Transverse Myelitis

TRANSVERSE MYELITIS
Learning objectives
At the end of session students will be learn about
• Definition of Transverse myelitis
• Enumerate Clinical presentation
• Enumerate differential diagnosis
• List out Physiotherapy goals
• List out physiotherapy management.
Definition
• Transverse Myelitis (TM), AKA Acute Transverse
Myelitis (ATM) is a rare neurological disorder of the
spinal cord, caused by inflammation and occurring
across one spinal segment, leading to severe motor,
sensory and autonomic dysfunction
• The term Transverse Myelitis (TM) was first coined in
1948 by Dr Suchett-Kaye, an English neurologist. He
uses this to describe a case of rapidly progressive
paraparesis with a thoracic sensory level, occurring as a
post-infectious complication of pneumonia
Mechanism of Injury / Pathological
Process
• The mechanism of injury is inflammation of the
spinal cord causing damage to the myelin sheath
of the nerves.
•
Clinical Presentation
• Sensory, motor, or autonomic dysfunction

attributable to the spinal cord
• Bilateral signs and/or symptoms
• Clearly defined sensory level
C’D
• The symptoms of TM include muscle weakness,
paralysis, parasthesia, neuropathic pain,
spasticity, as well as bladder, bowel and sexual
dysfunction.
C’D
• Symptoms progress over hours whereas in other
instances, the presentation is over days. Neurologic
function tends to decline during the 4-21 day acute
phase, while eighty-percent of cases reach their maximal
deficit within 10 days of symptom onset
• 50% of individuals have lost all movements of their legs
• 80-94% experience numbness,
• Paresthesias or banding or girdling,
• Bladder dysfunction.
• Presentation of symptoms vary based on the level of the
spinal cord affected and on the severity of the damage to
the myelin and the neurons in the spinal cord.
• Some people recover from transverse myelitis with
minor or no residual problems,
• Some Suffer permanent impairments that affect their
and ability to perform ordinary tasks of daily living. Most
people will have only one episode of transverse . A small
percentage (10-20%) may have a recurrence.
Differential Diagnosis
• Multiple Sclerosis
• Guillain Barre Syndrome
• Disc herniation
• Parainfectious myelitis
• NMO (Devic's disease)
• Myelitis related to systemic disease, such as systemic
lupus erythematosis
• Compression of spinal cord caused by trauma eg.
vertebral fractures
• Epidural or subdural hematoma
• Epidural and/or paraspinal abscess
• Tumour
PHYSIOTHERAPY GOALS
SHORT TERM GOAL
• To Maintain ROM
• To improve muscle power
• To Enhance bed mobility
• To enhance general mobility
• To reduce pain
• To improve bladder control
LONG TERM GOAL
• To prevent bed ridden complication
• To prevent contractures
• To improve functional independence
Physiotherapy
• Stretching programme – to prevent contractures
• Strengthening
• Transfers
• Gait training
• Wheelchair training
• Reduce risk of pressure ulcers
• Aid control of spasticity
• Pain reduction/management
• Bladder training
Early stage, 1st 6-12 weeks:
• Immediately after the onset of TM, there is

frequently a period of transient loss or reduction
of neural activity below the involved spinal cord
lesion; this is known as “spinal shock,” and
generally lasts approximately 6 to 12 weeks,
although it can persist for 6 months or more.
Later stage, post spinal shock:
• The bladder can become overly sensitive, and

empty after only a small amount of urine has
collected, OR
• the bladder comes relatively insensitive, and
thus becomes over extended and tends to
overflow.
• Distended bladder increases the likelihood of
urinary tract infections and, in time, may
threaten the health of the kidneys.
• Depending on the dysfunction, treatment
options include timed voiding, medicines,
external catheters for males (a catheter
connected to a condom), padding for women,
intermittent internal self-catheterization[5], an
indwelling catheter, Botox[6] or electrical
stimulation
End of session

Transverse Myelitis

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TRANSVERSE MYELITIS

• Sensory, motor, or autonomic dysfunction

• Immediately after the onset of TM, there is

• The bladder can become overly sensitive, and

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