Acute transverse myelitis

Abstract

There have been few population-based studies of acute transverse myelitis (ATM). Therefore, incidence and population selectivity of this disorder in different regions is not well known. Data on all Jewish patients with ATM throughout Israel were collected for the period 1955 through 1975. Based on 62 patients who satisfied rigid diagnostic criteria, the average annual incidence rate was 1.34 per million population. No significant difference in incidence was noted between European/American-born and Afro/Asian-born populations. There was no significant seasonal or annual fluctuation in frequency. In 37% of the patients, a history of infection prior to ATM was reported, more commonly among younger patients. ATM rarely evolved into multiple sclerosis. More than one-third of the patients with ATM made a good recovery; in another one-third recovery was only fair; 14 patients failed to improve and 3 died. If other population-based studies of ATM were undertaken, comparison with our results might shed further light on the causes of this disorder.

Acute inflammatory myelopathies

“…None of the 15 patients classified as definite or possible idiopathic ATM developed MS. The overall incidence of ATM was 24.6 (18.2-31.1, 95% confidence interval (CI)) per million, considerably higher than prior estimates (Berman et al, 1981;Jeffery et al, 1993). However, when cases of partial ATM and ATM with brain lesions were excluded, the incidence was 6.2 (2.9-9.6, 95% CI).…”

“…The first estimate of the relative prevalence of ATM compared to MS came from a study of Jewish patients from Israel between 1955(Berman et al, 1981. During this time, 62 patients developed ATM whereas 747 patients in Israel were diagnosed with MS. ATM was defined as: (1) acute paraparesis with motor, sensory, and sphincter impairment; (2) spinal sensory level (patients with patchy deficits or BrownSéquard syndrome were excluded); (3) non-progressive clinical course; (4) no spinal cord compression; and (5) absence of other known neurologic disease to account for the symptoms, such as syphilis, trauma, malignancy, encephalitis, or spinal cord irradiation.…”

Venous hypertensive myelopathy as a potential mimic of transverse myelitis

“…Second, no evidence of an underlying inflammatory disorder was found. Third, unlike virtually all patients with ATM, 4,6,[8][9][10][11] the patient in the Venous hypertensive myelopathy C Krishnan et al current report never developed any autonomic dysfunction. Fourth, the patient did not respond to high-dose intravenous steroids.…”

“…There is often a clearly defined rostral border of sensory dysfunction and a spinal magnetic resonance imaging (MRI) and lumbar puncture often show evidence of acute inflammation. [2][3][4][5][6][7][8] When the maximal level of deficit is reached, approximately 50% of patients have lost all movements of their legs, virtually all patients have some degree of bladder dysfunction, and 80-94% of patients have numbness, paresthesias or band-like dysesthesias. [5][6][7][8][9][10] Autonomic symptoms consist variably of increased urinary urgency, bowel or bladder incontinence, difficulty or inability to void, incomplete evacuation or bowel constipation.…”

Transverse myelitis following general anaesthesia

“…In these three series of cases, those associated with direct cord trauma were not studied; in one series, this excluded group contained patients who had received epidural or spinal anaesthesia [7]. A patient in whom obstetric delivery preceded transverse myelitis has been recorded [8], but there were no other cases reported following gencral anaesthesia.…”