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Acute Transverse Myelitis

Acute (transverse) Myelitis


Presentation

  • Fever, paraparesis, quadri-paresis and bladder dysfunction were the most common presentations. Median score on disability rating scale (DRS) was twelve.[ncbi.nlm.nih.gov]
  • We present a case of a 36-year-old female patient with a rare genetic disorder (ANE1: Acute Necrotizing Encephalopathy due to a RANBP2 mutation) who presented with an acute quadriplegia.[ncbi.nlm.nih.gov]
  • A case of Acute Transverse Myelitis (ATM) is presented. ATM is a rare disease in childhood.[ncbi.nlm.nih.gov]
  • Patients with SLE were more likely to be African American, have CNS demyelinating lesions on MRI, a high IgG% on their CSF analysis and a higher sedimentation rate on presentation.[ncbi.nlm.nih.gov]
  • We present the unusual case of a 49-year-old female carrier of HTLV-I with myasthenia gravis who presented with acute transverse myelitis.[ncbi.nlm.nih.gov]
Fecal Incontinence
  • Deficits may progress over several more days to a complete transverse sensorimotor myelopathy, causing paraplegia, loss of sensation below the lesion, urinary retention, and fecal incontinence.[merckmanuals.com]
Back Pain
  • These symptoms included bilateral lower extremity paresthesias, back pains in the thoracic and lumbar areas and pronounced lower extremity weakness.[ncbi.nlm.nih.gov]
  • We report a 31-year-old man who complained of back pain and claudication of both lower extremities. The patient showed typical inflammatory back pain and significant sacroiliitis, consistent with AS.[ekjm.org]
  • Two weeks prior to admission, he had received low back injection to relieve back pain in a healthcare clinic. One day prior to admission, his condition had worsened.[ncbi.nlm.nih.gov]
  • Remarkably, the patient reported only mild symptoms with severe back pain in the absence of profound signs of myelopathy.[karger.com]
  • If the swelling is in the lower back, then symptoms can include back pain, weakness of both legs and bowel and bladder problems.[gosh.nhs.uk]
Contusion
  • The initial presumptive diagnosis was spinal cord contusion due to a fall versus an unknown mechanism of trauma, but eventual laboratory studies revealed Salmonella bacteremia, indicating a probable diagnosis of parainfectious ATM.[ncbi.nlm.nih.gov]
Withdrawn
  • In conclusion, concurrent use of cART and corticosteroids was effective against PHI accompanied by ATM and could be withdrawn after improvement of ATM.[ncbi.nlm.nih.gov]
Unable to Walk
  • Eighty-nine percent were unable to walk, required assisted ventilation, or both.[ncbi.nlm.nih.gov]
  • Only 9.4% of patients with IATM were unable to walk unassisted at the end of follow-up.[ncbi.nlm.nih.gov]
  • Approximately 50% of patients with this condition are unable to walk upon reaching their maximum level of disability, 3 and a third recover poorly and remain severely disabled. 4 In 2002, the Transverse Myelitis Consortium Working Group (TMCWG) proposed[elsevier.es]
Hyperreflexia
  • Flaccid weakness gradually changes to pyramidal tract signs, with hyperreflexia, clonus, and extensor responses. A sensory level (between T5-T10) affects primarily pain and temperature, and posterior columns are usually spared.[pediatricneurologybriefs.com]
  • Sx: leg weakness, sphincter dysfunction, abnormal DTRs [acutely may be absent, but hyperreflexia the rule]. Sensory level helps distinguish from polio/Guillain-Barre (GB).[hopkinsguides.com]
  • Clinical presentation Typical presentation • Prior history of fever (nonspecific viral illness) • ATM, the onset of spinal cord dysfunction usually progress in 4 hours to 21 days, the patient's signs usually plateau and evolve toward spasticity/hyperreflexia[slideshare.net]
Polyradiculoneuropathy
  • The diagnosis was later revised to include GBS on the basis of worsening facial diplegia in the setting of a flaccid tetraparesis, and neurophysiological evidence of a sensorimotor axonal polyradiculoneuropathy.[ncbi.nlm.nih.gov]
  • Ddx: may be confused w/ acute inflammatory demyelinating polyradiculoneuropathy (AIDP) or GB. R/o compressive or vascular explanation, tropical spastic paraparesis ( HTLV-I ) or vacuolar myelopathy (HIV). DIAGNOSIS Dx: MRI with contrast.[hopkinsguides.com]
Pyramidal Tract Signs
  • Flaccid weakness gradually changes to pyramidal tract signs, with hyperreflexia, clonus, and extensor responses. A sensory level (between T5-T10) affects primarily pain and temperature, and posterior columns are usually spared.[pediatricneurologybriefs.com]
Hyperactivity
  • In the presence of sympathetic nerve hypofunction, relative hyperactivity of the parasympathetic nerves may have led to severe bradycardia and cardiac arrest in the presence of an inducer, such as a postural change.[ncbi.nlm.nih.gov]
Urinary Retention
  • We describe a 40-year-old man who presented with an acute onset quadriparesis with urinary retention, which was preceded by fever and headache 3 weeks prior. He had elevated IgM titres against JE virus in serum and cerebrospinal fluid.[ncbi.nlm.nih.gov]
  • Deficits may progress over several more days to a complete transverse sensorimotor myelopathy, causing paraplegia, loss of sensation below the lesion, urinary retention, and fecal incontinence.[merckmanuals.com]
  • She required a urinary catheter for relief of urinary retention (1,000 to 1,500 cc) for two weeks, but at the end of this time she regained control of her bladder. She was able to return to home three weeks after admission.[kjim.org]
  • On May 2, he became ataxic and developed urinary retention. A diagnosis of transverse myelitis secondary to schistosomiasis was made when stool examinations showed ova of S. mansoni. The patient was treated with praziquantel and prednisone.[cdc.gov]
  • Physical therapy may also be helpful to retrain muscles necessary for improved bladder and bowel control and relief of constipation and urinary retention.[encyclopedia.com]
Urinary Incontinence
  • Bladder and bowel problems.These problems may include an increased urinary urge, urinary incontinence, difficulty urinating and constipation. Prognosis of TM Generally, prognosis for complete recovery from TM is not good.[mytm.ca]

Workup

  • We evaluated the spectrum clinical features and paraclinical findings encountered during diagnostic workup and aiding the diagnosis. SETTING: Department of Neurology, Inselspital Bern, Switzerland.[ncbi.nlm.nih.gov]
  • Abstract Despite an extensive diagnostic workup, some cases of acute transverse myelitis (ATM) remain of unknown etiology and have been referred to as "idiopathic" by the Transverse Myelitis Consortium group.[ncbi.nlm.nih.gov]
  • Once adequate neuroimaging has ruled out a compressive etiology, and a lumbar puncture has demonstrated signs of inflammation within the cerebrospinal fluid, a workup of causes for an acute transverse myelitis must be undertaken.[ncbi.nlm.nih.gov]
  • We propose that a redefined diagnostic workup of ATM might include ANE1, as the frequency of this rare disorder might be underestimated.[ncbi.nlm.nih.gov]
  • A recent IPMSSG paper reviews the current knowledge of how ATM develops, its clinical features, the recommended diagnostic workup and management strategies, and suggests future research directions.[ipmssg.org]

Treatment

  • There is scarce observational data and a lack of randomised controlled studies regarding the treatment of Sjoegren's syndrome in the presence of such complications.[ncbi.nlm.nih.gov]
  • There was statistically significant difference in modified Ashworth scale, FIM, and FAS values when the baseline and after treatment values were compared, which indicated improvement due to treatment (p 0.05).[ncbi.nlm.nih.gov]
  • Correct diagnosis is important for treatment and prognosis. Treatment begins with intensive surveillance for acute life-threatening respiratory or autonomic complications.[ncbi.nlm.nih.gov]
  • Despite various treatment strategies, all patients became severely disabled. Relapsing ATM not related to systemic disease appears to be a specific entity which accounts for severe disability and currently lacks effective treatment.[ncbi.nlm.nih.gov]
  • Early aggressive treatment may contribute to complete recovery of these patients.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis depends on a number of factors, and evidence suggests that the majority of children have a good outcome.[ncbi.nlm.nih.gov]
  • The purpose of the present study is to evaluate the relations between clinical variables and functional prognosis using new criteria.[ncbi.nlm.nih.gov]
  • The prognosis is variable. The following paper reviews the literature, clinical consideration, and nursing interventions of this puzzling condition.[ncbi.nlm.nih.gov]
  • A controlled multicenter study is suggested to assess epidemiology, etiology and prognosis of ATM.[ncbi.nlm.nih.gov]
  • ATM has been cited as a rare and unusual complication of Sjögren's syndrome, but early diagnosis and aggressive treatment might improve the prognosis.[ncbi.nlm.nih.gov]

Etiology

  • Therefore, the identification of clinical and paraclinical features providing clues of the underlying etiologies is needed.[ncbi.nlm.nih.gov]
  • Therefore, physicians must be aware of the many potential etiologies for acute myelopathy, and should pursue an ordered, efficient, and cost-effective approach to the diagnosis based on the patient's clinical history, examination, and magnetic resonance[ncbi.nlm.nih.gov]
  • OBJECTIVE: To determine the presenting features and etiological classification of acute transverse myelitis (ATM) at Aga Khan University Hospital, a tertiary care hospital in Pakistan.[ncbi.nlm.nih.gov]
  • Determining the etiology of transverse myelitis can be challenging because there are autoimmune, inflammatory, and infectious diseases associated with acute transverse myelitis.[ncbi.nlm.nih.gov]
  • A controlled multicenter study is suggested to assess epidemiology, etiology and prognosis of ATM.[ncbi.nlm.nih.gov]

Epidemiology

  • A controlled multicenter study is suggested to assess epidemiology, etiology and prognosis of ATM.[ncbi.nlm.nih.gov]
  • We recorded clinical epidemiological data, patients treated with methylprednisolone, maximal disability reached and disability at final follow-up.[ncbi.nlm.nih.gov]
  • This review summarizes the current published literature on acute transverse myelitis, including epidemiology, diagnostic criteria, pathogenesis, clinical presentation, clinical evaluation, and differential diagnosis.[ncbi.nlm.nih.gov]
  • METHODS: We reviewed 39 Chinese cases meeting the new criteria, recorded clinical epidemiological data, and followed activities of daily living measuring scale (Modified Barthel Index).[ncbi.nlm.nih.gov]
  • Epidemiological, clinical, laboratory, magnetic resonance imaging (MRI) data and outcome of 85 patients were analyzed. RESULTS: Eleven (13%) patients converted to MS after a median follow-up of 2.9 years (interquartile range 1.0-4.8).[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The significance of these findings and the possible role antiganglioside antibodies may play in acute transverse myelitis pathophysiology is discussed.[ncbi.nlm.nih.gov]
  • The pathophysiology of ATM consists primarily of inflammatory disorders, similar to the neurological complications of AS. We suggest that ATM is a possible extra-articular manifestation of AS.[ekjm.org]
  • •Postinfectious etiology largely predominates in children. 11. pathophysiology •Three hypotheses have been proposed: 1. Cell mediated autoimmune response 2. autoimmune vasculitis 3. direct viral invasion of spinal cord. 12.[slideshare.net]
  • Pathophysiology NA Epidemiology The incidence of transverse myelitis in children varies both geographically and over time, however, not in a predictable fashion.[clinicaladvisor.com]
  • However, several factors can differentiate it from MS: 1) it typically involves different parts of the brain than in MS, 2) the severity of attacks can be more robust as compared to MS, and 3) the pathophysiology differs from MS – whereas MS is thought[myelitis.org]

Prevention

  • Our report emphasizes that the Varicella zoster virus booster vaccine may be necessary to prevent not only acute varicella, but also its postinfectious neurologic complications.[ncbi.nlm.nih.gov]
  • We conclude that in a case of JE, one should be vigilant for early diagnosis of possible complication as ATM, in which an early institution of immunomodulator therapy prevents adverse consequences.[ncbi.nlm.nih.gov]
  • As long-term treatments for NMO are different from MS, early recognition of NMO and its variant is important for prevention of serious neurological deficits.[ncbi.nlm.nih.gov]
  • SATM is often relapsing and prognosis depends on prevention of further episodes. The documents contained in this web site are presented for information purposes only.[orpha.net]

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