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
- Pain
Furthermore, the patient had painful spasms and rigidity of the lower limb following ATM. [e-jmd.org]
Typical signs and symptoms include: Pain. Transverse myelitis pain may begin suddenly in your lower back. Sharp pain may shoot down your legs or arms or around your chest or abdomen. [mayoclinic.org]
Equip yourself to address increasing occurrences of pain among aging and physically active patients. [books.google.com]
Pain: Depending on the segment of the spinal cord that is affected, your child may experience pain in the lower back, shooting pain down the arms or legs, and pain in the chest and abdominal region. [brisbanechildneurology.com.au]
- Swelling
MRI showed moderate spinal swelling and multiple hyperintense signal changes on cervical levels C2–C5 and thoracic levels T1–T3. [medicinebyalexandrosgsfakianakisblog.wordpress.com]
Patients with parainfectious transverse myelitis show evidence of spinal cord swelling, whereas patients with multiple sclerosis-associated transverse myelitis have spinal cord plaques on MRI but not swelling [3]. [egms.de]
The aim of the treatment is to reduce swelling and irritation and speed recovery from the disease. [clevelandclinic.org]
[…] acute transverse myelitis, and poliomyelitis. myelitic, adj. myelitis Neurology Spinal cord inflammation, often caused by VZV Clinical Paraparesis, sensory defects, sphincter impairment Imaging T 2 -weighted MRI reveals hyperintense lesions, ± fusiform swelling [medical-dictionary.thefreedictionary.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]
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
- Myelopathy
[…] myelitis", abstract = "Cervical spondylotic myelopathy is a common cause of myelopathy and may mimic transverse myelitis. [mayoclinic.pure.elsevier.com]
Diffusion-weighted imaging in noncompressive myelopathies: a 33-patient prospective study.J Neurol.2010 ;257:1438-1445. Porter DA, Heidemann RM. [theassr.org]
Engelska synonymer Transverse Myelopathy Syndrome — Transverse Myelopathy Syndromes — Transverse Myelitis — Myelitis, Acute Transverse — Acute Transverse Myelitis — Transverse Myelitis, Acute — Myelitis, Subacute Transverse — Myelitides, Subacute Transverse [mesh.kib.ki.se]
Acute transverse myelopathy and echo-2 virus infection. Lancet Dec 1963 ; 1226 – 1227. 5. Grose, C, Feorino, P. Epstein-Barr virus and transverse myelitis. Lancet Apr 1973 ; 892. 6. Westenfelder, G, Akey, T. [cambridge.org]
- Paresthesia
Clinical Presentation: Profound neurologic déficits, including progressive sensory abnormalities, ascending paresthesias, weakness, ataxia, loss of sphincter control, and gait impairment. [ajnr.org]
We report a case of a 13-year-old girl affected by transverse myelitis who rapidly developed leg paresthesia and weakness, difficulty in deambulation, sensor and sphincter deficits. [medicoebambino.com]
At that time, she developed ATM with paresthesia below the waist, an improper gait due to paraparesis and jerkiness of the legs on standing further, and urinary difficulty due to sphincter disturbance. [e-jmd.org]
This is a case of a young person presenting with subacute progressive weakness and paresthesias with T2 weighted MRI with gadolinium showing a C-spine hyperintense spinal cord lesion consistent with transverse myelitis and hilar lymphadenopathy. [imrespdx.com]
The most typical initial symptoms are bilateral paresthesias and severe localized interscapular or back pain sometimes followed by spinal shock. [neuroweb.us]
- Tingling
Abnormal Sensations: Your child may experience tingling, numbness, and hot or cold sensations. There may also be extreme sensitivity to light touch of clothing. [brisbanechildneurology.com.au]
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]
Those who experience sensory disturbances often use terms such as numbness, tingling, coldness, or burning to describe their symptoms. [my-ms.org]
Patients who experience sensory disturbances often use terms such as numbness, tingling, coldness, or burning to describe their symptoms. [mytm.ca]
Some experience tingling or numbness in the legs. Pain and temperature sensation are diminished in the majority of patients. Vibration sensation and joint position sense may be decreased or spared. [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]
- 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]
Urogenital
- Incontinence
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. Four patients had urinary disturbance as the sole sequel of ATM. [nature.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. [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]
Clinical manifestations include motor weakness, sensory loss, and incontinence. (Adams et al., Principles of Neurology, 6th ed, pp1242-6) Svenska synonymer Inga svenska synonymer finns. [mesh.kib.ki.se]
- 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]
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]
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
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]
However, urinary incontinence persisted and subsequent uroflowmetry showed hypocontractile bladder with low compliance, which partly improved with anticholinergic drugs. [annalsofian.org]
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]
Motor deficit usually progresses from slight paresis of one or more limbs to a flaccid paraplegia or tetraplegia with sensory loss below the level of the lesion and eventual sphincter disturbances (urinary retention or incontinence and/or loss of rectal [emedicine.medscape.com]
- Urinary Urgency
Another one-third experience only fair recovery and are left with significant deficits such as spastic gait, sensory dysfunction, and prominent urinary urgency or incontinence. [themighty.com]
About 1/3 of patients recover, 1/3 retain some weakness and urinary urgency, and 1/3 are bedridden and incontinent. The majority of people with this disorder experience only one episode although in rare cases recurrent or relapsing TM does occur. [mytm.ca]
Adult patients often report pain in the back, extremities, or abdomen. [2] Patients also present increased urinary urgency, bowel or bladder dysfunctions such as bladder incontinence, difficulty or inability to void, and incomplete evacuation of bowel [en.wikipedia.org]
Another one-third show only fair recovery and are left with significant deficits such as spastic gait, sensory dysfunction, and prominent urinary urgency or incontinence. [neuroanatomy.wisc.edu]
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]
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]
Treatments After an initial evaluation and assessment, your physical therapist should work with you to develop goals and an appropriate treatment strategy. [verywell.com]
Timely treatment increases chances for complete recovery. [back.vsebolezni.com]
Patients particularly benefit from early treatment, and will typically be started on PLEX within days of starting steroids. [hopkinsmedicine.org]
Prognosis
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]
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]
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]
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]
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]
as well as to compare the clinical data, laboratory and epidemiological reported by these publications. [omicsonline.org]
[…] 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
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]
"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]
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]
Preventive therapies include immunomodulatory drugs for acute partial TM at high risk for multiple sclerosis. Immunosuppressive therapies are used for longitudinally extensive TM at high risk for recurrent myelitis or neuromyelitis optica. [online.epocrates.com]