transverse myelitis


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Transverse Myelitis

 

Definition

Transverse myelitis (TM) is an uncommon neurological syndrome caused by inflammation (a protective response which includes swelling, pain, heat, and redness) of the spinal cord, characterized by weakness, back pain, and bowel and bladder problems. It affects one to five persons per million.

Description

TM affects the entire thickness of the spinal cord, producing both sensory and movement problems. It is believed to be linked to the immune system, which may be prompted to attack the body's own spinal cord. Striking rapidly without warning, its effects can be devastating.

Causes and symptoms

Transverse myelitis has many different causes, often triggered by a variety of viral and bacterial infections (especially those associated with a rash such as measles or chickenpox). Once the infection subsides, the inflammation in the cord begins. About a third of patients experience a flu-like illness with fever about the time they develop symptoms of TM. Sometimes, there appears to be a direct invasion of, and injury to, the spinal cord by an infectious agent (such as herpes zoster or the AIDS virus).
TM can also accompany a variety of diseases that break down tissue that surrounds and insulates the nerves (demyelinating diseases), such as multiple sclerosis (MS).
Some toxic substances, such as carbon monoxide, lead, or arsenic, can cause a type of myelitis characterized by inflammation followed by hemorrhage or bleeding that destroys the entire circumference of the spinal cord. Other types of myelitis can be caused by poliovirus; herpes zoster; rabies, smallpox or polio vaccination; or parasitic and fungal infections.
Many experts believe that TM can occur without any apparent cause, probably as the result of an autoimmune process. This means that a person's immune system attacks the spinal cord, causing inflammation and tissue damage.
Regardless of the cause of the myelitis, onset of symptoms is sudden and rapid. Problems with movement and sensation appear within one or two days after inflammation begins. Symptoms include soft (flaccid) paralysis of the legs, with pain in the lower legs or back, followed by loss of feeling and sphincter (muscles which close an opening, as in the anus) control. The earliest symptom may be a girdle-like sensation around the trunk.
The extent of damage occuring will depend on how much of the spinal cord is affected, but TM rarely involves the arms. Severe spinal cord damage also can lead to shock.

Diagnosis

A doctor will suspect transverse myelitis in any patient with a rapid onset of paralysis. Medical history, physical examination, brain and spinal cord scans, myelogram, spinal tap, and blood tests are used to rule out other neurological causes of symptoms, such as a tumor. If none of these tests suggest a cause for the symptoms, the patient is presumed to have transverse myelitis.

Treatment

There is no effective treatment for transverse myelitis, but any underlying infection must be treated. After this, the focus of care shifts from diagnosis and treatment to learning how to live with the effects of the syndrome. Patients are helped to cope psychologically with new limitations, and are given physical rehabilitation.
Physical adaptations include learning to cope with bowel and bladder control, sexuality, inability to control muscles (spasticity), mobility, pain, and activities of daily living (such as dressing).
As nerve impulses from the spinal cord are often scrambled and misinterpreted by the brain as pain, painkillers are given to ease discomfort. Antidepressants or anticonvulsants may also help.

Prognosis

The prognosis depends on how much of the cord was damaged. Some people recover completely, while others have lasting problems and need help in learning how to cope with activities of daily living. People who develop spastic reflexes early in the course of the condition are more likely to recover than those who do not. If spinal cord tissue death (necrosis) occurs, the chance of a complete recovery is poor. Most recovery occurs within the first three months. A certain percentage of patients with TM will go on to develop multiple sclerosis.

Resources

Organizations

Transverse Myelitis Association. 1787 Sutter Parkway, Powell, OH 43065-8806. (614) 766-1806. http://www.myelitis.org.

Key terms

Demyelinating disorders — A group of diseases characterized by the breakdown of myelin, the fatty sheath surrounding and insulating nerve fibers. This breakdown interferes with nerve function, and can result in paralysis. Multiple sclerosis is a demyelinating disorder.
Myelogram — An x-ray examination of the brain and spinal cord with the aid of a contrast dye, to look for tumors or spinal cord injury.

trans·verse my·e·li·tis

an abrupt onset inflammatory process involving almost the entire thickness of the spinal cord but of limited longitudinal extent, generally one or a few segments; of multiple etiologies, the most common being viral and post-viral causes, and multiple sclerosis.

transverse myelitis

Neurology An acute spinal cord disorder causing sudden low back pain and muscle weakness and abnormal sensory sensations in the legs; TM often remits spontaneously; severe or long-lasting cases may lead to permanent disability
References in periodicals archive ?
Recurrent transverse myelitis associates with anti-Ro (SSA) autoantibodies.
This paper reports the gait rehabilitation of a patient with acute transverse myelitis. Although recovery was good, and the speed with which it occurred may have been as a result of spontaneous recovery, the functional approach to rehabilitation presented in the paper may have facilitated the recovery process.
Out of 100 patients, 32 patients had thrombocytopenia, 9 patients had arthralgia/arthritis, 7 patients had AKI, 5 patients had pancreatitis, 4 patients had rash, acute transverse myelitis and thrombocytosis for one patient each.
Moreover, the consistent time course of the disease, lack of an alternative diagnosis, and similarity to other clinical courses suggest CSD-associated transverse myelitis (2).
She was admitted two weeks ago with enterovirus and pneumonia which then developed into Transverse Myelitis.
Transverse myelitis is caused by a respiratory virus and is more common in people with weak immune system, like diabetics, the elderly, those with autoimmune diseases or HIV, Reyes explained.
To the best of our knowledge, in the literature, there is another case of NBD with longitudinally extensive transverse myelitis who achieved marked clinical improvements after treatment with intravenous and oral steroids followed by six months of pulsed intravenous cyclophosphamide.
The success of the Glaswegian, who contracted Transverse Myelitis - a disease affecting the spinal cord - aged 13, has not gone unnoticed, with the Murray family taking particular interest.
It has been a horrendous year for former teaching assistant Emma, who was diagnosed with transverse myelitis in July last year.
Owen, who lives with mum Rosie, dad Dave and older brother Kyle, 21, has a rare neurological disorder, Transverse Myelitis, in which the immune system attacks the spinal cord.
Lauren, who is coached by Job King, took up wheelchair racing two years ago after contracting transverse myelitis, a rare neurological condition.

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