Transverse Myelitis
Definition
· Inflammatory disorders of the spinal cord
· Working group definition for idiopathic TM:
o Sensory, motor, or autonomic dysfunction attributable to the spinal cord
o Bilateral signs and/or symptoms (not necessarily symmetric), clearly defined sensory level
o Exclusion of other forms of demyelinating disease (e.g. no cerebral lesions suggestive of MS, consider: infectious and autoimmunity serum tests, evoked potentials, etc.)
o Spinal cord inflammation demonstrated by CSF pleocytosis or elevated IgG index or gadolinium-enhanced MRI
o
Progression to nadir between 4 h and 21 days
Epidemiology
· Age – bimodal peaks 10-19yrs and 30-39yrs
·
Sex – 80% women
Incidence:
· Idiopathic/postinfectious
o Severe - 1/million/year
o Mild - 8/million/year
· All (including MS)
o 24/million/year
Aetiology
Clinical
Diagnosis
Treatment
References
Infectious
Myelitis
|
Etiologies |
Clues
to Diagnosis |
Diagnostic
Tests |
|
Viruses DNA
Viruses Herpesviruses Cytomegalovirus Epstein-Barr
virus Herpes
simplex types 1 and 2 Human
herpes virus-6 Varicella
zoster virus RNA
Viruses Picornaviruses Coxsackieviruses A and
B Echoviruses Enteroviruses 70
and 71 Hepatitis
Aand C Polioviruses Orthomyxoviruses Influenza
A and B Paramyxoviruses Measles Mumps Parainfluenza
virus Flaviviruses West
Nile virus Japanese
encephalitis virus St.
Louis encephalitis virus Tick-borne
encephalitis virus Dengue
virus Retroviruses Human
immunodeficiency virus-1 (HIV) Human
T-lymphotrophic virus type 1 (HTLV-1) Bacteria Mycoplasma
pneumoniae Chlamydia |
Meningoencephalitic
symptoms Fever Meningismus Encephalopathy/confusion Current
systemic infection Immunocompromised
status Underlying
disease (e.g., malignancy; HIV/AIDS) Immunosuppressive
medications Rash Vesicles,
dermatomal (Herpes zoster) Vesicles,
buccal/hands/feet (Enterovirus
71) Erythema
chronicum migrans (B. burgdorferi) Macules/petechiae ankles/wrists (R. rickettsii) Other
systemic features of infection Pharyngitis
(Epstein-Barr virus) Lymphadenopathy
(several viruses) Other
historical clues Residence/travel
history (parasites) Tick
exposure (Lyme disease, Rocky Mountain spotted
fever) HIV
risk factors Sexually
transmitted disease history |
Chest
radiography and other body imaging as indicated CSF
Investigations For
viruses: Antibodies
and PCR: HSV-2,
VZV, EBV, CMV, HHV-6, HSV-1 Antibody
(IgM) for West Nile virus Antibody
for HTLV-1 Viral
culture For
bacteria: Gram’s
stain and bacterial culture Venereal
Disease Research Laboratory (VDRL) test for syphilis Antibodies
and PCR: B. burgdorferi R. rickettsii For
mycobacteria; Acid-fast
bacilli smear Mycobacterial
culture For
fungi and parasites India
ink smear Fungal
culture Blood
Investigations For
viruses Serology
for HSV-2, VZV, HIV-1, HTLV-1, hepatitis A, B, C For
bacteria Blood
cultures Serology
for Mycoplasma For
rickettsia Serology
and PCR for B. burgdoferi Serology
for R. rickettsii |