transverse myelitis?

Just posting here for a friend to see if anyone has experience with
this. a friend of her son's, a young man in his 20's, suddenly had
trouble walking and is now partially and perhaps permanently paralyzed
from this autoimmune disease. it's one i hadn't heard of.

diane

i haven't heard of that either. i'll be interested in becoming informed by
those who respond that are in the know.

kate

"Diane" <dcham@aol.com> wrote in message
news:1164396945.993703.24690@f16g2000cwb.googlegro ups.com...
Just posting here for a friend to see if anyone has experience with
this. a friend of her son's, a young man in his 20's, suddenly had
trouble walking and is now partially and perhaps permanently paralyzed
from this autoimmune disease. it's one i hadn't heard of.

diane

Diane wrote:

> Just posting here for a friend to see if anyone has experience with
> this. a friend of her son's, a young man in his 20's, suddenly had
> trouble walking and is now partially and perhaps permanently paralyzed
> from this autoimmune disease. it's one i hadn't heard of.

Polio??????


It doesn't sould like an anutoimmune disease, Diane. Infection,
virii, bacteria appear to be the major contributors.......or an
injury.....or surgery.

myelitis: 1. Inflammation of the spinal cord, resulting from either an
infection (e.g., a viral or bacterial infection) or a non-infecttous
necrosing or demyelinting lesion of the cord. Patients often exhibit
flaccid limbs, paralysis, incontenence, weakness or numbnees of the
limbs, or a combination of symptoms. SEE: poliomyelitis. 2.
Inflammation of bone morrow. SEE: osteomyelitis.

transversr myelitis: Myelitis involving the whole thickness of the
spinal cord, bot limied longitudinally.

poliomyelitis: Inflammation of the gray matter of the spinal cord. It
is an acute viral disease characterized by fever, sore thtoat,
headache, vomiting, and often stiffness of the neck and back. Late
consequences of the infection include atrophy of groups of muscles
ending in contractions and permanent deformity. POLIO is preventable
with standard vacinations given to children and adults.

osteomylitis: Inflammation of bone and marrow caused by infection
(less often by radiation). It most commonly occurs in the long bones
or the spine.
ETIOLOGY: Infections may reach the bone by sveral routes. Usually
disease causing germs are carried to the bone as a result of a
bloodborne infection. Organisms also may invade bone from an adjacent
site such as a decubitus ulcer or an infected tooth socket, or be
introduced during tramatic injiry or bone surgery. Pyogenic bacteria
are the most common cause; also gram-negative bacteria, mycobacteria,
fungi, and viruses. vascular disease, sickle cell disease. UTI,
prosthetic joints, malnutrition, diabetes, aging and soft tissue
infections increase the risk.

interesting, chief. the docs said it's autoimmune in nature, but who
knows? it's severe inflammation of the spinal chord, etiology can be a
lot of things, and according to the website i saw, it happens very
quickly, as was the case with this young man. they're loading him up
with prednisone. just hope he recovers.

diane

On 24 Nov 2006 11:35:46 -0800, "Diane" <dcham@aol.com> wrote:

>Just posting here for a friend to see if anyone has experience with
>this. a friend of her son's, a young man in his 20's, suddenly had
>trouble walking and is now partially and perhaps permanently paralyzed
>from this autoimmune disease. it's one i hadn't heard of.

My sister had it, initially they thought it was early MS but it did
not reoccur and, thankfully, she recovered most of her mobility and
feeling. They now believe it was an immune reaction to west Nile
virus. It usually only strikes once and is a bit of a mystery. It
attacks the spinal column and can actually demyelinate the spinal cord
and cause permanent paralysis. Cody Unser (Unsers of indycar racing
fame) has permanent paralysis from it. Some folks recover and others
do not.

glad your sister recovered, m. i'm passing along the encouraging part
of your post to my friend.

diane

Wow, Diane, don't know anything about this, but sure does sound scary!!!

Prayers for your friend and all concerned!
..
..


Donna G.
..
..
..
ANGELS EXIST, but some times, since they don't all have wings, we call
them FRIENDS......

Diane wrote:

> interesting, chief. the docs said it's autoimmune in nature, but who
> knows?

Have you visited the Arthritis Foundation http://arthritis.org to
see
it it's include in its lonnnnnng list of autoimmune diseases?

.... You have been exposed to TOP SECRET material.
.... Please destroy yourself before leaving you reader.

hi dianek, just saw your message and had this on file - it's form '97,
but afaik, still relatively how the thinking goes:



Transverse Myelitis: Symptoms, Causes and Diagnosis
Joanne Lynn, M.D.

Transverse myelitis (TM) is a neurologic syndrome caused by inflammation
of the spinal cord. TM is uncommon but not rare. Conservative estimates
of incidence per year vary from 1 to 5 per million population (Jeffery,
et.al., 1993). The term myelitis is a nonspecific term for inflammation
of the spinal cord; transverse refers to involvement across one level of
the spinal cord. It occurs in both adults and children. You may also
hear the term myelopathy, which is a more general term for any disorder
of the spinal cord.

Clinical Symptoms

TM symptoms develop rapidly over several hours to several weeks.
Approximately 45% of patients worsen maximally within 24 hours (Ibid.).
The spinal cord carries motor nerve fibers to the limbs and trunk and
sensory fibers from the body back to the brain. Inflammation within the
spinal cord interrupts these pathways and causes the common presenting
symptoms of TM which include limb weakness, sensory disturbance, bowel
and bladder dysfunction, back pain and radicular pain (pain in the
distribution of a single spinal nerve).

Almost all patients will develop leg weakness of varying degrees of
severity. The arms are involved in a minority of cases and this is
dependent upon the level of spinal cord involvement. Sensation is
diminished below the level of spinal cord involvement in the majority of
patients. Some experience tingling or numbness in the legs. Pain
(ascertained as appreciation of pinprick by the neurologist) and
temperature sensation are diminished in the majority of patients.
Appreciation of vibration (as caused by a tuning fork) and joint
position sense may also be decreased or spared. Bladder and bowel
sphincter control are disturbed in the majority of patients. Many
patients with TM report a tight banding or girdle-like sensation around
the trunk and that area may be very sensitive to touch.

Recovery may be absent, partial or complete and generally begins within
1 to 3 months. Significant recovery is unlikely, if no improvement
occurs by 3 months (Feldman, et. al., 1981). Most patients with TM show
good to fair recovery. TM is generally a monophasic illness (one-time
occurrence); however, a small percentage of patients may suffer a
recurrence, especially if there is a predisposing underlying illness.

Causes of Transverse Myelopathy and Myelitis

Transverse myelitis may occur in isolation or in the setting of another
illness. When it occurs without apparent underlying cause, it is
referred to as idiopathic. Idiopathic transverse myelitis is assumed to
be a result of abnormal activation of the immune system against the
spinal cord. A list of illnesses associated with TM includes:

Table: Diseases Associated with Transverse Myelitis

Parainfectious (occurring at the time of and in association with an
acute infection or an episode of infection).

Viral: herpes simplex, herpes zoster, cytomegalovirus, Epstein-Barr
virus, enteroviruses (poliomyelitis, Coxsackie virus, echovirus), human
T-cell, leukemia virus, human immunodeficiency virus, influenza, rabies

Bacterial: Mycoplasma pneumoniae, Lyme borreliosis, syphilis,
tuberculosis

Postvaccinal (rabies, cowpox)

Systemic autoimmune disease

Systemic lupus erythematosis

Sjogren's syndrome

Sarcoidosis

Multiple Sclerosis

Paraneoplastic syndrome

Vascular

Thrombosis of spinal arteries

Vasculitis secondary to heroin abuse

Spinal arterio-venous malformation

The cause of idiopathic transverse myelitis is unknown, but most
evidence supports an autoimmune process. This means that the patient's
own immune system is abnormally stimulated to attack the spinal cord and
cause inflammation and tissue damage. Examples of autoimmune diseases
which are more common include rheumatoid arthritis, in which the immune
system attacks the joints, and multiple sclerosis, in which myelin, the
insulating material for nerve cells in the brain, is the target of
autoimmune attack.

TM often develops in the setting of viral and bacterial infections,
especially those which may be associated with a rash (e.g., rubeola,
varicella, variola, rubella, influenza, and mumps). Approximately one
third of patients with TM report a febrile illness (flu-like illness
with fever) in close temporal relationship to the onset of neurologic
symptoms. In some cases, there is evidence that there is a direct
invasion and injury to the cord by the infectious agent itself
(especially poliomyelitis, herpes zoster, and AIDS). A bacterial abscess
can also develop around the spinal cord and injure the cord through
compression, bacterial invasion and inflammation.

However, experts believe that in many cases infection causes a
derangement of the immune system which leads to an indirect autoimmune
attack on the spinal cord, rather than a direct attack by the organism.
One theory to explain this abnormal activation of the immune system
toward human tissue is termed "molecular mimicry." This theory
postulates that an infectious agent may share a molecule which resembles
or "mimics" a molecule in the spinal cord. When the body mounts an
immune response to the invading virus or bacterium, it also responds to
the spinal cord molecule with which it shares structural
characteristics. This leads to inflammation and injury within the spinal
cord.

Vaccination is well known to carry a risk of the development of acute
disseminated encephalomyelitis (ADEM) which is an acute inflammation of
the brain and spinal cord. This was particularly common with the older
antirabies vaccine which was grown in animal spinal cord cultures; the
use of the newer antirabies vaccine grown in human tissue culture has
almost eradicated this complication. This is also thought to occur as an
immune system response.

Transverse myelitis may be a relatively uncommon manifestation of
several autoimmune diseases including systemic lupus erythematosis
(SLE), Sjogren's syndrome, and sarcoidosis. SLE is an autoimmune disease
of unknown cause which affects multiple organs and tissues in the body.
Features of this illness include arthralgias (joint pain) and arthritis
(joint inflammation), rashes, kidney inflammation, low blood counts
(including white and red blood cells, platelets), oral ulcers and the
presence of abnormal autoantibodies (antibodies which are directed
against the person's own tissues) in the blood. The fully developed
syndrome of SLE is easy to recognize; however, this illness may begin
with just one or two signs and is then more difficult to diagnose.

Sjogren's disease is another autoimmune disease characterized by
invasion and infiltration of the tear and salivary glands by
(lymphocytes) white blood cells with resultant decreased production of
these fluids. Patients complain of dry mouth and dry eyes. Several tests
can support this diagnosis: the presence of a SS-A antibody in the
blood, ophthalmologic tests that confirm decreased tear production and
the demonstration of lymphocytic infiltration in biopsy specimens of the
small salivary glands (a minimally invasive procedure). Neurologic
manifestations are unusual in Sjogren's syndrome, but TM can occur.

Sarcoidosis is a multisystem inflammatory disorder of unknown cause
manifested by enlarged lymph nodes, lung inflammation, various skin
lesions, liver and other organ involvement. In the nervous system,
various nerves, as well as the spinal cord, may be involved. Diagnosis
is generally confirmed by biopsy demonstrating features of inflammation
typical of sarcoidosis.

Multiple sclerosis is an inflammatory autoimmune disease of the central
nervous system (brain and spinal cord) which results in demyelination or
loss of myelin (the insulating material on nerve fibers) with resultant
neurologic dysfunction. A definite diagnosis of MS is not given until a
patient has had at least two attacks of demyelination (hence, multiple)
at two different sites in the central nervous system. The spinal cord is
frequently affected in multiple sclerosis and may be the site of
involvement of the first attack of MS. This presents the possibility
that patients with acute transverse myelitis could later go on to have a
second episode of demyelination and receive a diagnosis of MS.

Just what percentage of patients with a first attack of acute transverse
myelitis will go on to develop MS is unclear in the medical literature,
ranging from 15 to 80%; however, the majority of studies show a low
risk. We do know that patients who have abnormal MRI scans of the brain
with lesions like those seen in MS are much more likely to go on to
develop MS than those who have normal brain MRIs at the time of their
myelitis (between 60 and 90% for those with abnormal brain scans, less
than 20% for those with normal scans in one study). It is also suggested
in the medical literature that patients with "complete" transverse
myelitis (which means severe leg paralysis and sensory loss) are less
likely to develop MS than those who had a partial or less severe case.
The literature also suggests that patients who have abnormal antibodies
in their spinal fluid, called oligoclonal bands, are at higher risk to
develop MS subsequently.

Myelitis related to cancer (called a paraneoplastic syndrome) is
uncommon. There are several reports in the medical literature of a
severe myelitis occurring in association with a malignancy. In addition,
there are a growing number of reports of cases of myelopathy associated
with cancer in which the immune system produces an antibody to fight off
the cancer and this cross-reacts with the molecules in the spinal cord
neurons. It should be emphasized that this is an unusual cause of
myelitis.

Vascular causes are listed because they present with the same problems
as transverse myelitis; however this is really a distinct problem
primarily due to inadequate blood flow to the spinal cord instead of
actual inflammation. The blood vessels to the spinal cord can close up
with blood clots or atherosclerosis or burst and bleed; this is
essentially a "stroke" of the spinal cord.

Diagnosis

The general history and physical examination are first performed, but
often do not give clues about the cause of spinal cord injury. The first
concern of the physician who evaluates a patient with complaints and
examination suggestive of a spinal cord disorder is to rule out a
mass-occupying lesion which might be compressing the spinal cord.
Potential lesions which might compress the cord include tumor, herniated
disc, stenosis (a narrowed canal for the cord), and abscess. This is
important because early surgery to remove the compression may sometimes
reverse neurologic injury to the spinal cord. The easiest test to rule
out such a compressive lesion is magnetic resonance imaging of the
appropriate levels of the cord. However, if MRI is not available or the
images are equivocal, myelography must be performed. A myelogram is a
set of X-rays taken after a lumbar puncture has been performed either in
the neck or in the low back and a contrast agent (dye) is injected into
the sac that surrounds the spinal cord. The patient is then tilted up
and down to let the dye flow and outline the spinal cord while the
X-rays are taken.

If the MRI or myelogram shows no mass lesion outside or within the
spinal cord, then the patient with spinal cord dysfunction is thought to
have transverse myelitis or vascular problems. The MRI can sometimes
show an inflammatory lesion within the cord. It is difficult to get to
the cause of the inflammation, because biopsy is rarely done on the
spinal cord because of the damage this would cause. The physician would
next send blood for general bloodwork and studies for SLE and Sjogren's
syndrome, HIV infection, vitamin B12 level to rule out deficiency and a
test for syphilis. The next test which is commonly performed is a lumbar
puncture to obtain fluid for studies, including white cell count and
protein to look for inflammation, cultures to look for infections of
various types, and tests to examine for abnormal activation of the
immune system (immunoglobulin level and protein electrophoresis). A MRI
of the brain is often performed to screen for lesions suggestive of MS.
If none of these tests are suggestive of a specific cause, the patient
is presumed to have idiopathic transverse myelitis or parainfectious
transverse myelitis, if there are other symptoms to suggest an
infection.

References

1. Jeffery DR, Mandler RN, Davis LE. "Transverse myelitis: retrospective
analysis of 33 cases, with differentiation of cases associated with
multiple sclerosis and parainfectious events." Arch Neurol, 1993;
50:532.

2. Berman M, Feldman S, Alter M, et. al. "Acute transverse myelitis:
incidence and etiological considerations." Neurology, 1981; 31:966.

3. Stone LA. "Transverse Myelitis" in Rolak LA and Harati Y (eds.)
Neuroimmunology for the Clinician. Boston, MA: Butterworth-Heinemann,
1997; 155-165.

Dr. Lynn is an Assistant Professor of Neurology at The Ohio State
University. She received her medical degree from The Ohio State College
of Medicine and then served residencies in internal medicine and
neurology at Stong Memorial Hospital, University of Rochester. She then
returned to The Ohio State University for fellowship training in
neuromuscular disease. She is currently on the staff of The Ohio State
University Multiple Sclerosis Center and has special interests in
clinical research on the treatment of MS.
Document Date: October 1997


hth

be well

paul


Diane wrote:
>
> Just posting here for a friend to see if anyone has experience with
> this. a friend of her son's, a young man in his 20's, suddenly had
> trouble walking and is now partially and perhaps permanently paralyzed
> from this autoimmune disease. it's one i hadn't heard of.
>
> diane