Acute transverse myelitis

Acute transverse myelitis is an acute inflammation of the gray and white matter of one or more adjacent segments, usually the thoracic segments. Causes include postinfectious inflammation, multiple sclerosis, autoimmune inflammation, vasculitis, and drug effects. Diagnosis is based on MRI data, CSF, and blood tests. In the early stages of this inflammatory neurological disease, intravenous glucocorticoids and plasma transfusions help. Symptomatic treatment of acute transverse myelitis and correction of the cause of the lesion are performed.

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Causes acute transverse myelitis

Acute transverse myelitis may complicate vasculitis, multiple sclerosis, mycoplasma infection, Lyme disease, syphilis, tuberculous or viral meningoencephalitis, amphetamine use, intravenous heroin use, antiparasitic or antifungal drugs. The mechanism is often unknown. Sometimes the disease develops after a viral infection or vaccination, which suggests an autoimmune reaction. The inflammation diffusely involves the spinal cord at one or more levels, affecting all spinal functions.

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Symptoms acute transverse myelitis

Neck, back, or headaches may occur. Within hours or days, a feeling of encircling stiffness at the level of the chest or abdomen, weakness, tingling, numbness of the feet and shins, and dysfunction of the pelvic organs develop. Within a few days, the symptoms worsen with the development of complete transverse myelopathy with paraplegia, loss of sensitivity below the level of the lesion, urinary retention, and fecal incontinence. Vibration sensitivity and joint-muscle sensation sometimes persist (more often in the initial stages). The syndrome may complicate multiple sclerosis, systemic lupus erythematosus, and antiphospholipid syndrome. In 10-20% of cases, the cause of which is not established, multiple sclerosis subsequently develops.

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Diagnostics acute transverse myelitis

Diagnosis is based on the presence of transverse sensorimotor myelopathy with segmental deficits. Localization to a specific spinal cord segment is not typical for Guillain-Barré syndrome. Diagnosis requires MRI and CSF analysis. MRI typically shows spinal cord edema and helps exclude other potentially treatable causes of spinal dysfunction (eg, compression). CSF analysis shows monocytes, decreased protein levels, and increased IgG (normal <0.85).

To exclude other potential causes, chest X-ray, tuberculin test, serology for mycoplasma infection, Lyme disease and HIV, vitamin B12 and folate levels, ESR, antinuclear antibodies, VDRL for syphilis, blood and CSF tests are performed _. It is necessary to ask about the medications used. An MRI of the brain should be performed: if multiple foci of periventricular leukomalacia are detected on the T2 _- weighted image, then multiple sclerosis will develop in 50% of cases, and if not, then in 5%.

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Treatment acute transverse myelitis

Treatment is determined by the cause or underlying disease, otherwise it is symptomatic. When the cause is unclear and autoimmune mechanisms may be involved, high doses of glucocorticoids are prescribed, sometimes accompanied by plasma exchange transfusion. The effectiveness of such therapy has not been proven.

Forecast

In general, the more acute the progression, the worse the prognosis. Pain suggests more severe inflammation. Recovery occurs in about 1/3 of cases, some weakness and frequent urination persist in 1/3, and the patient remains bedridden with persistent urinary and fecal incontinence in 1/3.

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