Acute transverse myelitis

Acute transverse myelitis is an acute inflammation of the gray and white matter of one or more adjacent segments, usually of the thoracic. Among the causes are postinfectious inflammation, multiple sclerosis, autoimmune inflammation, vasculitis and the effect of medications. The diagnosis is based on MRI, CSF and blood tests. In the early stages of this inflammatory neurological disease, intravenous glucocorticoids and plasma transfusion help. Conduct symptomatic treatment of acute transverse myelitis and correction of the cause of the lesion.

[1], [2], [3], [4],

Causes of the acute transverse myelitis

Acute transverse myelitis may complicate vasculitis, multiple sclerosis, mycoplasma infection, Lyme disease, syphilis, tuberculosis or viral meningoencephalitis, the use of amphetamine, heroin intravenously, the use of antiparasitic or antifungal agents. The mechanism is often unknown. Sometimes the disease develops after a viral infection or vaccination, which suggests an autoimmune reaction. Inflammation diffusely involves the spinal cord on one or more levels, hitting all the spinal functions.

[5], [6], [7], [8], [9]

Symptoms of the acute transverse myelitis

There may be pain in the neck, back, or headaches. During the hours or days, a feeling of shingling on the level of the chest or abdomen develops, weakness, tingling, numbness of the feet and shins, impairment of the functions of the pelvic organs. For several days, the symptomatology is aggravated with the development of complete transverse myelopathy with paraplegia, loss of sensitivity below the level of lesion, urinary retention and incontinence. Sometimes vibration sensitivity and joint-muscular feeling remain (more often - in the initial stages). The syndrome can complicate multiple sclerosis, systemic lupus erythematosus and antiphospholipid syndrome. In 10-20% of cases, the cause of which is not established, later develops multiple sclerosis.

[10]

Diagnostics of the acute transverse myelitis

The diagnosis is based on the presence of transverse sensorimotor myelopathy with segmental deficiency. For Guillain-Barre syndrome, the localization in some particular segment of the spinal cord is uncharacteristic. The diagnosis requires MRI and CSF analysis. Typically, the MRI can see the swelling of the spinal cord, in addition, it helps to exclude other potentially curable causes of spinal dysfunction (for example, compression). In the CSF analysis, monocytes, a decrease in protein level and an increase in IgG (normal <0.85).

To exclude other potential causes, chest radiography, tuberculin test, serological test for mycoplasma infection, Lyme disease and HIV, vitamin B ₁₂  and folate levels , ESR, antinuclear antibodies, VDRL for syphilis, blood tests and CSF are performed. It is necessary to ask about the drugs used. MRI of the brain should be performed: if multiple foci of periventricular leukomalacia are detected on a T ₂ -weighted image, multiple sclerosis will develop in 50% of cases, and if not, in 5%.

[11], [12]

Treatment of the acute transverse myelitis

Treatment determines the cause or underlying disease, otherwise it is symptomatic. When the cause is unclear and the involvement of autoimmune mechanisms is possible, glucocorticoids are administered in high doses, which is sometimes accompanied by an exchange transfusion of plasma. The effectiveness of such therapy has not been proven.

Forecast

In general, the more acute the progression, the worse the prognosis. Pain suggests a more pronounced inflammation. Approximately in 1/3 of cases, recovery occurs, in 1/3 some weakness and frequent urination persist, in 1/3 the patient remains bedridden with persistent incontinence of urine and feces.

[13]