View source for Transverse myelitis

==Background==
*Inflammatory disorder that involves a complete transverse section of the spinal cord
**Results from viral infection (30% of cases), 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==
*Rapidly progressive paraplegia (as little as 4 hours), but may progress over days-weeks
*Neck or [[back pain]] + neuro complaints:
**Bilateral [[weakness|motor]], [[numbness|sensory]] (burning or tingling pain), and autonomic disturbances
**Fecal/[[urinary retention]] and [[urinary incontinence|incontinence]]

==Differential Diagnosis==
{{Weakness DDX}}

{{Lower back pain DDX}}

==Evaluation==
*Neurologic findings that are consistent with epidural compression but normal [[mri|MRI]]
*Must rule-out compressive lesion of the cord
*[[MRI]]
**May show cord swelling
**Hyperintense lesion on T2 weighted images
*[[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>

==Management==
*Foley for bladder decompression
*Consider work up for clotting disorder for spinal artery thrombosis, drug user, risk for [[aortic dissection]]
*Neurological consultation
*[[Corticosteroids]] and [[plasma exchange]]
**High dose steroid regimen, such as [[methylprednisolone]] 1 gram daily or [[dexamethasone]] 200 mg daily 
*The more rapid the progression is, the worse the prognosis

==Disposition==
*Admission

==See Also==
*[[Weakness]]
*[[Acute flaccid myelitis]]

==External Links==

==References==
<references/>

*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.
<references/>

[[Category:Neurology]]