Acute transverse myelopathy

Synonyms

Transverse myelitis, Devic's neuromyelitis optica (if optic neuritis is also present).

Definition

An acute neurologic condition, usually with numbness and/or weakness that reflects impairment of spinal cord function; a rare and serious complication in about 1–2% patients with SLE; other disease associations include Sjogren's syndrome, multiple sclerosis, antiphospholipid syndrome, sarcoidosis, ischemia after thoracic aneurysm repair, infection or neoplasm; magnetic resonance imaging (MRI) scans of the spinal cord may show increased signal intensity or attenuation of the spinal cord.

Therapy

Pharmacological

For inflammatory causes from autoimmune diseases: Prednisone 1–2mg/kg or intravenous solumedrol 1gram/day for three days. In a majority of patients this regimen would be followed by immunosuppressive therapy, such as cyclophosphamide. The role of plasmapheresis is unclear. For suspected thrombosis, early use of anticoagulants; efficacy of intravenous immunoglobulin treatment...