Questions and Answers
Which of the following is a common symptom of transverse myelitis?
Transverse myelitis can only occur as a result of autoimmune conditions.
False
Name one notable pathogen associated with peri-infectious causes of transverse myelitis.
Dengue virus
Transverse myelitis can result in __________ weakness due to anterior gray horn damage.
Signup and view all the answers
Match the cytokine with its effect in transverse myelitis:
Signup and view all the answers
Which diagnostic method is the first line for detecting transverse myelitis?
Signup and view all the answers
Autoimmune causes of transverse myelitis are primarily associated with multiple sclerosis.
Signup and view all the answers
What type of dysfunction can lead to fecal incontinence in patients with transverse myelitis?
Signup and view all the answers
The involvement of T cells in transverse myelitis leads to the release of __________.
Signup and view all the answers
Which of the following is not categorized as a cause of transverse myelitis?
Signup and view all the answers
What is the first-line treatment for transverse myelitis?
Signup and view all the answers
Transverse myelitis primarily affects the lumbar spinal cord.
Signup and view all the answers
What procedure is used to analyze cerebrospinal fluid in transverse myelitis?
Signup and view all the answers
_________ is a second-line treatment for transverse myelitis in cases unresponsive to corticosteroids.
Signup and view all the answers
Which of the following drugs inhibits the transcription of pro-inflammatory cytokines?
Signup and view all the answers
Early diagnosis and intervention are unnecessary for improving outcomes in transverse myelitis.
Signup and view all the answers
Name one cytokine that mycophenolate aims to decrease.
Signup and view all the answers
Corticosteroids are used to manage __________ causes related to transverse myelitis.
Signup and view all the answers
Match the treatments with their intent:
Signup and view all the answers
What is a common outcome for patients with transverse myelitis?
Signup and view all the answers
What is the main role of T cells in the pathophysiology of transverse myelitis?
Signup and view all the answers
Which of the following cytokines is known to be released by T cells during transverse myelitis?
Signup and view all the answers
What type of immune response is primarily associated with the peri-infectious causes of transverse myelitis?
Signup and view all the answers
What symptom might be observed in patients due to involvement of the dorsal column in transverse myelitis?
Signup and view all the answers
What is the primary aim of using high-dose corticosteroids in the treatment of transverse myelitis?
Signup and view all the answers
In addition to multiple sclerosis, which condition is commonly associated with autoimmune causes of transverse myelitis?
Signup and view all the answers
Which of the following pathogens is NOT a known cause of peri-infectious transverse myelitis?
Signup and view all the answers
Which of the following treatments is classified as second-line for transverse myelitis?
Signup and view all the answers
What is the primary role of plasmapheresis in the management of transverse myelitis?
Signup and view all the answers
What effect do cytokines have in the inflammatory process of transverse myelitis?
Signup and view all the answers
Which imaging technique is considered the first-line diagnostic tool for transverse myelitis?
Signup and view all the answers
Which medication is used to inhibit the transcription of pro-inflammatory cytokines in transverse myelitis?
Signup and view all the answers
What is a significant potential outcome of transverse myelitis based on the affected spinal cord segments?
Signup and view all the answers
What is the primary focus during acute treatment of transverse myelitis?
Signup and view all the answers
What is a significant benefit of early diagnosis and intervention in transverse myelitis?
Signup and view all the answers
Which is NOT a focus of long-term management strategies for transverse myelitis?
Signup and view all the answers
What is a potential cause of transverse myelitis that is classified as idiopathic?
Signup and view all the answers
What main effect do cytokines released by T cells have in the context of transverse myelitis?
Signup and view all the answers
Which symptom might be present due to dysfunction in the spinal cerebellar tracts associated with transverse myelitis?
Signup and view all the answers
Which cytokine is NOT commonly released by T cells in the context of transverse myelitis?
Signup and view all the answers
In the diagnosis of transverse myelitis, which MRI sequence is specifically indicated?
Signup and view all the answers
What is a common outcome related to the autonomic dysfunction seen in transverse myelitis?
Signup and view all the answers
Which of the following is NOT considered a peri-infectious cause of transverse myelitis?
Signup and view all the answers
In severe cases of transverse myelitis, which symptoms may arise from damage to the anterior gray horn?
Signup and view all the answers
What is the primary therapeutic focus during the acute treatment of transverse myelitis?
Signup and view all the answers
Which long-term management option aims to inhibit pro-inflammatory cytokines?
Signup and view all the answers
What is a significant potential outcome of transverse myelitis depending on the affected spinal cord segments?
Signup and view all the answers
What role does rituximab play in the treatment of transverse myelitis?
Signup and view all the answers
In the management of transverse myelitis, plasmapheresis is primarily utilized for what purpose?
Signup and view all the answers
Why is early diagnosis and intervention crucial in transverse myelitis?
Signup and view all the answers
Which of the following cytokines does mycophenolate aim to decrease the levels of?
Signup and view all the answers
What is the effect of corticosteroids in the context of infectious causes related to transverse myelitis?
Signup and view all the answers
What is the primary goal of using plasmapheresis in the treatment of transverse myelitis?
Signup and view all the answers
Which drug is commonly used as a first-line treatment for transverse myelitis?
Signup and view all the answers
What role does mycophenolate play in the management of transverse myelitis?
Signup and view all the answers
What is a notable consequence of transverse myelitis depending on the spinal cord segments affected?
Signup and view all the answers
Which cytokines does mycophenolate aim to decrease in relation to transverse myelitis?
Signup and view all the answers
How does rituximab contribute to the treatment of transverse myelitis?
Signup and view all the answers
What is a critical aspect of long-term management strategies for patients with transverse myelitis?
Signup and view all the answers
Why is early diagnosis and intervention important in transverse myelitis?
Signup and view all the answers
What type of immune response is generally responsible for peri-infectious transverse myelitis?
Signup and view all the answers
Which cytokine is involved in increasing capillary permeability during the inflammatory response in transverse myelitis?
Signup and view all the answers
Which symptom is associated with upper motor neuron involvement due to transverse myelitis?
Signup and view all the answers
What is the effect of cytokines released by T cells in the context of transverse myelitis?
Signup and view all the answers
In transverse myelitis, which diagnostic imaging technique is most often used as the first line to confirm the condition?
Signup and view all the answers
What is a potential trigger for autoimmune-related transverse myelitis aside from multiple sclerosis?
Signup and view all the answers
Which symptom is indicative of involvement in the spinal thalamic tracts due to transverse myelitis?
Signup and view all the answers
What is a characteristic feature of the idiopathic causes of transverse myelitis?
Signup and view all the answers
What is the main function of cytokines produced by T cells in transverse myelitis?
Signup and view all the answers
Which of the following is a notable peri-infectious pathogen associated with transverse myelitis?
Signup and view all the answers
In acute cases of transverse myelitis, which symptom indicates involvement of the corticospinal tract?
Signup and view all the answers
Transverse myelitis can occur idiopathically. What does 'idiopathic' mean in this context?
Signup and view all the answers
During the diagnostic process for transverse myelitis, what is the primary imaging method utilized?
Signup and view all the answers
Which cytokine is primarily associated with increasing capillary permeability in the context of transverse myelitis?
Signup and view all the answers
What kind of treatment approach is typically employed for autoimmune-related transverse myelitis?
Signup and view all the answers
What underlying mechanism primarily leads to the demyelination observed in transverse myelitis?
Signup and view all the answers
Which treatment is primarily used for managing autoimmune causes of transverse myelitis in the long term?
Signup and view all the answers
What is the primary goal of conducting a lumbar puncture in suspected cases of transverse myelitis?
Signup and view all the answers
What principal mechanism does mycophenolate utilize to affect inflammation in transverse myelitis?
Signup and view all the answers
Which of the following is a second-line treatment option for transverse myelitis when corticosteroids are ineffective?
Signup and view all the answers
In acute transverse myelitis treatment, what is the primary focus during the early management phase?
Signup and view all the answers
Which of the following describes a significant risk if transverse myelitis is not diagnosed and treated early?
Signup and view all the answers
What is the role of plasmapheresis in the context of transverse myelitis?
Signup and view all the answers
What consequence can arise from damage to specific spinal cord segments due to transverse myelitis?
Signup and view all the answers
Which of the following best describes the role of T cells in the pathophysiology of transverse myelitis?
Signup and view all the answers
Which of the following symptoms is correlated with upper motor neuron damage in transverse myelitis?
Signup and view all the answers
Which approach is vital for the initial diagnosis of transverse myelitis?
Signup and view all the answers
What is a primary consequence of increased capillary permeability due to cytokine release in transverse myelitis?
Signup and view all the answers
Which pathogen is specifically noted as a peri-infectious cause of transverse myelitis?
Signup and view all the answers
What type of immune response commonly leads to transverse myelitis as an autoimmune condition?
Signup and view all the answers
Which of the following effects is NOT attributed to cytokines produced during transverse myelitis?
Signup and view all the answers
In severe cases of transverse myelitis, which symptom may develop from damage to the anterior gray horn?
Signup and view all the answers
What is the main goal of high-dose corticosteroids in the treatment of transverse myelitis?
Signup and view all the answers
Which treatment option clears abnormal proteins from the blood in patients with transverse myelitis?
Signup and view all the answers
What is a pivotal role of mycophenolate in the management of transverse myelitis?
Signup and view all the answers
What potential complication can arise from transverse myelitis related to the affected spinal cord segments?
Signup and view all the answers
Which of the following statements is true regarding the long-term management strategies for transverse myelitis?
Signup and view all the answers
Which treatment serves as a second-line option in cases of transverse myelitis that are unresponsive to corticosteroids?
Signup and view all the answers
Which of the following cytokines is targeted by mycophenolate to decrease inflammation in transverse myelitis?
Signup and view all the answers
What is the key reason early diagnosis and intervention are emphasized in managing transverse myelitis?
Signup and view all the answers
Study Notes
Transverse Myelitis Overview
- Transverse myelitis involves inflammation and demyelination of spinal cord axons.
- Causes are categorized into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to pathogens leads to central nervous system damage.
- Notable pathogens include:
- Dengue virus
- Herpes virus
- Mycoplasma pneumoniae (bacterial infection)
- Schistosomiasis (parasite related to liver fluke)
-
Autoimmune Causes:
- Associated with multiple sclerosis.
- Can occur alongside acute disseminating encephalomyelitis (ADEM), particularly in children.
-
Idiopathic Causes:
- Presence of transverse myelitis without identifiable cause.
Pathophysiology
- Involvement of T cells crossing the blood-brain barrier.
- T cells release cytokines such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Effects of cytokines:
- Increase cell adhesion molecules, promoting white blood cell adhesion.
- Induce vasodilation, enhancing blood flow and leukocyte recruitment.
- Raise capillary permeability, allowing white blood cells and proteins to exit vessels.
- Activate macrophages, increasing phagocytic activity.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction leading to urinary and fecal incontinence.
- Depending on spinal cord involvement:
- Loss of dorsal column sensations (light touch, proprioception).
- Upper motor neuron symptoms from corticospinal tract involvement (spasticity, hyperactive reflexes).
- Changes in pain and temperature sensation from damaged spinal thalamic tracts.
- Ataxia from compromised spinal cerebellar tracts.
-
Severe Cases:
- May exhibit lower motor neuron symptoms from anterior gray horn damage (flaccid weakness, decreased tone, fasciculations).
Diagnosis
-
First Line Diagnostic:
- MRI of the spinal cord, using T1 and T2 imaging with and without contrast.
- Most commonly affected area is thoracic spinal cord.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis, looking for pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids to reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis for cases unresponsive to corticosteroids or when contraindicated; clears abnormal proteins from the blood.
Important Notes
- Transverse myelitis can lead to significant neurological deficits depending on the affected spinal cord segments.
- Early diagnosis and intervention are crucial for improving outcomes.### Transverse Myelitis Treatment Overview
- Acute treatment involves processing blood through a chamber and tubing, allowing for clearing of harmful proteins and antibodies.
- Donor plasma or solutions like saline with albumin are reinfused to restore circulation, reducing immune response.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of specific genes that produce pro-inflammatory cytokines.
- Aims to decrease levels of interleukin-1, interleukin-6, and tumor necrosis factor-alpha among other cytokines.
-
Rituximab:
- Targets immune cells including T helper cells, macrophages, and B cells to modulate immune response.
- Enhances the activity of regulatory T cells, promoting anti-inflammatory effects and reducing further neural damage.
Long-term Management Strategies
- Emphasis on mycophenolate and rituximab for chronic treatment following acute episodes.
- Corticosteroids effectively manage infectious causes related to transverse myelitis, often without the need for antibiotics or antiparasitic medications.
Key Points to Remember
- Acute therapies primarily focus on plasmapheresis.
- Mycophenolate and rituximab serve as pivotal long-term management options.
- Managing immune response is crucial to prevent further injury, demyelination, and axonal destruction in transverse myelitis.
Transverse Myelitis Overview
- Involves inflammation and demyelination of spinal cord axons, affecting neurological function.
- Causes are classified into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to various pathogens can damage the central nervous system.
- Notable pathogens include Dengue virus, Herpes virus, Mycoplasma pneumoniae, and Schistosomiasis.
-
Autoimmune Causes:
- Associated with multiple sclerosis and may accompany acute disseminating encephalomyelitis (ADEM), especially in children.
-
Idiopathic Causes:
- Occurs without any identifiable factors.
Pathophysiology
- T cells cross the blood-brain barrier and release pro-inflammatory cytokines, such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Cytokines enhance white blood cell adhesion, induce vasodilation, increase capillary permeability, and activate macrophages, leading to further inflammation and damage.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction can result in urinary and fecal incontinence.
- Symptoms vary based on spinal cord involvement:
- Loss of sensations such as light touch and proprioception due to dorsal column damage.
- Upper motor neuron symptoms include spasticity and hyperactive reflexes from corticospinal tract damage.
- Altered pain and temperature sensation from spinal thalamic tract damage.
- Ataxia may occur from compromised spinal cerebellar tracts.
-
Severe Cases:
- Can show lower motor neuron symptoms from anterior gray horn damage, leading to flaccid weakness and decreased muscle tone.
Diagnosis
-
First-Line Diagnostic:
- MRI of the spinal cord is essential, particularly T1 and T2 imaging with and without contrast; thoracic spinal cord is the most affected area.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis reveals pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis is used for cases resistant to corticosteroids or when corticosteroids are contraindicated.
Important Notes
- Timely diagnosis and intervention are critical for minimizing neurological deficits.
- Long-term outcomes can be significantly affected by the speed and effectiveness of treatment.
Transverse Myelitis Treatment Overview
- Acute treatment involves utilizing plasmapheresis, clearing harmful proteins and antibodies from the blood, followed by reinfusion of donor plasma or saline with albumin.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of genes that produce pro-inflammatory cytokines, reducing interleukin-1, interleukin-6, and TNF-alpha levels.
-
Rituximab:
- Targets immune cells to modulate the immune response while enhancing regulatory T cell activity for anti-inflammatory effects.
Long-term Management Strategies
- Focus on mycophenolate and rituximab for chronic treatment post-acute episodes.
- Corticosteroids are effective against infections related to transverse myelitis, often minimizing the need for additional antibiotics or antiparasitic treatments.
Key Points to Remember
- Acute therapies rely heavily on plasmapheresis.
- Mycophenolate and rituximab play crucial roles in long-term management.
- Controlling immune response is vital to prevent continued demyelination and axonal damage in transverse myelitis.
Transverse Myelitis Overview
- Involves inflammation and demyelination of spinal cord axons, affecting neurological function.
- Causes are classified into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to various pathogens can damage the central nervous system.
- Notable pathogens include Dengue virus, Herpes virus, Mycoplasma pneumoniae, and Schistosomiasis.
-
Autoimmune Causes:
- Associated with multiple sclerosis and may accompany acute disseminating encephalomyelitis (ADEM), especially in children.
-
Idiopathic Causes:
- Occurs without any identifiable factors.
Pathophysiology
- T cells cross the blood-brain barrier and release pro-inflammatory cytokines, such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Cytokines enhance white blood cell adhesion, induce vasodilation, increase capillary permeability, and activate macrophages, leading to further inflammation and damage.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction can result in urinary and fecal incontinence.
- Symptoms vary based on spinal cord involvement:
- Loss of sensations such as light touch and proprioception due to dorsal column damage.
- Upper motor neuron symptoms include spasticity and hyperactive reflexes from corticospinal tract damage.
- Altered pain and temperature sensation from spinal thalamic tract damage.
- Ataxia may occur from compromised spinal cerebellar tracts.
-
Severe Cases:
- Can show lower motor neuron symptoms from anterior gray horn damage, leading to flaccid weakness and decreased muscle tone.
Diagnosis
-
First-Line Diagnostic:
- MRI of the spinal cord is essential, particularly T1 and T2 imaging with and without contrast; thoracic spinal cord is the most affected area.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis reveals pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis is used for cases resistant to corticosteroids or when corticosteroids are contraindicated.
Important Notes
- Timely diagnosis and intervention are critical for minimizing neurological deficits.
- Long-term outcomes can be significantly affected by the speed and effectiveness of treatment.
Transverse Myelitis Treatment Overview
- Acute treatment involves utilizing plasmapheresis, clearing harmful proteins and antibodies from the blood, followed by reinfusion of donor plasma or saline with albumin.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of genes that produce pro-inflammatory cytokines, reducing interleukin-1, interleukin-6, and TNF-alpha levels.
-
Rituximab:
- Targets immune cells to modulate the immune response while enhancing regulatory T cell activity for anti-inflammatory effects.
Long-term Management Strategies
- Focus on mycophenolate and rituximab for chronic treatment post-acute episodes.
- Corticosteroids are effective against infections related to transverse myelitis, often minimizing the need for additional antibiotics or antiparasitic treatments.
Key Points to Remember
- Acute therapies rely heavily on plasmapheresis.
- Mycophenolate and rituximab play crucial roles in long-term management.
- Controlling immune response is vital to prevent continued demyelination and axonal damage in transverse myelitis.
Transverse Myelitis Overview
- Involves inflammation and demyelination of spinal cord axons, affecting neurological function.
- Causes are classified into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to various pathogens can damage the central nervous system.
- Notable pathogens include Dengue virus, Herpes virus, Mycoplasma pneumoniae, and Schistosomiasis.
-
Autoimmune Causes:
- Associated with multiple sclerosis and may accompany acute disseminating encephalomyelitis (ADEM), especially in children.
-
Idiopathic Causes:
- Occurs without any identifiable factors.
Pathophysiology
- T cells cross the blood-brain barrier and release pro-inflammatory cytokines, such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Cytokines enhance white blood cell adhesion, induce vasodilation, increase capillary permeability, and activate macrophages, leading to further inflammation and damage.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction can result in urinary and fecal incontinence.
- Symptoms vary based on spinal cord involvement:
- Loss of sensations such as light touch and proprioception due to dorsal column damage.
- Upper motor neuron symptoms include spasticity and hyperactive reflexes from corticospinal tract damage.
- Altered pain and temperature sensation from spinal thalamic tract damage.
- Ataxia may occur from compromised spinal cerebellar tracts.
-
Severe Cases:
- Can show lower motor neuron symptoms from anterior gray horn damage, leading to flaccid weakness and decreased muscle tone.
Diagnosis
-
First-Line Diagnostic:
- MRI of the spinal cord is essential, particularly T1 and T2 imaging with and without contrast; thoracic spinal cord is the most affected area.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis reveals pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis is used for cases resistant to corticosteroids or when corticosteroids are contraindicated.
Important Notes
- Timely diagnosis and intervention are critical for minimizing neurological deficits.
- Long-term outcomes can be significantly affected by the speed and effectiveness of treatment.
Transverse Myelitis Treatment Overview
- Acute treatment involves utilizing plasmapheresis, clearing harmful proteins and antibodies from the blood, followed by reinfusion of donor plasma or saline with albumin.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of genes that produce pro-inflammatory cytokines, reducing interleukin-1, interleukin-6, and TNF-alpha levels.
-
Rituximab:
- Targets immune cells to modulate the immune response while enhancing regulatory T cell activity for anti-inflammatory effects.
Long-term Management Strategies
- Focus on mycophenolate and rituximab for chronic treatment post-acute episodes.
- Corticosteroids are effective against infections related to transverse myelitis, often minimizing the need for additional antibiotics or antiparasitic treatments.
Key Points to Remember
- Acute therapies rely heavily on plasmapheresis.
- Mycophenolate and rituximab play crucial roles in long-term management.
- Controlling immune response is vital to prevent continued demyelination and axonal damage in transverse myelitis.
Transverse Myelitis Overview
- Involves inflammation and demyelination of spinal cord axons, affecting neurological function.
- Causes are classified into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to various pathogens can damage the central nervous system.
- Notable pathogens include Dengue virus, Herpes virus, Mycoplasma pneumoniae, and Schistosomiasis.
-
Autoimmune Causes:
- Associated with multiple sclerosis and may accompany acute disseminating encephalomyelitis (ADEM), especially in children.
-
Idiopathic Causes:
- Occurs without any identifiable factors.
Pathophysiology
- T cells cross the blood-brain barrier and release pro-inflammatory cytokines, such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Cytokines enhance white blood cell adhesion, induce vasodilation, increase capillary permeability, and activate macrophages, leading to further inflammation and damage.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction can result in urinary and fecal incontinence.
- Symptoms vary based on spinal cord involvement:
- Loss of sensations such as light touch and proprioception due to dorsal column damage.
- Upper motor neuron symptoms include spasticity and hyperactive reflexes from corticospinal tract damage.
- Altered pain and temperature sensation from spinal thalamic tract damage.
- Ataxia may occur from compromised spinal cerebellar tracts.
-
Severe Cases:
- Can show lower motor neuron symptoms from anterior gray horn damage, leading to flaccid weakness and decreased muscle tone.
Diagnosis
-
First-Line Diagnostic:
- MRI of the spinal cord is essential, particularly T1 and T2 imaging with and without contrast; thoracic spinal cord is the most affected area.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis reveals pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis is used for cases resistant to corticosteroids or when corticosteroids are contraindicated.
Important Notes
- Timely diagnosis and intervention are critical for minimizing neurological deficits.
- Long-term outcomes can be significantly affected by the speed and effectiveness of treatment.
Transverse Myelitis Treatment Overview
- Acute treatment involves utilizing plasmapheresis, clearing harmful proteins and antibodies from the blood, followed by reinfusion of donor plasma or saline with albumin.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of genes that produce pro-inflammatory cytokines, reducing interleukin-1, interleukin-6, and TNF-alpha levels.
-
Rituximab:
- Targets immune cells to modulate the immune response while enhancing regulatory T cell activity for anti-inflammatory effects.
Long-term Management Strategies
- Focus on mycophenolate and rituximab for chronic treatment post-acute episodes.
- Corticosteroids are effective against infections related to transverse myelitis, often minimizing the need for additional antibiotics or antiparasitic treatments.
Key Points to Remember
- Acute therapies rely heavily on plasmapheresis.
- Mycophenolate and rituximab play crucial roles in long-term management.
- Controlling immune response is vital to prevent continued demyelination and axonal damage in transverse myelitis.
Transverse Myelitis Overview
- Involves inflammation and demyelination of spinal cord axons, affecting neurological function.
- Causes are classified into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to various pathogens can damage the central nervous system.
- Notable pathogens include Dengue virus, Herpes virus, Mycoplasma pneumoniae, and Schistosomiasis.
-
Autoimmune Causes:
- Associated with multiple sclerosis and may accompany acute disseminating encephalomyelitis (ADEM), especially in children.
-
Idiopathic Causes:
- Occurs without any identifiable factors.
Pathophysiology
- T cells cross the blood-brain barrier and release pro-inflammatory cytokines, such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Cytokines enhance white blood cell adhesion, induce vasodilation, increase capillary permeability, and activate macrophages, leading to further inflammation and damage.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction can result in urinary and fecal incontinence.
- Symptoms vary based on spinal cord involvement:
- Loss of sensations such as light touch and proprioception due to dorsal column damage.
- Upper motor neuron symptoms include spasticity and hyperactive reflexes from corticospinal tract damage.
- Altered pain and temperature sensation from spinal thalamic tract damage.
- Ataxia may occur from compromised spinal cerebellar tracts.
-
Severe Cases:
- Can show lower motor neuron symptoms from anterior gray horn damage, leading to flaccid weakness and decreased muscle tone.
Diagnosis
-
First-Line Diagnostic:
- MRI of the spinal cord is essential, particularly T1 and T2 imaging with and without contrast; thoracic spinal cord is the most affected area.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis reveals pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis is used for cases resistant to corticosteroids or when corticosteroids are contraindicated.
Important Notes
- Timely diagnosis and intervention are critical for minimizing neurological deficits.
- Long-term outcomes can be significantly affected by the speed and effectiveness of treatment.
Transverse Myelitis Treatment Overview
- Acute treatment involves utilizing plasmapheresis, clearing harmful proteins and antibodies from the blood, followed by reinfusion of donor plasma or saline with albumin.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of genes that produce pro-inflammatory cytokines, reducing interleukin-1, interleukin-6, and TNF-alpha levels.
-
Rituximab:
- Targets immune cells to modulate the immune response while enhancing regulatory T cell activity for anti-inflammatory effects.
Long-term Management Strategies
- Focus on mycophenolate and rituximab for chronic treatment post-acute episodes.
- Corticosteroids are effective against infections related to transverse myelitis, often minimizing the need for additional antibiotics or antiparasitic treatments.
Key Points to Remember
- Acute therapies rely heavily on plasmapheresis.
- Mycophenolate and rituximab play crucial roles in long-term management.
- Controlling immune response is vital to prevent continued demyelination and axonal damage in transverse myelitis.
Transverse Myelitis Overview
- Involves inflammation and demyelination of spinal cord axons, affecting neurological function.
- Causes are classified into three groups: peri-infectious, autoimmune, and idiopathic.
Etiology
-
Peri-infectious Causes:
- Immune response to various pathogens can damage the central nervous system.
- Notable pathogens include Dengue virus, Herpes virus, Mycoplasma pneumoniae, and Schistosomiasis.
-
Autoimmune Causes:
- Associated with multiple sclerosis and may accompany acute disseminating encephalomyelitis (ADEM), especially in children.
-
Idiopathic Causes:
- Occurs without any identifiable factors.
Pathophysiology
- T cells cross the blood-brain barrier and release pro-inflammatory cytokines, such as interleukin-1, interleukin-6, TNF-alpha, and interferon-gamma.
- Cytokines enhance white blood cell adhesion, induce vasodilation, increase capillary permeability, and activate macrophages, leading to further inflammation and damage.
Clinical Features
-
Common Symptoms:
- Autonomic dysfunction can result in urinary and fecal incontinence.
- Symptoms vary based on spinal cord involvement:
- Loss of sensations such as light touch and proprioception due to dorsal column damage.
- Upper motor neuron symptoms include spasticity and hyperactive reflexes from corticospinal tract damage.
- Altered pain and temperature sensation from spinal thalamic tract damage.
- Ataxia may occur from compromised spinal cerebellar tracts.
-
Severe Cases:
- Can show lower motor neuron symptoms from anterior gray horn damage, leading to flaccid weakness and decreased muscle tone.
Diagnosis
-
First-Line Diagnostic:
- MRI of the spinal cord is essential, particularly T1 and T2 imaging with and without contrast; thoracic spinal cord is the most affected area.
-
Additional Test:
- Lumbar puncture for cerebrospinal fluid analysis reveals pleocytosis (increased white blood cell count).
Treatment
-
First-Line Treatment:
- High-dose corticosteroids reduce inflammation and limit demyelination.
-
Second-Line Treatment:
- Plasmapheresis is used for cases resistant to corticosteroids or when corticosteroids are contraindicated.
Important Notes
- Timely diagnosis and intervention are critical for minimizing neurological deficits.
- Long-term outcomes can be significantly affected by the speed and effectiveness of treatment.
Transverse Myelitis Treatment Overview
- Acute treatment involves utilizing plasmapheresis, clearing harmful proteins and antibodies from the blood, followed by reinfusion of donor plasma or saline with albumin.
Pharmacological Interventions
-
Mycophenolate:
- Inhibits transcription of genes that produce pro-inflammatory cytokines, reducing interleukin-1, interleukin-6, and TNF-alpha levels.
-
Rituximab:
- Targets immune cells to modulate the immune response while enhancing regulatory T cell activity for anti-inflammatory effects.
Long-term Management Strategies
- Focus on mycophenolate and rituximab for chronic treatment post-acute episodes.
- Corticosteroids are effective against infections related to transverse myelitis, often minimizing the need for additional antibiotics or antiparasitic treatments.
Key Points to Remember
- Acute therapies rely heavily on plasmapheresis.
- Mycophenolate and rituximab play crucial roles in long-term management.
- Controlling immune response is vital to prevent continued demyelination and axonal damage in transverse myelitis.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the overview of transverse myelitis, including its causes and pathophysiology. It explores peri-infectious, autoimmune, and idiopathic factors contributing to the condition, along with the immune responses involved. Test your understanding of how this neurological disorder affects the spinal cord!