TRANSVERSE

MYELITIS
TERMS

• MYELITIS Spinal cord

• NEURITIS Axon
• RADICULITIS Root
• POLIOMYELITIS Gray matter
• LEUKOMYELITIS White matter
• TRANSVERSE MYELITIS Whole cross sectional
• MENINGOMYELITIS Meninges & spinal cord
• MENINGORADICULITIS Meningeal & root
• PACHYMENINGITIS Spinal dura
• EPIDURAL SPINAL ABSCESS Epidural space
• GRANULOMA Subdural space
DEFINITION

• Neurological disorder caused by inflammation

affects gray and white matter across both sides
of one level, or segment, of the spinal cord
• a demyelinating (loss of the fatty tissue around the nerves)
disorder of the spinal cord.
• a clinical syndrome , Not a true disease
• Also called acute transverse myelopathy
EPIDEMIOLOGY

• Adults and children (peak 10-19 years and 30-39 years)

• Both genders, all races
• Is not inherited
• Incidence : UK 300, US 1400
SITE OF ENTRY
• Respiratory tract
• Gastrointestinal tract : poliovirus
• Subcutaneous tissue
• Peripheral nerves
-antegrade
-retrograde transport : rabies, polio

PREDILECTION
• Thoracic cord
• Cervical cord
 ETIOLOGY

• INFECTION : - Viral, Bacterial, Fungal, Parasitic,

• AUTOIMMUNE :
- PERIINFECTION (Measles, varicella, rabies, typhoid)
- POSTINFECTION
- POSTVACCINAL (Rubella, Diphteria, Polio)
• MULTIPLE SCLEROSIS
• NEOPLASTIC (paracarcinomatosis necrosis)
• TOXIC (secondary to heroin inj.)
• VASCULAR (Vascular insufficiency)
• DEGENERATIVE (irradiation)
• IDIOPATHIC
INFECTIONS
HERPES ENTEROVIRUS RETROVIRUS
EBV Coxsackie HTLV -I and II
VCV Echovirus HIV
CMV Hepatitis
HSV Rubella OTHERS
HHV6 Measles Influenza
Herpes B Mumps West Nile
Polio Rabies

BACTERIA FUNGAL PARASITIC

Lyme Cryptococcal Schistosomiasis
Mycoplasma Toxoplasmosis
Yersinia Cysticercosis
Catscratch Toxocariasis
Syphilis Gnathostoma
Tuberculosis Angiostrongyllus
• EBV : mononucleosis, prognosis good
• VZV : reactivation of shingles
• CMV : immunocompromise (AIDS)
• HSV : aggressive with necrosis of spinal cord
associated with encephalopathy
• HHV6 : rare, relation to multiple sclerosis
• Herpes B : expossure to monkey
SYMPTOMS & SIGNS

• Acute (hours yo several days)

• Subacute (over 1-2 weeks)
• Chronic ( > 6 weeks)

• Leg weakness
• Sensory level disturbance (ascending paresthesia)
• Urinary bladder & bowel dysfunction
• Back pain (interscapular region)
PATHOLOGY

• Necrosis of the cord (center)

• Posterior nerve root
• Posterior root ganglion
DIAGNOSIS

• Imaging (MRI) : - negative

- mild swelling of the cord
• Myelography ± subarachnoid block
• CSF : - elevation protein
- pleocytosis (monocytes)
• Elevated IgG level
• Causa : - PCR : proteins of viral DNA
- serology
- culture CSF
DIFFERENTIAL DIAGNOSIS

• GUILLAIN-BARRE SYNDROME
• ANTERIOR SPINAL ARTERY OCLUSION
• ACUTE CORD COMPRESSION
• EPIDURAL ABSCESS, HEMATOMA
• TUMOR
• ACUTE MENINGOVASCULAR SYPHILIS
• MYCOPLASMAL INFECTION
• MULTIPLE SCLEROSIS
TREATMENT

• No efective cure
• Depend on underlying cause (infection, connect. tissue)

• MS, idiopathic, postvaccinial, post infection :

- Methylprednisolone, 250-500 mg/12 hours, 3-7 days, follow
- Prednison oral, 60-80 mg/day, 7 days
tapp. 10mg/ 4days
- Dexamethasone : 10mg iv, follow 6 x 4-6mg/days

• Physiotherapy
PROGNOSIS

• Recovery :
2-12 weeks  good
3-6 months  poor

• 1/3 full recovery : walk normally, minimal paresthesia

1/3 fair recovery : spastic gait, sensory dysf, incontinence
1/3 no recovery : wellchair - bedridden

• Majority only one episode

some (MS, SLE) recover than relapse