Transverse Myelitis

Original Editor - Wendy Walker

Lead Editors  Wendy Walker

Introduction

Transverse Myelitis (TM), AKA Acute Transverse Myelitis (ATM) is a rare neurological disorder of the spinal cord, caused by inflammation and occurring across one spinal segment, leading to severe motor, sensory and autonomic dysfunction.

The term Transverse Myelitis (TM) was first coined in 1948 by Dr Suchett-Kaye, an English neurologist. He uses this to describe a case of rapidly progressive paraparesis with a thoracic sensory level, occurring as a post-infectious complication of pneumonia.

In the MRI scan opposite, the TM lesion  is the lighter, oval shape at center-right.

Epidemiology

The incidence of TM is 1 (severe) to 8 (mild) cases/million per year.

It occurs in adults and children, in both genders, and in all races.

A peak in incidence rates (the number of new cases per year) appears to occur between 10 and 19 years and 30 and 39 years.

Mechanism of Injury / Pathological Process

The mechanism of injury is inflammation of the spinal cord causing damage to the myelin sheath of the nerves.

Clinical Presentation

• Sensory, motor, or autonomic dysfunction attributable to the spinal cord
• Bilateral signs and/or symptoms
• Clearly defined sensory level

The symptoms of TM include muscle weakness, paralysis, parasthesia, neuropathic pain, spasticity, as well as bladder, bowel and sexual dysfunction.

In some cases, symptoms progress over hours whereas in other instances, the presentation is over days. Neurologic function tends to decline during the 4-21 day acute phase, while eighty-percent of cases reach their maximal deficit within 10 days of symptom onset. At its worst point, 50% of individuals have lost all movements of their legs, 80-94% experience numbness, paresthesias or banding or girdling, and almost all have some degree of bladder dysfunction.

There is tremendous variability in the presentation of symptoms, which are based on the level of the spinal cord affected and on the severity of the damage to the myelin and the neurons in the spinal cord.

Some patients recover from transverse myelitis with minor or no residual problems.
Others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living.
Most people will have only one episode of transversemyelitis.
A small percentage (10-20%) may have a recurrence.

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

The most common etiologies to be distinguished from idiopathic acute transverse myelitis are:

Multiple Sclerosis

Guillain Barre Syndrome

Disc herniation

Parainfectious myelitis
NMO (Devic's disease)
Myelitis related to systemic disease, such as systemic lupus erythematosis
Compression of spinal cord caused by trauma eg. vertebral fractures
Epidural or subdural hematoma
Epidural and/or paraspinal abscess
Tumour

Key Evidence

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Resources

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Case Studies

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References

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