ACUTE TRANSVERSE MYELITIS
Acute transverse myelitis is characterized by abrupt onset of progressive weakness and sensory disturbances in lower extremities following viral infections, e.g. EBV, HSV, Influenza, rubella, varicella, etc.
Etiologically, Transverse myelitis is thought to be the result of direct viral invasion of the spinal cord, or more likely, an immunological reaction to viral infections.
Clinically, these cases present with:
• Prodromal features, e.g. fever, nuchal rigidity, low backache and parasthesia following a viral infection.
• Acute flaccid parelysis of lower limbs with loss of external senses, e.g. pain and temperature but preservation of proprioceptive senses, e.g. position and vibration. Sensory involvement has a characteristic identifiable spinal level. Bladder involvement is common.
• Changing course from flaccid to spastic lesions, over next few days with appearance of upper motor neuron signs.
Diagnosis is mainly clinical, based on sensory level and the change from flaccid to spastic paralysis. CSF is normal or shows mild elevation of proteins and cells. MRI reveals mild to moderate fusiform swelling in the affected region. Early cases must be differentiated from other causes of acute flaccid paralysis.
Management is largely supportive including general nursing care, treatment of complications and physiotherapy. Spontaneous recovery occurs in ~ 60% cases within few months with residual deficit. High-dose steroids, e.g. methylprednisolone may be beneficial in initial stages of the disease. other therapeutic approaches include IV immunoglobulin, plasmapherersis or Rituximab in refractory cases.
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