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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]
  • Grasp and apply the latest knowledge from more than 25 brand-new chapters, as well as extensive revisions or total rewrites to the majority of existing chapters to present all of the most up-to-date information available on every aspect of spine surgery[books.google.com]
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]
Chest Discomfort
  • This started three weeks ago when she had a 36-hour bout of sore throat, cough and upper chest discomfort. At around the same time, she began to note a feeling of numbness of the right foot.[egms.de]
Nausea
  • 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]
  • She denied headache, nausea or vomiting. Review of systems was otherwise negative. Muscle strength was intact in the upper and lower extremities. Muscle tone was slightly increased in the lower limbs. There was no clonus.[egms.de]
  • Halothane, trichloroethylene and methoxyflurane 1964 Jan MUSCULAR PARALYSIS DUE TO STREPTOMYCIN FOLLOWING INHALATION ANAESTHESIA 1987 Jun Nausea and vomiting after prostaglandins in day case termination of pregnancy.[database.pherobase.com]
  • A careful review may yield systemic symptoms, including the upper respiratory tract with cough and difficulty in breathing, chest pain, rashes, joint aches, muscle pain, vision changes, nausea, diarrhea, constipation, and problems with urinary function[clinicalgate.com]
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]
Back Pain
  • pain and psychosocial interactions, biomechanics, and more.[books.google.com]
  • Acute or subacute necrotizing myelopathy : This is usually not associated with severe back 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]
Behavior Disorder
  • ., brain tumors), including cerebrovascular diseases, dementias and behavioral disorders, demyelinating disorders, and disorders of consciousness and brain death.[books.google.com]
Negativism
  • Der Liquor war klar, der Test auf Borrelia Burgdorferi IgG und IgM war negativ. Herpes simplex-, Mycoplasma-, Coxiella-, Anaplasma-, Cryptococcus- und Hepatits B-Tests waren alle negativ. Oligoklonale Banden konnten nicht nachgewiesen werden.[egms.de]
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]
  • Deep tendon reflexes were generalized hyperreflexia. No ankle clonus was observed. Babinski’s sign was the plantar response. The anal sphincter tone was intact.[karger.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]
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]
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]
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]
  • Abstract In ten patients with acute transverse myelitis (ATM), seven patients had urinary retention, and the other three patients had difficulty in voiding within 1 month from the onset of the disease.[nature.com]
Urinary Incontinence
  • 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]
  • A review of 25 patients, published in 1998, revealed the following: [2] Motor deficits only (24%) Sensory deficits only (4%) Motor and sensory deficits (68%) Brainstem dysfunction (4%) Urinary incontinence (56%) Meningismus (12%) Causes Presence of spinal[emedicine.medscape.com]
Oliguria
  • He began to have difficulty emptying his bladder, with urinary frequency and oliguria; he . . . Funding and Disclosures * Staff neurologist, St.[nejm.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]
Decreased Platelet Count
  • In the current patient, transverse myelitis was diagnosed based on the following typical symptoms: Transiently decreased platelet count, positive dengue antigen and IgM/IgG, and according to the features of an MRI scan of the spinal cord.[spandidos-publications.com]

Treatment

  • In parallel, treatment options that avoid costly disease-modifying drugs have been stressed throughout.[books.google.com]
  • Treatment with intravenous pulse methylprednisolone immunoglobulin plasmapheresis and physiotherapy resulted in partial recovery at 3 months post‑infection.[spandidos-publications.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]

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]
  • It can occur in an acute or subacute clinical onset, with the acute presentation having a worse prognosis. An early diagnosis and intensive treatment are important features recommended in these patients.[reumatologiaclinica.org]
  • 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]
  • 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]

Etiology

  • This case highlights the utility of extension MRI in cervical myelopathy of uncertain etiology.[mayoclinic.pure.elsevier.com]
  • […] differentiation with diseases of neoplastic and vascular etiologies, for example.[rb.org.br]
  • 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]
  • Transverse myelitis Epidemiology The term TM was first used in 1948 by an English neurologist, Dr.[neupsykey.com]
  • Epidemiology Incidence: Estimated 1–8/million cases per year in the United States (20% children) or approximately 300 affected children annually.[unboundmedicine.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]
  • , as well as to compare the clinical data, laboratory and epidemiological reported by these publications.[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • Recent decades have also witnessed fundamental progress in understanding of the pathophysiology of spinal cord diseases, treatment options, neurosurgical procedures, and endovascular treatments.[books.google.ro]
  • •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]
  • 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]
  • […] 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]
  • Pressure ulcers are much easier to prevent than to heal. Spasticity is often a very difficult problem to manage.[rarediseases.org]
  • The goal is to promote bowel continence and prevent complications.[now.aapmr.org]

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