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1. MAGBURAKA GOVERNMENT
HOSPITAL
FENTY BENK SANKOH
School of Clinical Sciences, Makambo Makeni
23/07/19
TRANSVERSE
MYALITIS
INTERNAL MED. 2

2. TRANSVERSE
MYALITIS
The spinal cord carries
nerve signals to and from the
brain through nerves that
extend from each side of the
spinal cord to elsewhere in
the body. The term myelitis
refers to inflammation of the
spinal cord; transverse refers
to the pattern of changes in
sensation

3.  DEFINITION
 Transverse Myelitis (TM) is a
rare neurological disorder of the
spinal cord, caused by
inflammation and occurring across
one spinal segment, leading to
severe motor, sensory and
autonomic dysfunction .
 This disorders may damage or
destroy myelin, the fatty white
insulating substance that covers
nerve cell fibers.
TRANSVERSE
MYALITIS

5. EPIDEMIOLOGY
 Transverse myelitis can affect people of any age, gender,
or race. It does not appear to be genetic or run in
families. A peak in incidence rates appears to occur
between 10 and 19 years and 30 and 39 years. It is
estimated that about 1,400 new cases of transverse
myelitis are diagnosed each year in the United States.

6.  In autoimmune disorders, antibodies incorrectly bind to
normal body proteins. Aquaporin-4 is a key protein that
carries water through the cell membrane of neural cells.
The myelin oligodendrocyte glycoprotein sits on the
outer layer of myelin.
PATHOPHYIOLOGY
 The discovery of circulating antibodies to the proteins
aquaporin-4 and anti-myelin oligodendrocyte point to a definite
cause in some individuals with transverse myelitis. These are
antibodies /proteins produced by cells of the immune system that
bind to bacteria, viruses, and foreign chemicals to prevent them from
harming the body

8.  A number of conditions appear to cause transverse myelitis,
including
 Immune system disorders
These disorders appear to play an important role in causing damage to
the spinal cord such disorders are aquaporin-4 autoantibody
associated neuromyelitis optica multiple sclerosis.
 Post-infectious or post-vaccine autoimmune phenomenon
In which the body’s immune system mistakenly attacks the body’s own
tissue while responding to the infection or, less commonly, a
vaccine
 An abnormal immune response
This is due to an underlying cancer that damages the nervous
system; or other antibody-mediated conditions that are still being
discovered.
ETIOLOGY

9. ETIOLOGY Cont…
 Viral infections
It is often difficult to know whether direct viral infection or a
post-infectious response to the infection causes the transverse
myelitis. Associated viruses include herpes viruses such as
 varicella zoster (the virus that causes chickenpox and shingles),
 herpes simplex,
 cytomegalovirus and Epstein-Barr;
 flaviviruses such as West Nile and Zika;
 Influenza,
 Hepatitis B,
 Mumps,
 measles, and rubella.

10.  Bacterial infections
 Syphilis
 Tuberculosis
 Pertussis
 Clostridium Tetani(tetanus)
 Diphtheria
 campylobacter jejuni
 mycoplasma bacterial
ETIOLOGY Cont…
 Parasities
 Toxoplasmosis
 Cysticercosis
 Shistosomiasi
 Angtiostrongyloides.
Vascular disorders
Arteriovenous malformation
Dural arterial-venous fistula
Intra spinal cavernous
malformations
Disk embolism

11. CLINICAL PRESENTATION
 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 paraplegia
(complete paralysis of the legs),
requiring the person to use a
wheelchair.

12. Pain .
Initial symptoms usually
include lower back pain
or sharp, shooting
sensations that radiate
down the legs or arms
or around the torso.
CLINICAL PRESENTATION
Cont…
Sensory alterations.
Which can cause paresthesias abnormal sensations.
Burning tingling) in the legs
tickling,
 pricking
Sensory loss.

13.  Bowel and bladder
dysfunction
 Increased frequency
 urge to use the toilet
 Incontinence
 difficulty voiding
CLINICAL Cont…

14. HISTORY
 The following factors provide evidence of cause:
 Family history: hereditary ataxias,
phenylketonuria, neurofibromatosis.
 Drug history, including phenytoin (cerebellar
signs), vincristine (peripheral neuropathy),
penicillamine (myasthenia).
 Dietary history: intake of vitamins B1, B6 and B12.
 Alcohol history.
 Pre-existing illness, such as diabetes, hypertension
(cerebrovascular disease), rheumatoid arthritis, or
malignancy.
 History of trauma.

15.  Tone
-Tone may be increased throughout a
movement, when it is called "lead
pipe" rigidity (as in parkinsonism)
- More pronounced at the beginning of
a movement, so-called "clasp
knife" rigidity (as with an upper
motor neuron lesion).
 Strength/power
0 No movement
1 Flicker of movement
2 Movement when gravity removed
3 Movement against moderate gravity
4 Movement against additional
resistance
5 Normal power
 Coordination
 Ask the patient to alternately
touch their nose and your
finger
 Ask the patient to tap one
palm with alternating sides of
the other hand as quickly as
possible
 Rebound phenominin
EXAMINATION

16. EXAMINATION
Reflexes

17. DIFFERENTIAL DIAGNOSIS
 Multi sclerosis
 Gulian Barr syndrome
 Disk herniation
 Parainfectious myelitis
 Myelitis related such as systemic lupus
 Vertebral fractures( Trauma)
 Epidural / Subdural hematoma
 Epidural and paraspinal abscess
 Tumor

18. LABS AND & INVESTIGATION
 Lumbar puncture (also
called spinal tap)
Patient with transverse
myeleitis, the CSF contains
more protein than usual and
an increased number of
(leukocytes)
Spinal tap is important to
identify or rule out infectious
causes.
 Computed tomography (CT)
 X-rays-

19. Labs….
 Blood tests
 This may performed to
rule out various disorders
such as
 HIV infection,
 vitamin B12 deficiency,
 Autoantibodies (anti-
aquaporin-4, anti-myelin
oligodendrocyte)
 Antibodies associated with
cancer (paraneoplastic
antibodies)
 Magnetic resonance
imaging (MRI)
A spinal MRI will
almost always confirm
the presence of a
lesion within the
spinal cord, whereas a
brain MRI may
provide clues to other
underlying causes,
especially MS

20. MANAGEMENT
 Frequently assess vital
signs
 watch carefully for signs of
spinal shock ( hypotention
and excessive sweating)
 Watch for UTI’s from foley
catheters
 Assist patient with physical
therapy , bowel and bladder
training.
Treatments are designed to address infections that may cause the
disorder, reduce spinal cord inflammation, and to manage and
alleviate symptoms.

21.  Intravenous corticosteroid
- Methylprednisolone or Dexamethasone * 7/7 days
May decrease swelling and inflammation in the spine and
reduce immune system activity.
 Plasma exchange therapy (plasmapheresis) _ may be used
for people who don’t respond well to intravenous steroids.
_Thus removing the antibodies and other proteins thought to
be causing the inflammatory reaction.
 Intravenous immunoglobulin (IVIG) _ IVIG is a highly
concentrated injection of antibodies pooled from many
healthy donors that bind to the antibodies that may cause the
disorder
MANAGEMENT

22. THANK YOU