Transverse Myelitis | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

356

Pages:

5
Author:

Mariam A. A.

Transverse Myelitis Definition Inflammation of the spinal cord leads to motor, sensory and autonomic dysfunction below the level of the affect SC level Epidemiology Rare Bimodal incidence Peaks in the 2 nd and 4 th decades of life Causes Idiopathic Most common Parainfectious Enterovirus, EBV, CMV CNS demyelinating disorders E.g. MS Systemic inflammatory autoimmune disease E.g. SLE and sarcoidosis Paraneoplastic syndromes Drug induced TNF-alpha inhibitors, chemotherapeutic agents Clinical Features Acute spinal shock may be present at onset ANS dysfunction Faecal and urinary incontinence If sacral involvement may have retention Sexual dysfunction CST UMNL Weakness Hypertonia Hyperreflexia Spinocerebellar tract Ataxia Spinothalamic tract and DCLM tract impairment If damage is to the anterior grey horn Flaccid paralysis Hypotonia Hyporeflexia Fasciculations Investigations Labs Serology testing for viral infections, syphilis and HIV antibodies Inflammatory markers ESR, CRP Serum antibody testing antinuclear antibodies, RF, antiphospholipid antibodies, NMO IgG Serum vit B12 TFTs LPs Inflammatory markers Pleocytosis Elevated IgG index Oligobands useful for MS diagnosis Cultures ad PCT VDRL syphilis Brain and spine MRI With or without gadolinium Investigation of choice T2 is preferred? Findings Focal lesions within the spinal cord DDx Anterior spinal artery infraction GBS Radiation myelitis Metabolic myelopathy Compressive myelopathy Management Acute for flare ups 1 st line high dose corticosteroids decreases inflammation 2 nd line if response to 1 st line treatment is not sufficient Plasmapheresis Cyclophosphamide Supportive management Prevent decubitus ulcer Prevent thrombosis Manage urinary retention, gastroparesis, constipation and resp failure (in high cervical cord lesions) Long term management Neurological rehab Ongoing management of underlying cause Long term immunomodulatory therapies for systemic autoimmune conditions or demyelinating disease Prevention therapy Mycophenolate inhibits the genes responsible for transcription in inflammatory cells Rituximab inhibits T helper cells macrophages, B cells and stimulates T regulatory cells Complications Paralysis and weakness Chronic pain Spasticity Most common Respiratory failure Bladder ad bowel dysfunction Sexual dysfunction Sores and infections due to limited motility MH changes Permanent disability