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Results for “Myelitis, Transverse”

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PubMed1990

[Acute transverse myelitis associated with ECHO-25 virus infection].

A case of acute transverse myelitis associated with ECHO-25 virus infection was reported here with a brief review of the literature. The patient was a 42-year-old house wife. Without any antecedent symptoms, weakness and paresthesia of bilateral lower extremities, and sphincter disturbance developed suddenly. Neurological examination revealed paraplegia of both legs, hyperreflexia of lower extremities, bilateral positive Babinski sign and impairment of all sensory modalities below Th4 level. No abnormality was found in myelography and CT myelography. Abnormal intensity area was found in lower cervical spinal cord on MRI. Serum antibody titer to ECHO-25 virus was elevated in the convalescent stage (X4096), and 7 month later from the onset of neurological symptoms, high value was continued (X128). We diagnosed her illness as acute transverse myelitis complicating ECHO-25 virus infection. In the literature, only 3 cases of transverse myelitis following ECHO virus infection (type 2, 5, 19) were found. This case seemed to be the first case of transverse myelitis associated with ECHO-25 virus infection.

Acute Disease↗

PubMedDate not supplied

Chronic recurrent transverse myelitis or multiple sclerosis.

The simultaneous occurrence of multiple sclerosis and transverse myelitis is known in the literature. Apart from the spinal symptoms, other neurological signs of brain involvement are usually found and magnetic resonance imaging (MRI) reveals disseminated foci in the brain. The positive evoked responses, the immunological abnormalities of the cerebrospinal fluid (CSF), and the oligoclonality together prove the presence of multiple sclerosis. In these cases the symptoms of transverse myelitis can separately precede other signs of multiple sclerosis, or appear as a relapse. Recurrent transverse myelitis as an independent entity, with negative MRI and CSF immunology, is an exciting topic in terms of the etiological factors and therapeutic considerations. The view in the literature is that the occurrence of transverse myelitis as an independent entity is rather rare. The present article reports the case of a female patient with recurrent spinal cord signs, and negative MRI and CSF immunology. During a ten-year follow-up observation period, symptoms of multiple sclerosis did not develop. Further studies of such cases are needed in order to clarify the etiological factors, the pathomechanism and the therapeutic considerations relating to this relatively new and probably independent clinical entity.

Adult↗

PubMed1992

The role of magnetic resonance imaging in acute transverse myelitis.

Eighteen adult patients presenting with acute transverse myelitis (ATM) were evaluated using magnetic resonance imaging. Only 7 had abnormal scans showing an area of increased signal intensity within the cord solely on T2 weighted images; T1 weighted images were normal. The MRI abnormality did not correlate with the cause of the transverse myelitis, the extent of maximum neurological deficit, or the prognosis. A scan performed more than 5 days after the onset of disease was most likely to be positive. Even though the prognostic value of MRI in ATM may be limited, it remains a valuable technique for ruling out other causes of noncompressive spinal cord lesions, such as hemorrhage, vascular malformation, or tumor.

Adolescent↗

PubMed1989

Acute transverse myelitis, a possible vascular etiology.

Seven acute transverse myelitis patients are presented, in whom the course of illness suggests a vascular pathogenesis. In the absence of predisposing risk factors for vascular accidents and such systemic symptoms as occur frequently in vasculitic syndromes, association in hypothesized with isolated angiitis of the central nervous system. Combined treatment with corticosteroids and cyclophosphamide is, therefore, suggested for severe cases of acute transverse myelitis, in whom no etiology can be found.

Acute Disease↗

PubMed2000

Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient.

PURPOSE: To report a case of transverse myelitis following inadvertent dural puncture and iatrogenic pneumocephalus and any possible causal relationship is explored. CLINICAL FEATURES: A 32-yr-old primigravida developed a severe headache associated with pneumocephalus following accidental dural puncture when the loss of resistance to air technique was used to locate the epidural space. She was treated with oxygen 100% to promote resorption of the air and the headache resolved. One month later she developed a sensory disturbance in her feet. Neurological examination revealed reduced sensation to cold and pain to ankle level and bilateral suppressed knee and ankle reflexes but was otherwise normal. A spinal cord lesion (epidural abscess/hematoma) was excluded with an emergency T1 and T2 weighted magnetic resonance imaging (MRI) scan of the lumbar spine. Over the next 48 hr the sensory disturbance worsened to involve her legs and waist. Examination revealed a sensory loss to waist level, reduced joint position sense and vibration sense in her lower limbs and absent knee and ankle reflexes bilaterally, but normal power in both her legs. A further full length T2 weighted MRI scan of the spine showed a small area of high signal at the level of T3 compatible with transverse myelitis. This was treated with high dose corticosteroids and her symptoms resolved over the next three months. CONCLUSION: The etiology of transverse myelitis after dural puncture in a parturient could not be identified nor could any causal link be established between the dural puncture, pneumocephalus, and subsequent transverse myelitis.

Adult↗

PubMed1994

Transverse myelitis--neurophysiological and MRI correlation.

Acute transverse myelitis (ATM) rarely involves the cervical spinal cord. We report on two patients with ATM and cervical cord involvement. Magnetic resonance imaging (MRI) revealed high intensity signals in T2 extending far beyond the sensory level in both patients. Motor evoked potential (MEP) was unrecordable in all but one limb, and there it was marginally prolonged. Tibial somatosensory evoked potential (SEP) was unrecordable while median SEP was normal in both patients. Both MEP and SEP correlated with their respective clinical deficits but MEP seemed to correlate better with the MRI changes.

Acute Disease↗

PubMed1996

Micturition disturbance in acute transverse myelitis.

In ten patients with acute transverse myelitis (ATM), seven patients had urinary retention, and the other three patients had difficulty in voiding within 1 month from the onset of the disease. Five of the patients with retention became able to urinate. After the mean follow-up period of 40 months, nine still had urinary symptoms including difficulty in voiding in five and urinary frequency, urgency and incontinence in four patients. Four patients had urinary disturbance as the sole sequel of ATM. Urodynamic studies performed on nine patients revealed that all of the three patients with the urgent incontinence had detrusor hyperreflexia, all of the four patients with retention had an areflexic cystometrogram as well as sphincter hyperreflexia, and three of five patients with voiding difficulty had detrusor-sphincter dyssynergia. An areflexic cystometrogram tended to change to a low compliance bladder, followed by detrusor hyperreflexia or a normal cystometrogram. Analysis of the motor unit potentials of the external sphincter revealed that two of the three patients had high amplitude or polyphasic neurogenic changes. Supranuclear as well as nuclear types of parasympathetic and somatic nerve dysfunctions seemed to be responsible for micturition disturbance in our patients with ATM.

Acute Disease↗

PubMed1999

[Acute transverse myelitis in systemic lupus erythematosus].

Acute transverse myelitis as complication of systemic lupus erythematosus is a known and well-characterized although uncommon clinical entity. We report here four cases of lupic myelitis collected at our hospital in the last few years and review the available literature of the last ten years, approximately the time when NMR became generally available. The clinical picture can be very variable and therefore, when facing a picture of acute myelitis, lupus should be included in the differential diagnosis; biochemistry evaluating the lupus "activity" is of poor diagnostic value, nuclear magnetic resonance is not conclusive for the etiologic diagnosis of myelitis and its prognosis has improved with therapy including pulses of steroid and immunosuppressant agents.

Acute Disease↗

PubMed1995

Transverse myelitis as a first manifestation of systemic lupus erythematosus: a case report.

Transverse myelitis as a first manifestation of systemic lupus erythematosus (SLE) is very uncommon. No pathognomonic clinical or biochemical characteristics exist, and therefore an early diagnosis is often difficult. Therapy with intravenous pulses of methylprednisolone and cyclophosphamide has been shown to improve the prognosis. However, morbidity and mortality rates in transverse myelitis are still high due to the fact that complications such as opportunistic infections and pulmonary embolism are still frequent causes of death. We report a woman with relapsing transverse myelitis which was the first manifestation of SLE. A good response to pulse methylprednisolone and cyclophosphamide therapy was obtained but she died later as a result of a pulmonary embolism. We conclude that intravenous pulse methylprednisolone and cyclophosphamide therapy improve the prognosis of transverse myelitis associated with SLE but that a careful follow-up is needed to avoid complications due to the illness itself or secondary to the therapy.

Female↗

PubMedDate not supplied

Idiopathic transverse myelitis: MR characteristics.

PURPOSE: To describe the MR characteristics that can distinguish idiopathic transverse myelitis from other intramedullary lesions. METHODS: A total of 32 initial and follow-up MR studies in 17 patients with clinically proved transverse myelitis were reviewed retrospectively. The location, size, pattern, and segmental length of areas of hyperintensity were estimated on T2-weighted axial and sagittal images. In 15 of the patients, whose neurologic abnormalities were limited to the spinal cord, the location and pattern of intramedullary contrast enhancement were evaluated on sagittal and axial T1-weighted images. Follow-up MR studies were available for 10 patients. The statistical significance of cord enhancement between the groups with and without cord expansion was calculated. RESULTS: Common MR findings of idiopathic transverse myelitis included a centrally located hyperintensity occupying more than two thirds of the cross-sectional area of the cord (88%); a length of 3 to 4 vertebral segments (53%), with variable presence of cord expansion (47%); a small central area of intensity, isointense with normal cord, in the core of hyperintensity (47%); focal, peripheral cord enhancement (53%), particularly in patients with cord expansion; and a slow regression of T2 hyperintensity with an enhancing nodule. Although no linear correspondence was observed between MR findings and neurologic signs and symptoms, all but 4 patients improved clinically as MR findings improved or remained stable. CONCLUSIONS: MR findings are helpful in detecting transverse myelitis and in differentiating this entity from multiple sclerosis and cord tumors, but clinical assessment and observation of MR changes over time are essential in making the diagnosis.

Adult↗

PubMed1998

Acute transverse myelitis in systemic lupus erythematosus: a case of rapid diagnosis and complete recovery.

Acute transverse myelitis is a rare and serious complication of systemic lupus erythematosus. Delay in diagnosis and treatment is associated with significant morbidity and mortality. Earlier diagnosis is facilitated by magnetic resonance imaging. Treatment of systemic lupus erythematosus-related acute transverse myelitis remains controversial. The use of steroids alone may result in incomplete recovery. We report a patient who was promptly diagnosed with systemic lupus erythematosus-related acute transverse myelitis by magnetic resonance imaging. The patient had complete resolution of her symptoms following aggressive treatment with steroids and cyclophosphamide. Review of published treatment of systemic lupus erythematosus-related acute transverse myelitis suggests aggressive therapy with steroids and cyclophosphamide may provide the best outcome.

Acute Disease↗

PubMed2002

Bladder dysfunction in acute transverse myelitis: magnetic resonance imaging and neurophysiological and urodynamic correlations.

AIMS: To evaluate micturition abnormalities in acute transverse myelitis and correlate these with evoked potentials, magnetic resonance imaging (MRI), and urodynamic findings. SETTING: Tertiary care teaching hospital. PATIENTS: 18 patients with acute transverse myelitis, aged 4-50 years; 15 had paraparesis and three quadriparesis. METHODS: Patients with acute transverse myelitis had a neurological evaluation and tibial somatosensory and motor evoked potential studies in the lower limbs. Spinal MRI was carried out using a 1.5 T scanner. Urodynamic studies were done using Dantec UD 5500 equipment. Neurological outcome was determined on the basis of Barthel index score at six months as poor, partial, or complete. In some patients, urodynamic studies were repeated at six and 12 months. RESULTS: Spinal MRI in 14 of the 18 patients revealed T2 hyperintense signal changes extending for at least three spinal segments in 13; one patient had normal MRI. In the acute stage, 17 patients had a history of urinary retention and one had urge incontinence. On follow up at six months two patients regained normal voiding, retention persisted in six, and storage symptoms developed in 10, of whom five also had emptying difficulties. Urodynamic studies showed an areflexic or hypocontractile bladder in 10, detrusor hyperreflexia with poor compliance in two, and detrusor sphincter dyssynergia in three. Early abnormal urodynamic findings commonly persisted at the six and 12 months examinations. Persistent abnormalities included detrusor hyperreflexia, dyssynergia, and areflexic bladder. The urodynamic abnormalities correlated with muscle tone and reflex changes but not with sensory or motor evoked potentials, muscle power, MRI signal changes, sensory level, or six months outcome. CONCLUSIONS: Bladder dysfunction is common in acute transverse myelitis and may be the only sequel. Urodynamic study is helpful in evaluating the bladder dysfunction and also in its management.

Adolescent↗

PubMed2003

Transverse myelitis secondary to coexistent Lyme disease and babesiosis.

OBJECTIVE: To describe transverse myelitis secondary to coexistent Lyme disease and babesiosis. METHOD: Case report. BACKGROUND: A 74-year-old man presented with rapid onset of weakness, numbness, and tingling in his legs, with symptoms ascending to his hands and forearms within days. He recalled an insect bite to his scapular area 2 weeks earlier. FINDINGS: T2-weighted magnetic resonance imaging demonstrated diffuse hyperintensity from T1 through T12. Western blot and enzyme-linked immunosorbent assay identified infection with Borrelia burgdorferi, the spirochete responsible for Lyme disease. Giemsa-stained blood smears identified ring forms later recognized by polymerase chain reaction as Babesia microti, the piroplasm responsible for babesiosis. Initial examination revealed C7 motor and T3 sensory complete tetraplegia, with recovery to T4 paraplegia by 2 months. CONCLUSION: The history, physical examination, imaging, and serologic studies were consistent with transverse myelitis related to Lyme disease and babesiosis. The severity and permanence of this patient's deficits were greater than those reported in the majority of previous cases of transverse myelitis due to Lyme disease alone, suggesting a possible role for coinfection with babesiosis.

Aged↗

PubMed1998

Acute transverse myelitis caused by Coxsackie virus B4 infection: a case report.

Acute transverse myelitis is a rare clinical manifestation of Coxsackie virus infection which cause acute and progressive debilitating illness associated with loss of spinal cord function in the affected patients. A 62 year-old female developed symptoms of rapidly progressive paraplegia with sensory loss. On spinal MRI, T2 sagittal image showed increased signal intensity with cord swelling at T11-L2 level and 8 folds or greater rise of Coxsackie virus B4 neutralizing antibody titers was observed in the CSF. There is only one previous report of acute transverse myelitis caused by Coxsackie virus B4 infection to our knowledge. The presence of specific viral antibody titers change in the CSF and a corresponding spinal cord lesion are sufficient to suggest a causal relationship between the virus and the illness. This article is a case report of an unusual acute transverse myelitis caused by Coxsackie virus B4 infection.

Acute Disease↗

PubMed2005

Acute transverse myelitis in a 7-month-old boy after diphtheria-tetanus-pertussis immunization.

STUDY DESIGN: Case report of a 7-month-old boy, who developed acute transverse myelitis after diphtheria-tetanus-pertussis immunization. OBJECTIVES: To describe the clinical course of acute transverse myelitis in an infant and to review the literature regarding the association of acute transverse myelitis and vaccinations. SETTING: Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA. METHODS: Case report. RESULTS: Magnetic resonance imaging (MRI) on admission demonstrated diffuse spinal cord edema with increased signal on T-2 weighted images and faint enhancement with gadolinium infusion. Urologic symptoms improved with steroids but motor function was never fully regained. Repeat MRI of the spinal cord several months later showed diminution of cord diameter with resolution of edema and signal abnormality. CONCLUSION: Based on the clinical course and MRI findings, the daignosis of acute transverse myelitis was made. The association of previously received DPT immunization and the genesis of transverse myelitis is explored.

Diphtheria-Tetanus-Pertussis Vaccine↗

PubMed2005

Idiopathic severe recurrent transverse myelitis: a restricted variant of neuromyelitis optica.

Recurrent idiopathic transverse myelitis occur in multiple sclerosis (MS) and neuromyelitis optica (NMO). In NMO, acute optic neuritis and myelitis occur, either monophasic or relapsing, without clinical manifestations of involvement of other parts of the central nervous system (CNS). Recent evidence suggests that NMO is different from multiple sclerosis. The authors reported two patients having severe recurrent transverse myelitis sparing the optic nerves and cerebral hemispheres. Both patients had longitudinally extensive myelitis in some attacks with poor neurological outcome despite aggressive immunomodulatory therapy. One patient had prominent clinical features of brainstem injury with radiological and histological confirmation of brainstem involvement, and the other patient had trigeminal neuralgia suggestive of possible brainstem dysfunction. Histologically, prominent necrosis and neutrophilic infiltration of spinal cord tissue without eosinophils or hyalinized vessels were observed, and oligoclonal bands were absent in their cerebrospinal fluid. It is likely to be a distinct idiopathic inflammatory demyelinating disorder restricted to the spinal cord and brainstem different from MS, but within the spectrum of NMO with probably an autoimmune basis.

Adult↗

PubMed1976

Comparative analysis of the therapy of acute transverse myelitis.

Three methods of treatment of acute transverse myelitis are presented. The first group of 16 patients were treated with antibiotics (average age 32.1). Three patients died, 11 remained unrecovered, while in two cases remarkable improvement was recorded. The second group of 15 patients, whose average age was 32.4, were treated with corticosteroid per os or instrumuscularly. Four of the patients died (three of them with ascendent course of disease), there was no change in five cases, while marked improvement ("cured" and "walking with assistance") was recorded in the remaining six cases. The third group of ten patients, eight women two men, ranging from 15 to 47 years of age (average age 26.9) was treated with methylprednisolone acetate intrathecally. Five patients were practically cured after 3 to 4 weeks. Two patients were cured to an extent that they could walk with assistance. In two cases no improvement was recorded, while one of the patients, who in addition suffered from serum myelitis, died of bilateral bronchopneumonia. In all these cases the drug was administered comparatively late, on the 6th or 7th day ofthe disease.

Acute Disease↗

PubMedDate not supplied

Acute transverse myelitis in children.

A case of Acute Transverse Myelitis (ATM) is presented. ATM is a rare disease in childhood. The diagnosis stems from the clinical presentation, cerebrospinal fluid findings, appearance of the spinal cord on imaging and ruling out differential diagnoses like Guillain-Barre syndrome (GBS) and Poliomyelitis. The proposed treatment is intravenous (IV) methyl prednisolone with variable chances of recovery. A controlled multicenter study is suggested to assess epidemiology, etiology and prognosis of ATM.

Acute Disease↗