Transverse Myelitis: Pathogenesis, Diagnosis, and Management

Carrilin C. Trecker, Dana E. Kozubal, Adam I. Kaplin, Douglas A. Kerr

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Transverse myelitis (TM) is a rare neuroinflammatory disease that causes neural injury to the spinal cord. Patients experience varying degrees of weakness, sen­sory alterations, and autonomic dysfunction. This chapter discusses the clinical features, natural history, immunopathogenesis, diagnosis, and classification of TM. The management and proposed treatments of TM are also discussed. The immunopathogenesis of TM is varied and multifaceted. Superantigens (SAGs) are microbial peptides that can activate the immune system and contribute to autoimmune disorders such as TM. Diagnostic criteria and potential workup for infectious disease-associated TM are tabulated. Diagnostic criteria are a clearly defined sensory level and evidence of inflammation, either on MRI as gadolinium enhancement or on lumbar puncture as elevated white blood cell count or IgG index. Intravenous steroid treatment is often instituted for patients with acute idio­pathic TM. Corticosteroids have multiple mechanisms of action, including anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions. Plasma exchange, promising neuroprotective therapies, and other immunomodulatory treatments are used as treatments of TM. Many patients with TM require rehabilitative care to improve their functional skills and prevent secondary complications of immobility.

Original languageEnglish (US)
Title of host publicationBlue Books of Neurology
EditorsClaudia F. Lucchinetti, Reinhard Hohlfeld
PublisherElsevier Inc.
Pages237-257
Number of pages21
ISBN (Print)9781416060680
DOIs
StatePublished - Jan 2010
Externally publishedYes

Publication series

NameBlue Books of Neurology
Volume35
ISSN (Print)1877-184X

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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