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| {{Transverse myelitis}} | | {{Transverse myelitis}} |
| {{CMG}} | | {{CMG}} |
| ==Overview== | | ==[[Transverse myelitis overview|Overview]]== |
| '''Transverse myelitis''' is a [[neurological]] disorder caused by an inflammatory process of the grey and white matter of the spinal cord, and can cause axonal demyelination.
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| This demyelination arises [[idiopathic]]ally following [[infection]]s or [[vaccination]], or due to [[multiple sclerosis]].
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| One major theory of the cause is that an immune-mediated inflammation is present as the result of exposure to a [[virus|viral]] [[antigen]].
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| The lesions are [[inflammation|inflammatory]], and involve the [[spinal cord]] on both sides.
| | ==[[Transverse myelitis pathophysiology|Pathophysiology]]== |
| With acute transverse myelitis, the onset is sudden and progresses rapidly in hours and days.
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| The lesions can be present anywhere in the spinal cord, though it is usually restricted to only a small portion.
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| In some cases, the disease is presumedly caused by viral infections or vaccinations and has also been associated with spinal cord injuries, immune reactions, [[schistosomiasis]] and insufficient blood flow through spinal cord vessels. Symptoms include weakness and numbness of the limbs as well as motor, sensory, and sphincter deficits. Severe backpain may occur in some patients at the onset of the disease. Treatment is usually symptomatic only, corticosteroids being used with limited success. A major differentiation or distinction to be made is a similar condition due to compression of the spinal cord in the spinal canal, due to disease of the surrounding vertebral column.
| | ==[[Transverse myelitis causes|Causes]]== |
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| == Detailed description of transverse myelitis pathology == | | ==[[Transverse myelitis differential diagnosis|Differentiating Transverse myelitis from other Diseases]]== |
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| The [[symptom]]s and signs depend upon the level of the spinal cord involved and the extent of the involvement of the various [[long tracts]]. In some cases, there is almost total [[paralysis]] and sensory loss below the level of the lesion. In other cases, such loss is only partial.
| | ==[[Transverse myelitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| If the high [[cervical]] area is involved, all four limbs may be involved and there is risk of [[respiratory paralysis]] (segments C3,4,5 to diaphragm). Lesions of the lower cervical (C2-T1) region will cause a combination of upper and lower motor neuron signs in the upper limbs, and exclusively upper motor neuron signs in the lower limbs. A lesion of the [[thoracic spinal cord]] (T1-12) will produce a [[spastic paraplegia]]. A lesion of the lower part of the [[spinal cord]] (L1-S5) often produces a combination of upper and lower motor neuron signs in the lower limbs.
| | ==[[Transverse myelitis risk factors|Risk Factors]]== |
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| The degree and type of sensory loss will depend upon the extent of the involvement of the various sensory tracts, but there is often a "sensory level" (at the [[sensory segmental level]] of the spinal cord below which sensation to pin or light touch is impaired). This has proven to be a reasonably reliable sign of the level of the lesion. [[Bladder paralysis]] often occurs and urinary retention is an early manifestation. Considerable pain often occurs in the back, extending laterally to involve the sensory distribution of the diseased spinal segments—so-called "radicular pain." Thus, a lesion at the T8 level will produce pain radiating from the spine laterally along the lower [[costal margins]]. These signs and symptoms may progress to severe weakness within hours. (Because of the acuteness of this lesion, signs of [[spinal shock]] may be evident, in which the lower limbs will be flaccid and areflexic, rather than spastic and hyperreflexic as they should be in [[upper motor neuron paralysis]].
| | ==[[Transverse myelitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| | | ==Diagnosis== |
| However, within several days, this spinal shock will disappear and signs of [[spasticity]] will become evident. The three main conditions to be considered in the differential diagnosis are: acute [[spinal cord trauma]], acute [[compressive lesion]]s of the spinal cord such as [[epidural metastatic tumour]], and [[infarction]] of the spinal cord, usually due to insufficiency of the [[anterior spinal artery]].
| | [[Transverse myelitis history and symptoms| History and Symptoms]] | [[Transverse myelitis physical examination | Physical Examination]] | [[Transverse myelitis laboratory findings|Laboratory Findings]] | [[Transverse myelitis x ray|X Ray]] | [[Transverse myelitis CT|CT]] | [[Transverse myelitis MRI|MRI]] | [[Transverse myelitis other diagnostic studies|Other Diagnostic Studies]] |
| | | ==Treatment== |
| From the symptoms and signs, it may be very difficult to distinguish acute transverse myelitis from these conditions and it is almost invariably necessary to perform an emergency [[magnetic resonance imaging]] (MRI) scan or computerised tomographic ([[Computed tomography|CT]]) myelogram. Before doing this, routine [[x-ray]]s are taken of the entire spine, mainly to detect signs of [[metastatic]] disease of the vertebrae, that would imply direct extension into the [[epidural]] space and compression of the spinal cord. Often, such bony lesions are absent and it is only the MRI or CT that discloses the presence or absence of a compressive lesion.
| | [[Transverse myelitis medical therapy|Medical Therapy]] | [[Transverse myelitis primary prevention|Primary Prevention]] | [[Transverse myelitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Transverse myelitis future or investigational therapies|Future or Investigational Therapies]] |
| | | ==Case Studies== |
| A family physician seeing such a patient for the first time should immediately arrange transfer to the care of a [[neurologist]] or [[neurosurgeon]] who can urgently investigate the patient in hospital. Before arranging this transfer, the physician should be certain that [[Respiration (physiology)|respiration]] is not affected, particularly in high spinal cord lesions. If there is any evidence of this, methods of [[respiratory assistance]] must be on hand before and during the transfer procedure. The patient should also be [[catheter]]ized to test for and, if necessary, drain an over-distended bladder. A [[lumbar puncture]] can be performed after the MRI or at the time of CT myelography. [[Steroid]]s are often given in high dose at the onset, in hope that the degree of [[inflammation]] and swelling of the cord will be lessened, but whether this is truly effective is still debated.
| | [[Transverse myelitis case study one|Case #1]] |
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| Unfortunately, the prognosis for significant recovery from acute transverse myelitis is poor in approximately 80% of the cases; that is, significant long-term disabilities will remain. Approximately 5% of these patients will, in later months or years, show lesions in other parts of the central nervous system, indicating, in retrospect, that this was a first attack of multiple sclerosis.
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| {{Fact|date=April 2007}}
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| ==Prognosis== | |
| Prognosis for complete recovery is generally poor. Recovery from transverse myelitis usually begins between weeks 2 and 12 following onset and may continue for up to 2 years in some patients, many of whom are left with considerable disabilities. Some patients show no signs of recovery whatsoever.<ref>http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm</ref>
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| == References ==
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| {{reflist|2}}
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| == External links == | | == External links == |