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2.1
Subacute Transverse Myelitis
Myelitides Subacute Transverse

Presentation

In the present study, a literature review identified 6 reported cases ( 8 – 13 ) of transverse myelitis attributed to dengue infection between 1996 and 2014, in addition to the present case. [spandidos-publications.com]

We are presenting an interesting case of SaTM with its MRI and unusual CSF findings. Case presentation A 46-year old African-American woman presented with decreased sensation in the lower extremities. [egms.de]

The clinical presentation is generally subacute, with a variable picture of muscle weakness, paraparesis or quadriparesis. Constitutional symptoms such as fever and weight loss may not be present(9,10). [rb.org.br]

Out of the twelve patients presenting with fever, eight had it for more than 5 days. Eleven out of nineteen patients presenting with para-paresis had it for more than 5 days. [jpma.org.pk]

Table 1: Signs and symptoms of acute transverse myelitis at presentation Presenting symptoms All of our patients had sensory disturbances at presentation ( n =63; (100%)), as shown in Table 2. [nature.com]

Entire Body System

  • Hodgkin Lymphoma

    Paraneoplastic myelitis : Hodgkin lymphoma Postradiation myelopathy : The syndrome of delayed radiation-induced myelopathy has bimodal incidence, with peaks at 12-14 months and 25-28 months after completion of radiation therapy. [neuroweb.us]

Gastrointestinal

  • Fecal Incontinence

    Key points Acute widespread neurologic deterioration, particularly involving urinary and fecal incontinence and para- or tetraparesis in a patient with systemic lupus erythematosus should arouse suspicion for longitudinally extensive transverse myelitis [cmaj.ca]

    A common problem in spinal cord injury is difficulty with evacuation of stool, although fecal incontinence can also occur. The neurologic pathways for defecation are similar to those of the bladder. [myelitis.org]

    Autonomic dysfunction was defined as “positive” when the patient had medical record documentation of urinary urgency, urinary incontinence, fecal incontinence, tenesmus, or sexual dysfunction. [ceemjournal.org]

Musculoskeletal

  • Back Pain

    pain and psychosocial interactions, biomechanics, and more. [books.google.com]

    The first symptoms of intramedullary tumors are often midline backpain or local back pain with or without radicular pain and dysesthesia. Tumors of the lumbar region and conus medullaris frequently present with back and leg pain. [neuroweb.us]

    People with symptoms of transverse myelitis may: Develop a rapidly progressive disorder with back pain, numbness, and tingling in the legs, trunk, and sometimes arms. Have weakness in the legs and sometimes in the arms. [my.clevelandclinic.org]

Neurologic

  • Hyperreflexia

    Urodynamic studies performed on nine patients revealed that all of the three patients with the urgent incontinence had detrusor hyperreflexia, all of the four patients with retention had an areflexic cystometrogram as well as sphincter hyperreflexia, [nature.com]

    Neurological Examination: severe reduction of visual acuity in the right eye with papilledema, paraparesis (stage 4), hyperreflexia and signs of bilateral Babinski. [omicsonline.org]

    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]

  • Unable to Walk

    Within five days she was unable to walk and subsequently developed painless urinary retention requiring catheterisation. On examination her cognitive function, speech, cranial nerves and optic fundi were normal. [ispub.com]

    He had regained all bowel and bladder function and some function of his legs, but he was unable to walk. Twelve months after the flare-up, the patient remained on maintenance mycophenolate, and he was actively involved in physical rehabilitation. [cmaj.ca]

  • Clonus

    There was no clonus. Deep tendon reflexes were traced in the upper extremities, 2+ at the knees, 2+ at the ankles. Toe signs were silent. There was no spine tenderness. [egms.de]

    No ankle clonus was observed. Babinski’s sign was the plantar response. The anal sphincter tone was intact. [karger.com]

Urogenital

  • Urinary Retention

    A 56-year-old man was admitted to the hospital reporting 5 months of progressive ascending lower extremity weakness and numbness, inability to walk, bowel incontinence,urinary retention and several episodes of nausea and vomiting. [medicinebyalexandrosgsfakianakisblog.wordpress.com]

    A 56-year-old man was admitted to the hospital reporting 5 months of progressive ascending lower extremity weakness and numbness, inability to walk, bowel incontinence,urinary retention and several episodes of nausea and vomiting. [casereports.bmj.com]

    Case presentation A 35 year-old male Caucasian recently returned from the tropics presented to our hospital with urinary retention and acute paraparesis. [bmcinfectdis.biomedcentral.com]

    Acute urinary Retention, paraplegia, hypoesthesia. [omicsonline.org]

    Five of the patients with retention became able to urinate. After the mean follow-up period of 40 months, nine still had urinary symptoms including difficulty in voiding in five and urinary frequency, urgency and incontinence in four patients. [nature.com]

  • Urinary Incontinence

    However, urinary incontinence persisted and subsequent uroflowmetry showed hypocontractile bladder with low compliance, which partly improved with anticholinergic drugs. [annalsofian.org]

    After the intensity of the pain decreases, symptoms of neurological disorders – weakness in the limbs, reduced sensation, urinary incontinence, flatulence, and constipation. In the later stages of the disease appear bedsores and trophic ulcers. [back.vsebolezni.com]

    This may include needing to urinate more frequently, urinary incontinence, difficulty urinating and constipation. When to see a doctor Call your doctor or get emergency medical care if you're experiencing signs and symptoms of transverse myelitis. [mayoclinic.org]

    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]

    Autonomic dysfunction was defined as “positive” when the patient had medical record documentation of urinary urgency, urinary incontinence, fecal incontinence, tenesmus, or sexual dysfunction. [ceemjournal.org]

Workup

The patient underwent an exhaustive workup including a lymph node biopsy showing noncaseating granulomas ultimately diagnosed with neurosarcoidosis. [imrespdx.com]

A typical workup is summarized in Table 14.2. [neupsykey.com]

Laboratory examination The workup included serum analyses with routine laboratory tests. [nature.com]

Disposition/Prognosis Most patients with severe enough disease will need to be admitted for further workup, usually to a neurologist or neurosurgeon. [emdocs.net]

Treatment

In parallel, treatment options that avoid costly disease-modifying drugs have been stressed throughout. [books.google.com]

Despite the delay in the initial diagnosis and treatment for several days because of inaccessibility, our patient received prompt diagnostic investigation and treatment after transfer to a tertiary care centre. [cmaj.ca]

If lupus or another disorder is causing the TM, treatment may take longer. [clevelandclinic.org]

MRI is also the choice of study for showing demyelination and for assessing response to treatment. [ispub.com]

[…] vs 1 of 17 (5.9%) who received sham treatment. 9 There are no established treatments for patients with cord infarction. [neurology.org]

Prognosis

Prognosis  risk factors for unfavorable outcomes at presentation, including 1. rapid progression to maximal neurologic deficit ( 47. Prognosis better course 1. Older age 2. increased deep tendon reflexes 3. presence of the Babinski sig [slideshare.net]

There are several types of myelitis, which has its own symptoms and prognosis. Optimalit usually occurs in adults, the disease has a favorable prognosis. [back.vsebolezni.com]

Q: What is the prognosis after an attack of transverse myelitis? A: The prognosis after an attack of transverse myelitis is highly variable among both adults and children. [blogs.nejm.org]

TM can be a rare complication following cat scratch disease. [3] Prognosis Edit Prognosis for complete recovery is generally poor. [psychology.wikia.com]

Etiology

[…] differentiation with diseases of neoplastic and vascular etiologies, for example. [rb.org.br]

This case highlights the utility of extension MRI in cervical myelopathy of uncertain etiology. [mayoclinic.pure.elsevier.com]

Based upon the above-mentioned clinical presentation and investigations, patients were classified according to their etiologies. [jpma.org.pk]

Acute transverse myelitis; incidence and etiologic consideration. Neurology 1981; 31 : 966–971. 3 Martinelli V et al. Acute myelopathy of unknown etiology: a clinical, neurophysiological and MRI study of short- and long-term prognostic factors. [nature.com]

Epidemiology

Neurology 42: 250–252 PubMed Google Scholar Hansen K, Lebech AM (1992) The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985–1990. [link.springer.com]

as well as to compare the clinical data, laboratory and epidemiological reported by these publications. [omicsonline.org]

Transverse myelitis Epidemiology The term TM was first used in 1948 by an English neurologist, Dr. [neupsykey.com]

[…] demyelinating disease multiple sclerosis neuromyelitis optica demylinating encephalomyelitis systemic autoimmune disease systemic lupus erythematosus Sjögren's syndrome Behçet ' s disease ankylosing spondylitis medications sulfasalazine TNF-α inhibitors Epidemiology [medbullets.com]

Epidemiology Incidence: Estimated 1–8/million cases per year in the United States (20% children) or approximately 300 affected children annually. [unboundmedicine.com]

Pathophysiology

•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]

"Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices". Current Neuropharmacology. 9 (3): 417–28. doi : 10.2174/157015911796557948. PMC 3151596. [en.wikipedia.org]

It is tempting to speculate intraneural spread of HSV-2 along anterior horn over a large area of the cervicothoracic cord may have been involved in the pathophysiology of our case. [frontiersin.org]

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

Preventive measures can prevent the occurrence of secondary inflammation. These include vaccinations against polio, measles, mumps, and rabies. The disease significantly more difficult to return the patient to normal life and can lead to disability. [back.vsebolezni.com]

Pressure ulcers are much easier to prevent than to heal. Spasticity Spasticity is often a very difficult problem to manage. [myelitis.org]

Pressure ulcers are much easier to prevent than to heal. Spasticity is often a very difficult problem to manage. [rarediseases.org]

[…] keeping the patients body function while this complete or partial spontaneous recovery occurs -Prevent muscle wasting -Regain control of bowel and bladder - women health (they do men's health too) [quizlet.com]

The goal is to promote bowel continence and prevent complications. [now.aapmr.org]

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