Transverse myelitis: Difference between revisions
(→Source) |
|||
| Line 21: | Line 21: | ||
==Management== | ==Management== | ||
*Must rule-out compressive lesion of the cord | *Must rule-out compressive lesion of the cord | ||
*MRI | *[[MRI]] | ||
**May show cord swelling | **May show cord swelling | ||
*LP | *[[LP]] | ||
**Contains monocytes, protein content is slightly increased, and IgG index is elevated<ref>http://www.merckmanuals.com/professional/neurologic_disorders/spinal_cord_disorders/acute_transverse_myelitis.html</ref> | **Contains monocytes, protein content is slightly increased, and IgG index is elevated<ref>http://www.merckmanuals.com/professional/neurologic_disorders/spinal_cord_disorders/acute_transverse_myelitis.html</ref> | ||
*Foley for bladder decompression | *Foley for bladder decompression | ||
*Consider work up for clotting disorder for spinal artery thrombosis, drug user, risk for aortic dissection | *Consider work up for clotting disorder for spinal artery thrombosis, drug user, risk for [[aortic dissection]] | ||
*Admit for corticosteroids and plasma exchange | *Admit for [[corticosteroids]] and plasma exchange | ||
*The more rapid the progression is, the worse the prognosis | *The more rapid the progression is, the worse the prognosis | ||
Revision as of 07:41, 27 January 2015
Background
- Inflammatory disorder that involves a complete transverse section of the spinal cord
- Results from viral infection, postvaccination or as part of MS, SLE, or cancer
- May present exactly like a compressive lesion of the spinal cord
- Usually thoracic origin, rarely cervical spine
Clinical Features
- May progress over days-weeks
- Neck or back pain + neuro complaints:
- Bilateral motor, sensory, and autonomic disturbances
- Fecal/urinary retention and incontinence
Differential Diagnosis
Weakness
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Spinal Infarct
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- Other
Diagnosis
- Neurologic findings that are c/w epidural compression but normal MRI
Management
- Must rule-out compressive lesion of the cord
- MRI
- May show cord swelling
- LP
- Contains monocytes, protein content is slightly increased, and IgG index is elevated[1]
- Foley for bladder decompression
- Consider work up for clotting disorder for spinal artery thrombosis, drug user, risk for aortic dissection
- Admit for corticosteroids and plasma exchange
- The more rapid the progression is, the worse the prognosis
Source
- Tintinalli
- Perron AD, Huff JS. “Spinal Cord Disorders,” in Rosen’s Emergency Medicine Concepts and Clinical Practice, edited by Marx JA, Hockberger RS, Walls RM, et al., 1389-1395. Philadelphia: Mosby, 2010.