Transverse Myelitis Flashcards

1
Q

What is Transverse Myelitis?

A

Transverse Myelitis is an inflammatory condition of the spinal cord characterised by rapidly developing motor and sensory deficits. It can occur at any level of the spinal cord.

Reference: Nelson’s Paediatrics [20th Edition], p. 2958.

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2
Q

How does Transverse Myelitis present?

Think about age groups

A

Transverse Myelitis presents in two different ways depending on age:

<3 years

  • Development of symptoms in hours to days
  • Preceding infection (usually viral) or immunisation
  • Severe loss of function
  • Slow recovery and likely incomplete
  • Perivascular infiltration with mononuclear cells
  • Spinal cord necrosis rarely

Older Children

  • Peak symptoms in 2 days to 2 weeks
  • More rapid recovery and likely complete
  • Acute demyelination
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3
Q

What are the symptoms in Transverse Myelitis?

A
  • Discomfort or pain in neck or back related to level of lesion (most often thoracic)
  • Numbness
  • Anaesthesia
  • Ataxia
  • Areflexia
  • Motor weakness in truncal musculature
  • Flaccidity developing into paralysis and later spasticity
  • Hyperreflexia
  • Clonus
  • Urinary retention and, later, incontinence
  • Visual loss (in Neuromyelitis Optica)
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4
Q

What are the differential diagnoses for Transverse Myelitis?

A

Demyelinating disorders

Meningitis

Spinal Cord Infarction

Mass lesions

Abscess

Spinal Cord Tumour

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5
Q

How is Transverse Myelitis investigated?

A

MRI

With and without contrast enhancement. Demonstrates high signal intensity over multiple segments (infantile form), 1-2 segments (adolescent form), or >3 segments with optic neuritis (Neuromyelitis Optica).

Lumbar Puncture

Evidence of CSF pleocytosis (increased WCC) >10.

Increased IgG

High Protein

Bloods

Aquaporin-4 Antibodies (AQP4 IgG)

Diagnostic for Neuromyelitis Optica (NMO; Devic’s Disease)

  • Anti-myelin oligodendrocyte*
  • Vitamin B12*

Subacute Degeneration of the Cord

  • Paraneoplastic Antibodies*
  • HIV*

Reference: Nelson’s Paediatrics [20th Edition], p. 2959; NINDS

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6
Q

How does Transverse Myelitis differ from Guillain-Barré Syndrome?

A

Guillain-Barré Syndrome involves spinal nerve root inflammation.

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7
Q

What is the function of Aquaporin-4?

A

Aquaporin-4 is a water channel protein found on astrocytes that surround the blood-brain barrier.

Reference: NMOUK

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8
Q

Useful Links

A

NINDS

Includes helpful patient information

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9
Q

How is Transverse Myelitis treated?

A

Transverse Myelitis is managed with immune response modulation, the mainstay treatment being:

High dose steroids (Methylprednisolone)

Other treatment options include:

Intravenous Immunoglobulin (IVIg)

Plasma Exchange

Rituximab

Cyclophosphamide

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