Diagnosing Transverse Myelitis

[Udkas]

I just thought I would put this up on the website (have found a page with a lot more info and depth but I know a few people on this forum have been diagnosed with TM and not MS and thought they might find this interesting.

Transverse Myelitis is a rare syndrome with only 1 to 8 new cases per million people per year.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.  There is often a clearly defined rostral border of sensory dysfunction and evidence of acute inflammation demonstrated by a spinal MRI and lumbar puncture.


virtually all patients have some degree of bladder dysfunction, and 80-94% of patients have numbness, paresthesias or band like dysesthesias.  Autonomic symptoms consist variably of increased urinary urgency, bowel or bladder incontinence, difficulty or inability to void, incomplete evacuation or bowel constipation and sexual dysfunction.   Like MS, TM is the clinical manifestation of a variety of disorders, with distinct presentations and pathologies.  Recently, we proposed a diagnostic and classification scheme which has defined TM as either idiopathic or associated with a known inflammatory disease (i.e. multiple sclerosis, systemic lupus erythematosus, Sjogren’s syndrome, or neurosarcoidosis).

Diagnostic Criteria for Transverse Myelitis

    *
      Sensory, motor or autonomic dysfunction attributable to the spinal cord
    *
      Bilateral signs and/or symptoms
    *
      Clearly-defined sensory level
    *
      Inflammation defined by CSF pleocytosis or elevated IgG index or gadolinium enhancement
    *
      Progression to nadir between 4 hours and 21 days

TM usually occurs as a single episode but can reoccur, usually when it reoccurs there is another underlying disease/cause like MS or Lupus etc.  Sometimes it can just keep reoccuring without any obvious cause.


      

[Udkas]

If you were to have a lumbar puncture when your symptoms weren't so active (still there) but not in the middle of a flare would the inflammation still be there CSF pleocystosis or elevated IgG index.

My flare was in September but my symptoms have remained (well some) but not as bad now, and I kinda of wonder if the LP is a waste of time and the gadolinium MRI as well it's all too late!

Cheers,
Udkas.

[sllowe]

Hey! Thanks for this! We need an HP on TM bigtime.  I remember a good discussion in the past, but have to dig for it. If I find it I'll bump it.

And, my thoughts are, no, not too late for the LP and the w/and w/out contrast MRIs.  I was in my 1st attack and the MRI w/and w/out still didn't show anything lit up. It did show the inflammation and the lesions. So, I just think it depends on when and if it's caught.

My LP was my last test and I was improving by then, and I still had O-bands.

I don't think it's a waste of time.

ttys,
Shell

[doni54]

Hi Udkas,

Thanks, this is a very good article.  Being undx, I always want to learn more about the mimics or other diseases that cause some of these symptoms.

I'm sorry I can't answer your question from experience, but I do agree with Shelly.  It couldn't hurt to go ahead and have the MRI and lumbar, maybe you could get some answers.

Good luck and I'll be praying for you.

hugs
doni

[Wobbly]

very good information... question I have is.. how do they Dx this...what is the Difference in the Diagnosing of MS and TM?  do the lesions look different?  

is inflammation different with one or the other??  
or do they just Dx by what symptoms you have?

I'm confused...but good article.

wobbly
undx

[Udkas]

Hi Wobbly,

If you were to go and read the article in full it would explain most of your questions.  My Dr has put me into the catagory that he believes in his opinion that I have TM.  This is based on my symptoms,  I have bladder dysfunction, band like dysesthesias, numbness, burning, radicular pain and sexual dysfunction (I'm numb down there), these are also common symptoms with MS, especially if there is spinal involvement in MS.

I think in using the criteria set out in this article I would have "probable TM'' I would fit all the diagnostic criteria apart from the MRI or LP (which may show something soon)

They have to rule out causes like spinal compression etc., so in some ways it is a process of elimination but yes MS and TM are similar.

I think if they find spinal cord lesions only and none in the brain you are thought to have TM.  Usually with TM they find a clear sensory line on examination (i have this), also they find your reflexes to be indicative on a spinal lesion or inflammation (I have this) but I think to the lesions can be a different shape.  Many people on this website have been diagnosed with TM and then later developed MS.  Usually TM occurs as a single episode, so in my case because the Dr found damage attributable to the spinal cord and I had gone 13 years he assumed (well I think he did) TM.  Now he believes it is re occuring but my exam shows spinal damage only he is looking for underlying causes as well so he knows how to treat me.

In TM as explained in the article above the stuff they look (sorry about tech terms there) is different, like I know with MS it's the O bands but for TM it's other ''stuff" but again a negative LP won't rule it out either. You can have an acute attack of TM where symptoms and onset is sudden (within hours), sub acute etc. Most people with TM have burning symptoms, and a lot have back pain when presenting.

Hope this helps Wobbly. B.T.W. this is only from my own understanding, I stand to be corrected on any of this info, it's only from my own research.
Cheers,
Udkas.

[Sarahsmom46]

Another interesting fact about TM is that not everyone gets the full blown form.  As is suspected in my case back in May (the verdict is still out as to whether it was TM or a first exacerbation of MS) is that you can have an incomplete version or partial TM flare.  This means that the symptoms may start in the feet and move up the legs, but it doesn't quite make it to the upper body and.  The myelitis is confined to a part of the spine and doesn't transverse the entire spinal column.  When you look at the possibility of patients with an initial TM dx converting to MS at some point, its the partial TM that is the more likely of the types of TM to later convert.  I don't recall reading anything about why this is the case, but perhaps someone else knows the answer and can fill in this information gap.  

TM is really an interesting area of research right now and several studies are being done in academic institutions to learn more about the short term and long term issues for patients who get this rare inflammatory disease.  

Thanks Udkas for bringing it up.  

Julie

[hbananas]

'Nother thing about TM.  The typical lesion in TM is a single transverse (covering 1/2 or more of the spinal column), long (3-8 vertebral segments) and without real clean boundaries.  They are more central to the cord.  They are usually thoracic.  There is usually cord swelling.  The symptoms of TM are more often motor than sensory.

Small (less than 1/3 the diameter of the cord, less than 2 segments long), defined, multiple lesions in the spine are more typical of MS.  They are peripheral--more "laterodorsal", and usually cervical.  There can be cord swelling, but less often than with TM.  Both can have OGBs in the spinal fluid, but more likely with MS.  MS symptoms are more often sensory than motor.

TM can be a consequence of an immune system gone wild after an illness (like mono, or a cold), can follow an immunization, I think especially after people have to have rabies shots, or it can just come out of nowhere and be idiopathic.

[Udkas]

Hi Everyone,
thank you for your contributions any info is most welcome.  I have tried to read as much as I can but there is always so much to learn and remember. Thanks forum friends for some interesting input.

Cheers,
Udkas

[hbananas]

Bump----
Anybody else have this dx or contributions to this topic?

[goldengirly]

It has been suggested to me by my neurologist that I probably the result of a terrifying and bizarre episode I had in December is probably due to transverse myelitis. However, my scans show a clear MRI. I didn't think this was possible? Most of my symptoms, except for crippling paesthesias/nerve pain and band-like sensations, have gone - is there any point in an LP?

[goldengirly]

Wow - badly written comment above - stoned on Pregabalin! Let me try again:

It has been suggested to me by my neurologist that my terrifying and bizarre episode in December was probably due to transverse myelitis. However, my MRI is clear. I didn't think this was possible?

Most of my symptoms, except for excruciating paesthesias/nerve pain and band-like sensations, have gone - is there any point in an LP now?