SECTION 11. NEUROLOGIC DISORDERS
130. SPINAL CORD DISORDERS
DEMYELINATING CORD DISORDERS
ACUTE TRANSVERSE MYELITIS
A syndrome, not a disease, in which an acute spinal cord transection of
unknown cause affects both gray and white matter in one or more
adjacent thoracic segments. Some cases follow nonspecific "viral"
illness, which suggests an immune-related pathogenesis; others are
associated with vasculitis, or IV use of heroin or amphetamine. Often
no cause is found. Sudden local back pain is followed by sensory
symptoms and motor weakness ascending from the feet. The defect may
progress over several days and is severe, usually with global
sensory-motor paraplegia below the lesion, urinary retention, and loss
of bowel control. Occasionally, posterior column functions are spared,
at least initially. The syndrome occasionally recurs.
Diagnosis and Treatment
The condition must be differentiated from anterior spinal artery
occlusion and acute cord compression, particularly from an epidural
abscess, hematoma, or tumor. Treatable causes of acute transverse
myelitis that should be considered are acute meningovascular syphilis
and mycoplasmal infections. The CSF may show monocytes and a slightly
increased protein content. MRI will rule out expanding extramedullary
lesions. Either MRI or myelography may show swelling of the cord,
occasionally even producing a subarachnoid block at the level of the
lesion. If myelography is used, supine and prone visualization should
be done to rule out a vascular malformation. Blood serologies are
abnormal in the rare case with collagen-vascular disease. Association
with a viral meningoencephalitis usually can be differentiated by a
more subacute onset, associated viral symptoms, and a lymphocytic
pleocytosis.
Treatment in most instances is nonspecific and symptomatic. Except for
those with a viral meningoencephalitis, most patients are left with
considerable disability. Corticosteroids are of no proven benefit.
Jim Lubin
jlubin(AT)eskimo.com
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Transverse Myelitis Internet Club
http://www.eskimo.com/~jlubin/disabled/tmic