Non traumatic injury of spinal cord autoimmune diseases

1. BY: DR. VAIBHAVI
PARMAR

2.  INTRODUCTION
 Transverse myelitis (TM) is an inflammatory disorder of the spinal cord.
 TM is characterized by focal inflammation within the spinal cord and clinical
manifestations are due to resultant neural dysfunction of motor, sensory and
autonomic pathways within and passing through the inflamed area.
 The incidence of TM is 1 (severe) to 8 (mild) cases/million per year.

3. CAUSES
 TM may exist as part of a multi-focal CNS disease (e.g. MS), multisystem disease
(e.g. Systemic lupus erythematosus), or as an isolated,
 Idiopathic
 May occur Post infection

4.  FOLLOWING SYMPTOMS OCCUR BELOW THE
LEVEL OF THE SPINAL CORD WHERE THE
INFLAMMATION IS
 Pain in back (not just lower back pain), extremities or abdomen
 Muscle weakness and/or paralysis
 Sensory alteration/loss - numbness, tingling, stabbing pain, pins and needles,
burning, crawling sensation.
 Pain cause by temperature or physical stimuli
 Tight banding around torso, arms, and/or legs
 Electrical shock like sensation through spine to feet (known as ‘lhermitte’s sign’)

5.  Muscle spasms and tightness (spasticity)
 Cold and/or hot sensations in an isolated part of your body
 Diminished temperature sensation
 Bladder and bowel issues – incontinence, bladder urgency or inability to pass
 Sexual dysfunction
 Fatigue

6.  Some people will experience the symptoms equally on both sides of their body.
Some people will experience the symptoms more on one side of the body than
the other, or even on one side only.
 Symptoms depends on the area and the extent of affection of the spinal cord.

7.  DIAGNOSTIC PROCEDURES
 MRI and/or CT scan
 Lumbar puncture is used to look for markers for inflammation in the
cerebrospinal fluid (CSF).
 Visual evoke potential/response
 History
 Neurological examination

8.  DIFFERENTIAL DIAGNOSIS
 Multiple sclerosis
 Disc lesions
 NMO ( neuromyelitis optica)
 ADEM(acute disseminated encephalomyelitis)

9.  MANAGEMENT
 MEDICAL MANAGEMENT
 Corticosteroids given intravenously
 Plasmapheresis - for moderate to severe cases, or those who do not respond to
steroids after 3-5 days
 Immunosuppressant medication

10.  PHYSIOTHERAPY
 Pain reduction/management
 Strengthening ( according to the extent of affection)
 Transfers
 Gait training
 Wheelchair training
 Reduce risk of pressure ulcers & other secondary complications
 Bladder and bowel management