Transverse myelitis: Difference between revisions
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− | == |
+ | ==Definition== |
− | * |
+ | *Heterogeneous condition characterized by inflammation of the spinal cord |
− | == |
+ | ==Etiology== |
+ | *CNS disorders |
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− | * Post-infectious |
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+ | **[[Multiple sclerosis]] |
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− | * Post vaccination |
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+ | **[[Neuromyelitis optica]] |
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+ | **[[Acute disseminated encephalomyelitis]] (ADEM) |
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− | ** VZV |
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+ | **[[Myelin oligodendrocyte glyocprotein antibody-associated disorder]] |
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− | ** CMV |
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⚫ | |||
− | ** Etc. |
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⚫ | |||
+ | **[[Sjögren syndrome]] |
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+ | **[[Systemic lupus erythematosus]] |
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− | * Acquired demyelinating disease |
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+ | **Others: [[ankylosing spondylitis]], [[antiphospholipid antibody syndrome]], [[Behçet disease]], [[mixed connective tissue disease]], [[rheumatoid arthritis]], and [[systemic sclerosis]] |
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− | ** MS |
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+ | **[[Enteroviruses]], especially D68 and EV71 |
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+ | **[[West Nile virus]] |
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+ | **[[Herpesviridae]], including [[HSV]], [[VZV]], [[EBV]], [[CMV]], and [[HHV-6]] |
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+ | **[[HIV]] |
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+ | **[[HTLV-1]] |
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+ | **[[Zika virus]] |
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+ | **[[Lyme disease]] |
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+ | **[[Mycoplasma species]] |
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+ | **[[Treponema pallidum]] |
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+ | *Paraneoplastic, most often secondary to [[small cell lung cancer]] |
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+ | **Anti-Hu disease |
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+ | **Anti-CRMP5 disease |
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⚫ | |||
− | == |
+ | ==Clinical Manifestations== |
+ | *Presentation is either acute or subacute, usually starting with sensory changes, weakness, or pain |
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− | * Motor and sensory deficits |
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+ | *Characterized by both motor and sensory deficits, with specific deficits depending on the spinal level of the lesion |
||
− | == |
+ | ==Investigations== |
− | * |
+ | *MRI spine '''with gadolinium''', showing characteristic T2 hyperintensity without evidence of cord compression |
+ | *CSF showing pleocytosis |
||
− | == |
+ | ==Diagnosis== |
− | * |
+ | *Sensorimotor and autonomic spinal cord dysfunction |
− | ** |
+ | **Generally bilateral but may be asymmetric |
− | * |
+ | *Clearly defined sensory level |
+ | *Bilateral signs and symptoms |
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− | * |
+ | *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 |
[[Category:Neurology]] |
[[Category:Neurology]] |
Revision as of 10:18, 29 July 2020
Definition
- Heterogeneous condition characterized by inflammation of the spinal cord
Etiology
- CNS disorders
- Systemic inflammatory disorders
- Infectious
- Enteroviruses, especially D68 and EV71
- West Nile virus
- Herpesviridae, including HSV, VZV, EBV, CMV, and HHV-6
- HIV
- HTLV-1
- Zika virus
- Lyme disease
- Mycoplasma species
- Treponema pallidum
- Paraneoplastic, most often secondary to small cell lung cancer
- Anti-Hu disease
- Anti-CRMP5 disease
- Idiopathic
Clinical Manifestations
- Presentation is either acute or subacute, usually starting with sensory changes, weakness, or pain
- Characterized by both motor and sensory deficits, with specific deficits depending on the spinal level of the lesion
Investigations
- MRI spine with gadolinium, showing characteristic T2 hyperintensity without evidence of cord compression
- CSF showing pleocytosis
Diagnosis
- Sensorimotor and autonomic spinal cord dysfunction
- Generally bilateral but may be asymmetric
- Clearly defined sensory level
- Bilateral signs and symptoms
- 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