Transverse Myelites

INTRODUCTION :

                        Transverse Myelites is an inflammation of a Spinal cord that extends horizontally  affecting both sides of the same section of the Spinal cord which is characterized by definite sensory or motor levels.

EPIDIMIOLOGY :

• Its is a rare disease.
• Its occurs most often in children age 10 to 19 and in adults age 30 to 39, but it can happen at any age.
• Mostly affects females
• Common site - thoracic region

ETIOLOGY:

• Infection
• Autoimmune Disease- lupus
• Idiopathic -(NO identifiable cause)
• Spinal malformation
• Spinal injuries
• Athelosclerosis – demand for oxygen(If parts of the spinal cord don’t have enough oxygen, nerve cells often begin to die. The dying tissue can cause the inflammation that leads to transverse myelitis.)

The inflammation that leads to transverse myelitis can result as a side effect of a number of other conditions, including:

• Lyme disease

• Syphilis

• Measles

• Viral infections - direct or post viral infection

• Bacterial infections

NORMAL MECHANISM :

• Neuron consist of Axon
• The axon is surrounded by Myelin sheeth

• The myelin sheeth is responsible for fast conduction of Action potential through the axon.
• Without myelin sheeth there will be a very slow or insufficient to conduct action potential  to the target organ.

PATHOGENISIS :

1.Molecular mimic theory :

• During an viral infection our immunue system wipe out all pathogens from the body by producing Antibody
• Molecular mimic theory says that proteins in  myelin sheeth of axon mimic same as the viral proteins
• Result in the cross reaction between the antibody (already produced to wipe out the viral infection ) and the myelin sheeth -Auto immunue reaction
• It destroy the myelin of the axon so there is an interept in signaling (message cannot process from brain to target organ or target organ to brain )

2.Direct invasion -Virus directly invade the spinal neurons

3.Auto immune vasculitis - immunue system attacks the blood vessels that supply the spinal cord - ischemic lesion -cells die - inflammation -Transverse myelitis

CLINICAL FEATURES:

Usually the symptoms are defined Sensory/ motor  Level – symptom occur below the area affected. 

       

Four classic features of transverse myelitis are:

• Weakness of the legs and arms.  People with transverse myelitis may have weakness in the legs that progresses rapidly.  If the myelitis affects the upper spinal cord it affects the arms as well.  Individuals may develop paraparesis (partial paralysis of the legs) that may progress to paraplegia (complete paralysis of the legs), requiring the person to use a wheelchair.  
• Pain.  Initial symptoms usually include lower back pain or sharp, shooting sensations that radiate down the legs or arms or around the torso.
• Sensory alterations.  Transverse myelitis can cause paresthesias (abnormal sensations such as burning, tickling, pricking, numbness, coldness, or tingling) in the legs, and sensory loss.  Abnormal sensations in the torso and genital region are common.  Sometimes the shooting sensations occur when the neck is bent forward and resolve when the neck is brought back to normal position (a condition called Lhermitte’s phenomenon).
• Bowel and bladder dysfunction.  Common symptoms include an increased frequency or urge to use the toilet, incontinence, difficulty voiding, and constipation.

The symptoms depends on what tract of spinal cord is involved

        

Corticospinal tract     -weakness of problems with Voluentary muscle movement

Spinothalamic Tract     – loss of Temperature & Pain Sensation

Dorsal-column             – problems with Balance & spastial orientation

                   

DIAGNOSIS:

1)    Lumbar puncture – 

•      Needle used to collect CSF fluid from spinal cord
•     shows increase in WBC in CSF(cerebro spinal fluid)

           2) MRI – used to spot the area of inflammation

TREATMENT:

1)    1.Steroids – Supress the activity of immune system,drugs may include methylprednisolone or dexamethasone (usually administered for 3 to 7 days 

     2.Pain relieves – eg: ibuprofen or acetaminophen

3)   3.Plasma exchange – 

• also known as plasmapheresis, is a way to "clean" your blood.It works  like kidney dialysis.During the treatment, plasma (the liquid part of your blood) gets replaced with plasma from a donor or with a plasma substitute
• Transverse myelitis patient's plasma could have certain proteins that are attacking their own body. When we take out the plasma, they will  get rid of those proteins, and symptoms may get better.

4.Treatement for permenent disability :

                   Permenent disability such as muscle stiffness,loss of bowel or bladder fuction ,muscle weakness and paralysis can occur in transverase myelitis.

a.Physical theraphy : increase muscle strength ,improve coordination and help gain control over bladder and bowel function.

b.Occupational theraphy : helps in doing everyday activities like bathing

c.Psychotheraphy : for the depressed or sad.

RECOVERY:

• Recovery from transverse myelitis usually begins from to 12 weeks after the first experience symptoms.
• Recovery can takes upto two years.
• Some may recover without disability some may recover poorly  experience permanent disability
• Most peoples have only one episodes of transverse myelitis