Transverse myelitis

Definition

• Heterogeneous condition characterized by inflammation of the spinal cord

Etiology

• Post-infectious
• Post vaccination
• Infectious
  • VZV
  • CMV
  • Etc.
• Systemic inflammatory conditions
  • Sarcoidosis
• Acquired demyelinating disease
  • MS
• Idiopathic

Clinical Presentation

• Motor and sensory deficits

Investigations

• MRI spine with gadolinium

Diagnosis

• Bilateral sensorimotor and autonomic spinal cord dysfunction
  • May be asymmetric
• Clearly defined sensory level
• Progression peaking between 4h and 21d after onset
• Demonstration of spinal cord inflammation
  • Cerebrospinal fluid with pleocytosis or increased IGG
  • MRI with gadolinium
• Exclusion of compressive, postradiation, neoplastic, and vascular causes

Management

• Determine cause
• Consider high-dose steroids 1g/d x3-5 days
• Thromboembolism prophylaxis
• Symptom management for pain and spasticity
  • Muscle relaxants
• Rehab (PT/OT)
• Follow-up investigations
  • Repeat MRI