DR Medhat MRCP

Diseases of spinal cord
Transverse myelitis
• Def :
- Transverse myelitis describes a heterogeneous group of conditions that are
characterised by acute or subacute motor, sensory and autonomic spinal cord
dysfunction.
• Pathogenesis :
- Interruption in ascending and descending pathways in the transverse plane of the spinal
cord → A sensory level is characteristic.
• Causes :
Autoimmune phenomenon after an infection or vaccination (main cause).
Direct infection.
Underlying autoimmune disease.
Acquired demyelinating disease
Idiopathic.
• Clinical features :
Acute (hours) or subacute (days –weeks) onset after an infection e.g URTI.
Midline (back) or dermatomal neuropathic pain.
Sensory level is characteristic .
Spastic paraparesis below the level of lesion.
Extensor planters.
Urine retention or incontinence/stool incontinence or constipation.
Sexual dysfunction : common
• Investigation of choice :
MRI :
- In acute phase : MRI may be normal.
- Myelitis enhances with the Gadollinium , may span ≥ vertebral segments.
• Treatment :
I.V pulse steroids followed by oral prednisolone : 1 st line
Plasma exchange : in non responsive cases
Long term immunsuppression : in demyelinating disease.
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