Transverse myelitis

Transverse Myelitis

Transverse myelitis is a rare neurological condition caused by inflammation of the spinal cord. The inflammation typically occurs across a section of the spinal cord, affecting both sides of the body at the level of the inflammation. This condition can damage the spinal cord, leading to various physical and neurological symptoms depending on the location and extent of the inflammation.

Causes

Transverse myelitis can be caused by several factors, including:

1. Autoimmune Responses:
   • The immune system mistakenly attacks the spinal cord, leading to inflammation. This can be associated with autoimmune diseases like multiple sclerosis (MS), neuromyelitis optica (NMO), or systemic lupus erythematosus (SLE).
2. Infections:
   • Viral infections, such as herpes simplex, varicella-zoster virus, influenza, HIV, cytomegalovirus, or hepatitis, can trigger transverse myelitis.
   • Bacterial infections or parasitic infections can also cause spinal cord inflammation.
3. Vaccinations:
   • In rare cases, transverse myelitis has been reported following vaccination, but this is extremely uncommon.
4. Inflammatory Disorders:
   • Certain inflammatory conditions, like sarcoidosis or Behçet’s disease, can cause transverse myelitis.
5. Trauma:
   • Injury to the spinal cord or surgery can occasionally result in transverse myelitis.
6. Unknown Causes (Idiopathic):
   • In many cases, the exact cause of transverse myelitis is never determined, and it may occur without any identifiable trigger.

Symptoms

The symptoms of transverse myelitis can develop rapidly, often within hours or days. The severity of symptoms depends on the location of the inflammation and the level of the spinal cord affected. Common symptoms include:

1. Motor Symptoms:
   • Weakness or paralysis of the limbs, often affecting both sides of the body (depending on where the inflammation occurs in the spinal cord).
   • Muscle spasms or stiffness.
2. Sensory Symptoms:
   • Pain or a burning sensation in the back, arms, legs, or chest.
   • Numbness or tingling (paresthesia) in the limbs, torso, or face.
   • Loss of sensation below the level of the inflammation.
3. Autonomic Dysfunction:
   • Bladder and bowel problems, such as incontinence or difficulty urinating.
   • Sexual dysfunction in some cases.
4. Other Symptoms:
   • Fatigue, fever, and general malaise.
   • Difficulty walking or balancing.
   • Spinal cord-related pain, which can be sharp or stabbing.

The symptoms typically begin suddenly and worsen rapidly. In severe cases, transverse myelitis can lead to complete paralysis or long-term disability.

Diagnosis

The diagnosis of transverse myelitis involves a combination of clinical evaluation, imaging studies, and laboratory tests:

1. Medical History and Physical Examination:
   • The doctor will ask about the onset and progression of symptoms, medical history, and any recent infections, vaccinations, or autoimmune disorders.
2. Magnetic Resonance Imaging (MRI):
   • MRI of the spinal cord is the most important imaging test for diagnosing transverse myelitis. It can show inflammation or lesions in the spinal cord and help determine the extent of damage.
3. Lumbar Puncture (Spinal Tap):
   • A sample of cerebrospinal fluid (CSF) may be analyzed for signs of infection, inflammation, or autoimmune markers. In transverse myelitis, CSF often shows elevated white blood cells and protein levels.
4. Blood Tests:
   • Blood tests can help rule out infections, autoimmune conditions, or other potential causes of inflammation.
5. Evoked Potentials:
   • Tests that measure the electrical activity in the brain and spinal cord in response to stimuli may be used to assess the extent of neurological impairment.

Treatment

There is no specific cure for transverse myelitis, but treatment focuses on reducing inflammation, managing symptoms, and improving function. Treatment options include:

1. Steroids:
   • High-dose corticosteroids (such as methylprednisolone) are often given intravenously in the early stages of the disease to reduce inflammation and prevent further damage to the spinal cord.
2. Plasma Exchange (Plasmapheresis):
   • If the condition does not respond to steroids, plasma exchange may be used. This process involves removing the patient's blood plasma and replacing it with a substitute, helping to remove antibodies or other immune system factors that may be attacking the spinal cord.
3. Immunosuppressive Therapy:
   • In cases where an autoimmune cause is identified, immunosuppressive medications (such as azathioprine or mycophenolate) may be prescribed to control the immune response.
4. Pain Management:
   • Pain relievers, muscle relaxants, and anticonvulsant medications may be used to control pain and spasms.
5. Physical Therapy:
   • After the acute phase, physical therapy is important for rehabilitation. It helps improve strength, mobility, and coordination and can assist in the recovery of motor and sensory functions.
6. Bladder and Bowel Management:
   • For individuals with bladder and bowel issues, specialized care, including medications, catheters, or bowel training, may be necessary.

Prognosis

The prognosis for individuals with transverse myelitis can vary widely depending on factors such as the severity of symptoms, the speed of treatment, and the underlying cause. Some individuals experience full recovery, while others may have lasting neurological deficits, including weakness, sensory loss, or bladder and bowel dysfunction.

• Early treatment with steroids or plasma exchange can help improve outcomes and reduce the risk of permanent damage.
• The recovery rate is better for those with mild forms of the disease, while more severe cases may result in long-term disability.

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