Transverse myelitis

Non traumatic injury of spinal cord
autoimmune diseases

1. Transverse myelitis BY: DR. VAIBHAVI PARMAR

2. introduction Transverse myelitis (TM) is an inflammatory disorder of the spinal cord. TM is characterized by focal inflammation within the spinal cord and clinical manifestations are due to resultant neural dysfunction of motor, sensory and autonomic pathways within and passing through the inflamed area. The incidence of TM is 1 (severe) to 8 (mild) cases/million per year .

3. CAUSES TM may exist as part of a multi-focal CNS disease (e.g. MS), multisystem disease (e.g. Systemic lupus erythematosus), or as an isolated, Idiopathic M ay occur Post infection

4. following symptoms occur below the level of the spinal cord where the inflammation is Pain in back (not just lower back pain), extremities or abdomen Muscle weakness and/or paralysis Sensory alteration/loss - numbness, tingling, stabbing pain, pins and needles, burning, crawling sensation. Pain cause by temperature or physical stimuli Tight banding around torso, arms, and/or legs Electrical shock like sensation through spine to feet (known as ‘ lhermitte’s sign’)

5. Muscle spasms and tightness (spasticity) Cold and/or hot sensations in an isolated part of your body Diminished temperature sensation Bladder and bowel issues – incontinence, bladder urgency or inability to pass Sexual dysfunction Fatigue

6. Some people will experience the symptoms equally on both sides of their body. Some people will experience the symptoms more on one side of the body than the other, or even on one side only. Symptoms depends on the area and the extent of affection of the spinal cord.

7. Diagnostic Procedures MRI and/or CT scan Lumbar puncture is used to look for markers for inflammation in the cerebrospinal fluid (CSF). Visual evoke potential/response History Neurological examination

8. Differential Diagnosis Multiple sclerosis Disc lesions NMO ( neuromyelitis optica ) ADEM(acute disseminated encephalomyelitis )

9. Management MEDICAL MANAGEMENT Corticosteroids given intravenously Plasmapheresis - for moderate to severe cases, or those who do not respond to steroids after 3-5 days Immunosuppressant medication

10. Physiotherapy Pain reduction/management Strengthening ( according to the extent of affection) Transfers Gait training Wheelchair training Reduce risk of pressure ulcers & other secondary complications Bladder and bowel management