days or more gradually over weeks. Symptoms include:

Transverse myelitis MRI

• Muscle weakness or paralysis
• Numbness or tingling
• Pain, often in the back or extremities
• Bowel and bladder dysfunction
• Muscle spasms
• Sensitivity to touch or temperature

Causes

The exact cause of transverse myelitis is often unknown, but potential causes include:

• Infections: Bacterial, viral, or parasitic infections can trigger an immune response leading to transverse myelitis.
• Autoimmune diseases: Conditions such as multiple sclerosis, neuromyelitis optica spectrum disorder, and systemic lupus erythematosus can cause transverse myelitis.
• Vaccinations: In rare cases, transverse myelitis may develop following vaccination.
• Vascular disorders: Disorders affecting blood vessels in the spinal cord may contribute to the development of transverse myelitis.
• Spinal cord injuries: Physical trauma to the spinal cord can cause localized inflammation and damage.

Diagnosis

The diagnosis of transverse myelitis involves several tests, including:

• Magnetic resonance imaging (MRI): This imaging technique is used to visualize the spinal cord and identify areas of inflammation.
• Lumbar puncture: A sample of cerebrospinal fluid is collected to check for abnormalities, such as elevated protein levels or the presence of immune cells.
• Blood tests: These are performed to rule out other potential causes, such as infections or autoimmune diseases.

Treatment

Recovery from TM varies among individuals and also depends on the underlying cause. Some patients start to recover between weeks 2 and 12 after onset and may continue to improve for up to two years. However, other patients may never show signs of recovery. If treated early, some patients experience complete or near-complete recovery. Treatment options also vary according to the underlying cause. One treatment option includes plasmapheresis.

Prognosis

The prognosis for TM depends on whether there is improvement within 3 to 6 months. Complete recovery is not likely if no improvement occurs within this time. Incomplete recovery can still happen; however, aggressive physical therapy and rehabilitation are crucial. One-third of people with TM experience full recovery, one-third experience fair recovery but have significant neurological deficits, such as spastic gait, and the final third experience no recovery at all.

Epidemiology

The incidence of TM is 4.6 in 1 million, affecting men and women equally. TM can occur at any age, but there are peaks around age 10, age 20, and after age 40.

History

Henry Charlton Bastian

The earliest reports describing the signs and symptoms of transverse myelitis were published in 1882 and 1910 by the English neurologist Henry Bastian.

In 1928, Frank Ford noted that in mumps patients who developed acute myelitis, symptoms only emerged after the mumps infection and associated symptoms began to recede. In an article in The Lancet, Ford suggested that acute myelitis could be a post-infection syndrome in most cases (i.e., a result of the body's immune response attacking and damaging the spinal cord) rather than an infectious disease where a virus or some other infectious agent caused paralysis.

Ford's theory of an allergic response being at the root of the disease was later shown to be only partially correct, as some infectious agents such as mycoplasma, measles, and rubella were isolated from the spinal fluid of some infected patients, suggesting that direct infection could contribute to the manifestation of acute myelitis in certain cases.

In 1948, Dr. Suchett-Kaye described a patient with rapidly progressing impairment of lower extremity motor function that developed as a complication of pneumonia. In his description, he coined the term transverse myelitis to reflect the band-like thoracic area of altered sensation that patients reported. The term 'acute transverse myelopathy' has since emerged as an acceptable synonym for 'transverse myelitis', and the two terms are currently used interchangeably in the literature.

See also

• Acute disseminated encephalomyelitis

Transverse myelitis Resources
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