Synonyms:
a.k.a. Primary transverse myelitis
Diagnosis:
Clinical +MRI +laboratory studies
+evidence of inflammation by CSF: pleocytosis or raised IgG index, or by MRI enchancement
+exclude secondary disease: including vascular myelopathy
Clinical features:
Acute or subacute onset
Bilateral symptoms and/or signs, usually symmetric i.e. acute complete transverse myelitis ACTM. [142] Acute partial transverse myelitis APTM may occur i.e. incomplete and asymmetric
Sensory, motor or autonomic deficits due to spinal cord involvement. Progresses to a nadir between 4hr and 21 days.
Transverse refers to anterior and posterior parts of the cord.
Back pain may occur
Findings on Investigations:
MRI:
- T2 High signal over many cord segments
- Diffuse swelling,
- T1 +contrast: enhancement
Investigations to consider:
MRI +gadolinium brain and spine: assess for MS, neuromyelitis optica, herniated disc, vertebral fracture, metastasis, tumor, abnormal flow voids of AVM
CSF analysis: Cell count +differential, protein, glucose, oligoclonal bands, IgG index
Viral PCR: HSV, etc
CXR: features of sarcoidosis
Blood tests:
- FBC, basic metabolic panel, LFT
- ESR, B12, methymalonic acid
- Vasculitis screen: ESR, CRP, ANA screen, ENA panel (anti- dsDNA, anti-Sm, anti-RNP, SSA, SSB, anti-Jo-1, antitopoisomerase ‘formerly anti Scl-70’, antinucleolar, anticentromere), ANCA (c-ANCA, p-ANCA), Complement C3, C4 and CH50
- Serology: Mycoplasma pneumoniae (and cold agglutinins), syphilis, HIV-1, HSV,
- ANA and ENAs
- ACE levels
- NMO IgG: to assess for Devic neuromyelitis optica
Urinalysis
Lip biopsy: Sjogren syndrome
Tests for Brucella spp. (Brucellosis), Schistosomiasis
14-3-3: early rise is associated with poor outcome.
Treatment:
Methylprednisone 1 gram I.V. 5-7 days followed by steroid taper
Consider:
- Plasmapheresis for steroid unresponsive cases
- Consider empiric therapy for viral or bacterial causes while tests are pending
- General measures for myelopathy