ACUTE TRANSVERSE MYELITIS
Acute Transverse Myelitis It is an acute inflamation of gray and white mater of spinal cord specially thoracic.
Causation of Acute Transverse Myelitis:
- Viral : Coxsackie, Polio, Herpes and EB virus.
- Non-viral infection: Syphilitic, Pyogenic, Tuberculous (Pot’s), Parasitic and Fungal infection.
- Vascular accidents: Spinal artery occlusion, Arteritis, etc.
- Nutritional myelopathy.
- Miscellaneous: Post-infectious or post-vaccinal, Multiple sclerosis, etc.
CLINICAL FEATURES OF ACUTE TRANSVERSE MYELITIS
This is conventiently divided into four stages.
1.Stage of neural shock.
This develops immediately after attack and may last for 2-3 weeks. The muscle power, tone and sensations are lost. There may be cramp-like pain at the level of lesion. Micturation and defecation reflexes are disturbed leading to incontinence of urine and faeces. As tone of the internal sphincter rapidly returns there may be retention of urine. The lower limbs are cold and may show cyanosis. The skin is dry and is very liable to develop bed sores.
2.Stage of reflex activity.
As the stage of shock passes off, functional activity returns first in the smooth muscles. The tone of internal sphincter of bladder returns first. In skeletal muscles and when tone to flexor muscles returns the lower limbs tend to assume a position of slight flexion. This is called paraplegia in flexion, of course the stage of paraplegia in extension though appears early so it is not prominent in such cases. Deep reflexes are brisk, clonus may appear and plantar reflexes become extensor. In course of time automatism of bladder develops. Skin becomes warm. cyanosis and dryness disappear.
3.Stage of hyper irritability.
In some of these cases after sometimes, widespread reaction is readily elicited by little stimulus. Thus scratching the sole of the foot may give rise to widespread muscular contraction not only limited to one limb but to all four limbs, anterior abdominal wall and even in bladder and intestine resulting in evacuation of urine and faeces. There may be sweating in the whole body. This is called mass reflex.
4.Stage of reflex failure.
If general infection or toxaemia occurs all reflexes are abolished. Mass reflex disappears. The threshold for all reflexes is raised. Muscular wasting and bed sores gradually develop.
SPECIAL INVESTIGATIONS OF ACUTE TRANSVERSE MYELITIS
1. In secondary stage the non-Treponemal Antigen Test like VDRL and RPR (Rapid plasma Regain) are positive. VDRL test is positive in 99% of cases in secondary and in 95% of cases in tertiary syphilis. Regarding Treponemal antibody test, FTA-ABS (Fluorescent Treponemal antibody absorption) Test is important. Where clinical suspicion is strong but Non-Treponemal antigen test is negative, this test is significant. TPHA (T pallidum Haemagglutination) test and TPPA (T pallidum particle agglutination) test are also positive.
2. CSF contains an excess of lymphocytes, more than 100/ cmm, protein is raised more than 50 mg per 100 cc and VDRL test may be positive, Lange’s colloidal gold curve Shows a meningeal reaction. FTA-ABS Test is controversial.
3. Contrast myelography and CT Scan may also be helpful so on cases.