Transverse myelitis

Question 1

What is transverse myelitis?

Answer 1

Inflammation of the spinal-cord – caused by the immune system becoming autoreactive and attacking the myelin in the spine

Transverse: inflammation across a total horizontal section of the spinal cord

Myelitis: inflammation of myelin

Most common = inflammation in thoracic region

Question 2

What causes transverse myelitis?

Answer 2

Unknown calls in many cases, can occur following a viral infection but often occurs with no warning or precipitating event

Infectious causes: EBV, CMV

Vaccines: transverse myelitis has been reported with almost all vaccines

Paraneoplastic syndromes

Question 3

Signs and symptoms of transverse myelitis

Answer 3

Symptoms occur quickly, depends on where the inflammation has occurred

Lower back: weakness of both legs, bowel and bladder problems

Upper back: arm and leg weakness, can affect breathing in severe cases

Usually a well-defined sensory level

Question 4

Investigation of transverse myelitis

Answer 4

Lumbar puncture: increased WCC

MRI: inflammation

Question 5

Management of transverse myelitis

Answer 5

Early steroid treatment can reduce symptoms and stop new symptoms from developing

If steroids show no improvement intravenous Ig can be given – a.k.a. plasma exchange

Question 6

Prognosis of transverse myelitis

Answer 6

Varies greatly, some recover totally, some are left with motor weakness and bowel and bladder dysfunction