Transverse Myelitis

Pathophysiology:

 • Excessive activation of an immune response against the spinal cord that results in inflammation and tissue damage.

 • Idiopathic- etiology unknown

 • Infectious- Direct microbial infection versus molecular mimicry or super-antigen mediated disease.

Clinical Presentation:

 • Injury to the spinal cord with varying degrees of: weakness, sensory alterations, autonomic dysfunction

 • Sensory features: paresthesias ascending from feet with or without back pain at/near level of myelitis

 • Weakness that preferentially affects the flexors of the legs and the extensors of the arms (pyramidal distribution of weakness)

 • Autonomic: Bowel/ Bladder dysfunction, temperature dysfunction, bouts of HTN

Diagnostic Criteria:

 • Sensory, motor or autonomic dysfunction located at the spinal cord

 • T2 hyperintense signal change on spinal MRI

 • No evidence of compressive cord lesion

 • Bilateral signs and/or symptoms

 • Clearly defined sensory level

 • CSF inflammation- CSF pleocytosis, elevated IgG index

 • Progression hours to days

Treatment:

 • Steroids

 • Plasma exchange

 • Immunomodulatory agents:lVlG

 • Cyclophosphamide



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