Transverse myelitis

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Background

  • Inflammatory disorder that involves a complete transverse section of the spinal cord
    • Results from viral infection (30% of cases), postvaccination or as part of MS, SLE, or cancer
  • May present exactly like a compressive lesion of the spinal cord
  • Usually thoracic origin, rarely cervical spine

Clinical Features

  • May progress over days-weeks
  • Neck or back pain + neuro complaints:
    • Bilateral motor, sensory, and autonomic disturbances
    • Fecal/urinary retention and incontinence

Differential Diagnosis

Weakness

Lower Back Pain

Evaluation

  • Neurologic findings that are consistent with epidural compression but normal MRI

Management

  • Must rule-out compressive lesion of the cord
  • MRI
    • May show cord swelling
  • LP
    • Contains monocytes, protein content is slightly increased, and IgG index is elevated[1]
  • Foley for bladder decompression
  • Consider work up for clotting disorder for spinal artery thrombosis, drug user, risk for aortic dissection
  • Admit for corticosteroids and plasma exchange
  • The more rapid the progression is, the worse the prognosis

References

  1. http://www.merckmanuals.com/professional/neurologic_disorders/spinal_cord_disorders/acute_transverse_myelitis.html
  • Perron AD, Huff JS. “Spinal Cord Disorders,” in Rosen’s Emergency Medicine Concepts and Clinical Practice, edited by Marx JA, Hockberger RS, Walls RM, et al., 1389-1395. Philadelphia: Mosby, 2010.