Makindo Medical Notes

📖 About

• Transverse Myelitis = inflammatory disorder of the spinal cord, affecting grey + white matter and producing motor, sensory, and autonomic dysfunction.
• 🧍‍♂️ Bimodal distribution: most common in ages 10–20 and >40 years.
• Symptoms vary depending on cord level and whether the lesion is partial or complete.

🔬 Aetiology

• Involves both grey and white matter → wide range of deficits.
• Lesion may be partial (one side/segment) or complete (whole cord cross-section).

🧾 Causes

• ⚡ Autoimmune: MS, ADEM, Neuromyelitis Optica (NMOSD).
• 🌐 Systemic Autoimmune Disease: SLE, Sjögren’s, vasculitis, sarcoid.
• 🦠 Infections: Viral (HIV, EBV, Coxsackie, Zika), Bacterial (Mycoplasma), rare fungal/parasitic.
• 🎗 Paraneoplastic: esp. small-cell lung cancer.
• 💉 Post-vaccination: Rare, causality debated.

⚡ Risk Factors

• Recent infection.
• History of autoimmune disease.
• Genetic predisposition to demyelination.
• Occasional link with recent immunisation.

🩺 Clinical Presentation

• ⏱ Onset: Rapid (hours–days) or subacute (weeks).
• 🌡 Initial: Fever, back pain, myalgia, “band-like” tightness around trunk.
• ⚡ Pain: Often sharp, radiating along dermatomes.
• 💪 Weakness: Spastic paraparesis or quadriparesis.
• 🧊 Sensory loss: Numbness, tingling, loss of pain/temp below level.
• 🚽 Autonomic: Urinary retention, incontinence, constipation.

🖼 MRI

🚨 Red Flags

• Sudden severe progression of weakness.
• Respiratory involvement → cervical/high thoracic lesions (can cause ventilatory failure).
• Systemic “B symptoms”: fever, night sweats, weight loss (consider infection/malignancy).

🧪 Investigations

• 🖥 MRI + contrast: Exclude compression, shows T2 hyperintensities spanning ≥3 vertebral segments in NMOSD.
• 💉 CSF: Pleocytosis, raised protein, oligoclonal bands (MS).
• 🧬 Bloods: ANA, ANCA, HIV, EBV, syphilis, aquaporin-4 antibodies (NMOSD).
• ⚡ Evoked Potentials: Detect conduction block in demyelinating disease.

🔍 Differential Diagnosis

• Spinal cord compression (tumour, disc, abscess).
• Multiple sclerosis.
• Spinal cord infarction.
• Neuromyelitis optica spectrum disorder (NMOSD).
• SLE/Sjögren’s-related myelopathy.

💊 Management

• Acute Phase:
  • 💉 IV methylprednisolone (3–5 days) → dampens inflammation, improves recovery.
  • 🩸 Plasma exchange (PLEX) → for steroid-refractory cases, esp. NMOSD.
  • 💉 IVIG → alternative in autoimmune or post-infectious causes.
• Supportive Care: Pain relief, catheterisation, physio, OT.
• Long-term: - Disease-modifying therapy if underlying MS/NMOSD. - Immunosuppression in SLE, Sjögren’s, sarcoid. - Regular rehab to optimise function.

📈 Prognosis

• Variable → some recover fully, others left with deficits.
• Better outcomes with early steroids & limited lesion length.
• NMOSD-related transverse myelitis often severe, relapsing, long cord lesions (“longitudinally extensive TM”).

📝 Exam Pearl: TM = motor + sensory + autonomic dysfunction. Red flag = rapid onset with preserved dorsal column sensation → think infarction instead. Always exclude compressive lesions on MRI before labelling “transverse myelitis.”