Transverse myelitis - Disorders of the spinal cord

Transverse myelitis

Definition

Acute inflammation of the spinal cord.

Aetiology

Causes include syphilis, viral and mycoplasma infections, multiple sclerosis, systemic lupus erythematosus and postradiation therapy. Some cases have been reported post-vaccination. Many cases are idiopathic.

Pathophysiology

Inflammation may be due to vasculitis, or the preceding infection. There is oedema of the cord, which causes upper motor neurone signs below the level of the lesion, usually a paraparesis, and sensory loss up to the level of the lesion. Sphincter dysfunction may occur.

Clinical features

Spinal shock, i.e. a flaccid weakness may initially occur, which then becomes a spastic paraparesis. The patient may complain of a tight band around the chest, which may suggest the level of the lesion. Upper motor neurone signs are found below the lesion. Occasionally lower mo-tor neurone signs are found at the level of the lesion, due to involvement of the anterior horn cells.

Investigations

MRI may show oedema and excludes a space-occupying lesion. CSF may be normal, or show increased protein content and pleocytosis. Other investigations are directed at the underlying cause, e.g. syphilis serology, mycoplasma titres, anti-dsDNA (for SLE).

Management

Steroids may be used, once infection has been excluded, to speed recovery. Vasculitis may need aggressive management. Supportive management, including physiotherapy.

Prognosis

Most idiopathic and postinfectious cases improve with time.