Transverse myelitis is a neurological disorder caused by inflammation of the spinal cord. The term of myelitis refers to an inflammation of the spinal cord, while the term of transverse refers to the location of the inflammatory process. The condition can be found both to children and adults.
Determining the exact cause of transverse myelitis installation is unknown. It was observed that the transverse myelitis can occur as a result of a viral infection that can be caused by herpes simplex virus, Epstein-Barr virus, influenza virus, enterovirus, measles, rubella, chicken pox or HIV infection. Also it can be cause by bacterial infection with Mycoplasma pneumoniae or with Treponema pallidum (etiologic agent of syphilis). Transverse myelitis can be determined by an autoimmune process or a recent vaccination.
Transverse myelitis may occur in some disease, such as:
- Multiple sclerosis;
- Systemic lupus erythematosus;
- Sjogren’s syndrome;
- Spinal arterio-venous malformation;
- Spinal artery thrombosis.
Inflammation of the spinal cord will cause damage or destruction of the myelin ( the layer that surrounds the axons of neurons), which will affect the relationship between spinal cord and whole body.
The symptoms that appear are rapidly worsen in a few hours or a few weeks. In most patients, symptoms develop within 24 hours. The firs symptom is pain of the back, which may radiate to the upper or lower limbs. Pain may be accompanied by moderate fever, burning sensation when the patient urinate, loss of appetite or headaches.
Gradually, can appear signs of spinal suffering, which can be represented by:
- paresthesia: numbness or abnormal sensation;
- paraplegia: paralysis of the arms or legs;
- tetraplegia: paralysis of all 4 members.
Other symptoms may appear such as:
- Sensitive disorder that is manifested by anesthesia;
- Sphincter disorders like loss of urine, constipation or sensation of incomplete evacuation of the colon;
- Vasomotor and trophic disorders which are represent by vasoparalisy that causes cyanosis and edema which determines pressure sores, whose superinfection can cause spesis;
- Respiratory infection.
Diagnosis is established on patient history, neurological examination and laboratory investigations which will determine with certainty if is transverse myelitis. Among para-clinical investigations required to establish the diagnosis include:
- Cerebrospinal fluid examination;
- Blood tests.
There is no specific treatment for transverse myelitis. Treatment can be used just for the improvement of the symptoms. A patient with transverse myelitis may receive:
- Corticosteroids like dexamethasone or methylprednisolone;
- Group B vitamins.
Fever should be treated only at very high, because it appears to disfavor the viral infection.
In cases with significant respiratory disorders that endanger the patient’s life, it will require placing the patient in the ICU. After the transition period of acute inflammation, massage and passive mobilization of paralyzed segments are necessary.
The prognosis of patients with transverse myelitis is darkened by pressure sores and disorders of the sphincter, because the superinfection of this lesions leads to reinfection of the spinal cord. Maild forms may remit by themselves. Unfortunately, many patients are cured but will remain important sequelae, while in other cases healing is not possible.