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Transverse myelitis

 
Gale Encyclopedia of Cancer:

Transverse Myelitis

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Key Terms: Autoimmune disease, Catheter, Infectious disease, Spinal cord, Spinal cord compression.

Description

Transverse myelitis (TM) is an inflammation or infection of the spinal cord in which the effect of the lesion spans the width of the entire spinal cord at a given level. The spinal cord consists of four regions: the cervical (neck), followed by the thoracic (chest), the lumbar (lower back) and the sacral (lowest back). TM can occur in any of these regions. The disease is uncommon, but not rare, as it occurs in one to five persons per million population in any given year in the United States. It is equally diagnosed in both adults and children. TM may occur by itself or in conjunction with other illnesses such as viral or bacterial infectious diseases, autoimmune diseases such as multiple sclerosis, vascular illnesses such as thrombosis, and cancer.

The symptoms of TM depend on the level of spinal cord lesion with sensation usually diminished below the spinal cord level affected. Some patients experience tingling sensations or numbness in the legs with bladder control also being disturbed. The condition is usually diagnosed following magnetic resonance imaging (MRI) or computed tomography (CT) with "spinal taps" (lumbar punctures) taken for additional analysis. Recovery depends on the general health status of the patient and is usually considered unlikely if no improvement is observed within three months.

Causes

The exact cause of TM is unknown but research results point to autoimmune deficiencies, meaning that the patient's own immune system abnormally attacks the spinal cord, resulting in inflammation and tissue damage.

There is also evidence suggesting that TM occurs as a result of spinal cord compression by tumors or as a result of direct spinal cord invasion by infectious agents, especially the human immunodeficiency virus (HIV) and the human T-lymphotropic virus type I (HTLV-1).

TM is also listed among the spinal cord disorders occurring in patients diagnosed with AIDS.

Treatments

There is no specific treatment for transverse myelitis. Treatment of the illness is largely symptomatic, meaning that it depends on the specific symptoms of the patient. The region in which the spinal cord has been infected is critical but a course of intravenous steroids is generally prescribed at the onset of treatment.

Treatment of the bladder function impairment resulting from TM include drugs, external catheters for men and padding for women, with surgery recommended in certain cases. A common TM side effect is difficulty with stool evacuation and this condition can be treated by diets that include stool softeners and fiber.

As a result of TM, muscle groups below the affected level may become spastic. Treatment of spasticity usually involves prescriptions of drugs such as Baclofen (Lioresal), which stops reflex activity, and Dantrolene sodium (Dantrium) which acts directly on muscle. A new very well-tolerated drug, Tizanidine, has also recently been introduced in the United States. Muscle pain is generally treated with analgesics such as acetaminophen (Tylenol) or ibuprofen (Naprosyn, Aleve, Motrin). Nerve disorders might be treated with anticonvulsant drugs such as carbamazepine, phenytoin or gabapentin (Tegretol, Dilantin, Neurontin).

Alternative and Complementary Therapies

Individuals with TM may experience serious difficulty with common tasks such as dressing, bathing and eating. Complementary TM therapies may accordingly include a course of physical therapy so as to help patients recover mobility. This can be achieved with special exercises, canes, walkers and custom-designed braces.

After the acute phase, people with TM start the rehabilitation process. During this period, the focus of care is shifted from designing an effective TM treatment to learning to cope with a serious disease. TM patients must learn to cope with the loss of abilities which healthy people take for granted and this process is necessarily harder if TM is associated with AIDS or another serious autoimmune disease. Resources that may help this required adjustment are psychological assistance from counselors, relatives and friends, and making contact with TM support groups. The Transverse Myelitis Association may also be contacted: 3548 Tahoma Pl. West, Tacoma, WA 98466-2141 (info@myelitis.org; www.myelitis.org) Phone:253-565-8156.

Resources

Books

Beers, M.H., and R. Berkow, editors. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Organizations

National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health. NIH Neurological Institute. P.O. Box 5801, Bethesda, MD 20824. (800) 352-9424. .

Transverse Myelitis Association. 3548 Tahoma Pl. West, Tacoma, WA 98466-2141. (253) 565-8156. .

—Monique Laberge, Ph.D.

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Transverse myelitis

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Home > Library > Miscellaneous > Wikipedia
Transverse myelitis
Classification and external resources

An MRI showing lesion of Transverse myelitis (the lesion is the lighter, oval shape at center-right), this MRI was taken 3 months after patient recovered
ICD-10 G37.3
ICD-9 323.82, 341.2
DiseasesDB 13265
MeSH D009188

Transverse myelitis (in Latin nomenclature: myelitis transversa) is a neurological disorder caused by an inflammatory process of the spinal cord, and can cause axonal demyelination. The name is derived from Greek myelón referring to the "spinal cord", and the suffix -itis, which denotes inflammation.[1] Transverse implies that the inflammation is across the thickness of the spinal cord.

Contents

Presentation

This demyelination arises idiopathically following infections or vaccination,[2] or due to multiple sclerosis. One major theory posits that immune-mediated inflammation is present as the result of exposure to a viral antigen.

The lesions are inflammatory, and involve the spinal cord typically on both sides. With acute transverse myelitis, the onset is sudden and progresses rapidly in hours and days. The lesions can be present anywhere in the spinal cord, though they are usually restricted to only a small portion.

Causes

Transverse myelitis can appear for several reasons. Sometimes the disorders classified as such can be referred to as "Transverse myelitis spectrum disorders"[3]

In some cases, the disease is presumed to be caused by viral infections such as cytomegalovirus (CMV) and has also been associated with spinal cord injuries, immune reactions, schistosomiasis and insufficient blood flow through spinal cord vessels. Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis.[4]

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.

Another possible cause is dissection of the Aorta, extending into one or more of the spinal arteries.

Transverse myelitis can be a rare complication following cat scratch disease.[5]

Prognosis

Recovery from transverse myelitis usually begins between weeks 2 and 12 following onset and may continue for up to 2 years in some patients. Some patients may never show signs of recovery.[6] However, if treated early, some patients experience complete or near complete recovery.

Treatment is usually symptomatic only, corticosteroids being used with limited success.

Signs and symptoms

Symptoms include weakness and numbness of the limbs as well as motor, sensory, and sphincter deficits. Severe back pain may occur in some patients at the onset of the disease. The symptoms 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.

  • If the upper cervical cord 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 (C5-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 upper motor neuron signs in the lower limbs, presenting as a spastic diplegia.
  • 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.

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.

Some patients have also described the feeling of their abdominal area being in a binder.

However, within several days, this spinal shock will disappear and signs of spasticity will become evident.

Differential diagnosis

The three main conditions to be considered in the differential diagnosis are: acute spinal cord trauma, acute compressive lesions of the spinal cord such as epidural metastatic tumour, and infarction of the spinal cord, usually due to insufficiency of the anterior spinal artery. Lyme disease serology is indicated in patients with transverse myelitis keeping in mind that dissociation in Lyme antibody titers between the blood and the CSF is possible.[7]

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 (CT) myelogram. Before doing this, routine x-rays 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.

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 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 catheterized 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. Steroids 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.

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. [8]

Notable cases

See also

References

  1. ^ Chamberlin SL, Narins B, ed. (2005). The Gale Encyclopedia of Neurological Disorders. Detroit: Thomson Gale. pp. 1859–70. ISBN 0-7876-9150-X. 
  2. ^ Akkad W, Salem B, Freeman JW, Huntington MK (August 2010). "Longitudinally extensive transverse myelitis following vaccination with nasal attenuated novel influenza A(H1N1) vaccine". Arch. Neurol. 67 (8): 1018–20. doi:10.1001/archneurol.2010.167. PMID 20697056. http://archneur.ama-assn.org/cgi/pmidlookup?view=long&pmid=20697056. 
  3. ^ Pandit L. Transverse myelitis spectrum disorders, Neurol India. 2009 Mar-Apr;57(2):126-33. PMID 19439840
  4. ^ Blanc F, Froelich S, Vuillemet F, et al. (November 2007). "[Acute myelitis and Lyme disease"] (in French). Rev. Neurol. (Paris) 163 (11): 1039–47. PMID 18033042. http://www.masson.fr/masson/MDOI-RN-11-2007-163-11-0035-3787-101019-200703533. 
  5. ^ Dr Thomas Stuttaford; Cat nipped;Body And Mind; The Times; 26 August 1993
  6. ^ About one third of patients do not recover at all: These patients are often wheelchair-bound or bedridden with marked dependence on others for basic functions of daily living. Transverse Myelitis Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)
  7. ^ Walid MS, Ajjan M, Ulm AJ (2008). "Subacute transverse myelitis with Lyme profile dissociation". Ger Med Sci 6: Doc04. PMC 2703261. PMID 19675732. http://www.egms.de/en/gms/2008-6/000049.shtml. 
  8. ^ Jeffery DR, Mandler RN, Davis LE (May 1993). "Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events". Arch. Neurol. 50 (5): 532–5. PMID 8489410. http://archneur.ama-assn.org/cgi/pmidlookup?view=long&pmid=8489410. 
  9. ^ "Greg Ball Profile". Australian Paralympic Committee. 2008. Archived from the original on 17 September 2008. http://pandora.nla.gov.au/pan/87762/20080917-1447/www.paralympic.org.au/AthleteProfile1b32.html. Retrieved 25 January 2012. 
  10. ^ Breitrose, Charlie (July 3, 2008). "She is among the elite". Natick Bulletin and Tab. http://www.wickedlocal.com/natick/archive/x415952841/She-is-among-the-elite. Retrieved 2008-10-16. 
  11. ^ BBC — Radio 4 — Today at 50:50th Birthday — Stephen Morris
  12. ^ "Tiger JK’s English interview". 16 August 2009. http://www.allkpop.com/2009/08/tiger_jks_english_interview. Retrieved 19 June 2011. 
  13. ^ [Interview]http://americanmusicchannel.com/features/comversation_corner/4-24-2009/conversation-corner-hal-ketchum by American Music Channel: 04-24-09
  14. ^ Daily Mail, 14 August 1998, I know I'm mean: I refused to let my wife have a new dustbin
  15. ^ Sham, Brad (2008-07-28). "Former Center Rafferty Battling Disease". DallasCowboys.com. http://www.dallascowboys.com/news/news.cfm?id=6C51445D-C4C6-8B2B-408CC6D5AD8F144B. Retrieved 2008-11-01. 
  16. ^ California Literary Review
  17. ^ "Venter tackles his biggest challenge". International Rugby Board. 29 June 2007. http://www.irb.com/newsmedia/features/newsid=278103.html. Retrieved 19 June 2011. "A veteran of 66 Tests for South Africa, Venter's life changed dramatically last year when he contracted the rare disease Transverse Myelitis, an inflammation of the spinal cord that affects between one and five people in every million." 
  18. ^ Cody Unser First Step Foundation. Retrieved 2010-07-24.

External links
Inflammation
Both/either
Brain/
encephalopathy
Episodic/
paroxysmal
Other
Spinal cord/
myelopathy
Both/either
Endocrine
Hematological
Neurological
Musculoskeletal
Mucocutaneous

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

 
 

 

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