Myelitis includes a wide range of inflammatory lesions of the spinal cord encompassing diverse pathological processes which may be infective or non-infective.
When there is a transverse and complete spinal syndrome it is referred to as transverse myelitis.
Etiology
- Myelitis may be due to viral infection of the cord, the more common being poliomyelitis and herpes zoster virus infection and the epidemic form of the enterovirus 70 (EV70).
- Rabies virus can cause transverse myelitis.
- Bacterial infections, meningo-vascular syphilis, tuberculosis, parasitic and fungal infections of the cord are other infective causes.
- The old myelinated spinal cord anti-rabies vaccine is reported to cause myelitis in 1 in 10,000 vaccinated persons. The new human diploid vaccine is much safe.
- Multiple sclerosis and necrotic myelitis are the non-infective forms of myelitis.
Pathology
- There may be selective destruction of neurons, meninges and white matter of the brain alone or in combination with grey matter.
- The cord is edematous, hyperemic and infiltrated with inflammatory cells. The nerve cell destruction may be selective e.g. the herpes zoster virus affected mainly the dorsal root ganglia and the poliomyelitis affect, anterior horn cells.
- In severe cases, softening of the cord (myelomalacia) may be present.
Symptoms and Clinical Features of Transverse Myelitis
- Onset of symptom may be acute or sub-acute. It starts with pain in the back; the thoracic region is most often involved. Partial or complete paralysis sets in rapidly.
- Sensory loss may be complete or incomplete, which occurs below the level of lesion.
- A zone of increased sensation is present between the area of sensory loss and the area of normal sensation.
- Bladder is involves causing urinary retention in acute stage.
- Loss of reflexes marks this phase of spinal shock.
- Abdominal reflexes are absent. Subsequently plantar response becomes extensor.
Diagnosis of Transverse Myelitis
- Cerebrospinal fluid (CSF)
- The CSF pressure is usually normal. There is considerable increase in its protein content.
- CSF cell count may be normal in few or may be elevated.
- Myelogram may show subarachnoid shock due to edema of cord.
Transverse Myelitis Treatment
- General treatment is along the lines indicated for the treatment of acute paraplegia, including care of skin, bladder, bowels and physiotherapy.
- ACTH, corticosteroids and immunosuppressant have been tried, but their usefulness is doubtful.
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I have recently been diagnosed with ATM at T11 secondary to SLE. I was making excellent recovery following pulse methlyprednisolone treatment and oral prednisone. A week following discharge, I had all my motor functions returned and about half of my sensory modality changes back to normal. However, last evening I stood for an hour and following this, developed moderate to severe lower lumbar pain, localized around L4 L5 as well as a “flare” up of my sensory symptoms. My legs are again burning and my feet more numb than ever before. I am concerned as I did not have much back pain during the course of my acute phase and it is now constant. Should I go back for reassessment or is it possible this is just an MSK-irritating-nerve type of thing?
Myelitis is inflammation of the spinal chord. It can occur due to some viral infection, there is gradual recovery. In most cases there is no recurrence of the disease, but it will depend on the individual’s immunity to the external environment. He should build his immunity by eating healthy food which contains vitamins, minerals, proteins, carbohydrates, fats.