Transverse myelitis

Suggested Alternatives for Differential Diagnosis Encephalitis, Herpes Simplex, tetanus, Guillain-Barre syndrome, poliomyelitis, transverse myelitis, cerebrovascular accident, psychosis, intracranial mass, epilepsy, atropine poisoning, and Creutzfeldt-Jacob disease. 

Complications of influenza may include exacerbation of underlying comorbidities, primary viral pneumonia, secondary bacterial pneumonia or other respiratory illnesses (e.g., sinusitis, bronchitis, otitis), encephalopathy, transverse myelitis, myositis, myocarditis, pericarditis, and Reye s syndrome. 

In most cases of the thoracolumbar infarction, the swollen cord shows peripheral enhancement of the central gray matter. The concomitant enhancement of the cauda equina was reported first by Friedman and Flanders in 1992 (Fig. 17.8). This phenomenon is a characteristic finding in the course of spinal cord ischemia which might involve the cord itself and the ventral cauda equina as well, which is composed of motor fibre bundles (Amano et al. 1998). It indicates disruption of the blood-cord barrier as well as reactive hyperemia (Friedman and Flanders 1992 Amano et al. 1998). The differential diagnosis of contrast enhancement of the cauda equina includes transverse myelitis, bacterial or viral meningitis, and spinal metastasis. 

This case of heroin myelopathy is similar to other reported cases, except that this case occurred with intranasal rather than intravenous use. The MRI findings were consistent with a transverse myelitis. The authors suggested that hypersensitivity and an immune-mediated attack on the spinal cord was the likely mechanism of injury. 

The most common cause of primary demyelination is MS, so demyelinating optic neuropathy is often associated with MS. Other conditions have been implicated in demyelinating optic neuropathy, including acute transverse myelitis, acute disseminated encephalomyelitis, herpes zoster, Gnillain-Barre syndrome, Devic s nemomyelitis optica, Epstein-Barr virus, Charcot-Marie-Tooth syndrome, and chronic multifocal demyelinating nemopathy. 

Demyelinating syndromes such as optic neuritis and transverse myelitis have clearly defined relationships with MS and are felt to represent the typical demyeHnating lesions found in the white matter of the brain in MS. Optic neuritis is frequently the initial clinical manifestation of MS, and is typically heralded by a decline in vision associated with eye pain over... 

Anantharaju, A., Baluch, M., van Thiel, D.H. Transverse myelitis occurring in association with primary biliary cirrhosis and Sjogren s syndrome (case report). Dig. Dis. Sci. 2003 48 830 - 833... 

Rntan, G., Martinez, A.J., Fieshko, J.T., van Thiel, D.H. Primary biliary cirrhosis, Sjogren s syndrome, and transverse myelitis. Gastroenterology 1986 90 206-210... 

An unusual but not unique case of transverse myelitis was reported in 1991, and other published case reports suggest links with chorea and ataxia (SEDA-16, 427). 

Transverse myelitis of abrupt onset has also been reported (9). 

A 45-year-old woman with resistant rheumatoid arthritis was given etanercept 25 mg twice weekly. Nine days later she developed total acute sensory loss, with flaccid paraplegia, fecal incontinence, and urinary retention. MRI imaging and cerebrospinal fluid analysis were consistent with a diagnosis of transverse myelitis. She also had positive antinuclear and anticardiohpin antibodies. After etanercept withdrawal and treatment with dexa-methasone and cyclophosphamide, her motor function improved with no change in sensory function. 

By 1988 it was possible to summarize the adverse effects reported after the distribution of over 1.8 million doses of plasma-derived hepatitis B vaccine (Table 1) (2). From 1982 onwards, the Centers for Disease Control, the Food and Drug Administration, and the manufacturers, Merck Sharp Dohme, had supported a special surveillance system to monitor spontaneous reports of reactions to plasma-derived hepatitis vaccine. During the first 3 years, about 850 000 persons were immunized. In all, 41 reports were received for one of the following neurological adverse events convulsion (n = 5), Bell s palsy (n — 10), Guillain-Barre syndrome (n = 9), lumbar radiculopathy (n — 5), brachial plexus neuropathy (n = 3), optic neuritis (n — 5), and transverse myelitis (n = 4). Half of these events occurred after the first vaccine dose. However, no conclusive causal association could be made between any neurological adverse event and the vaccine (3). 

Transverse myelitis developed 3 weeks after the first dose of hepatitis B vaccine in an 11-year-old girl (19). 

Bakshi R, Mazziotta JC. Acute transverse myelitis after influenza vaccination magnetic resonance imaging findings. J Neuroimaging 1996 6(4) 248-50. 

The authors of a report of the Institute of Medicine concluded that the evidence favored a causal relation between OPV and Guillain-Barre syndrome, but considered the evidence inadequate to accept or to reject a causal relation between OPV and transverse myelitis (SEDA-18, 325) (3). 

Nervous system complications after administration of DEV occurred, but in much lower frequency than after brain tissue rabies vaccines. Reports of transverse myelitis and other neurological complications have been published (SEDA-8, 300). There have been some efforts to develop a more purified version of DEV, but improvements in third-generation vaccines have made these the vaccines of choice when they can be afforded, much reducing the motivation to develop duck embryo vaccines further. 

There have been individual reports of fatal angio-immunoblastic lymphadenopathy, hemolytic uremic syndrome (after typhoid/paratyphoid/diphtheria vaccination), fatal hyperpyrexia (SED-11, 687), transverse myelitis (SEDA-10, 288), erythema nodosum (SEDA-11,289) (SEDA-14, 281), and Reiter s sjmdrome (SEDA-15, 350). 

None available to establish a causal relation None None Neuropathy Residual seizure disorder Transverse myelitis (IPV) Thrombocytopenia (IPV) None None... 

Inadequate to Residual seizure disorder Encephalopathy Encephalopathy Transverse myelitis Guillain-Barre Guillain-Barre syndrome... 

Secondary bacterial skin infection Thrombocytopenia Transverse myelitis Vasculitis... 

Pericarditis Pulmonary failure Renal failure Rhabdomyolysis Transverse myelitis Uveitis... 

Adapted from Acute schistosomiasis with transverse myelitis in American students returning from Kenya. MMWR Morb Mortal Wkly Rep 1984 33 445. 

B. Allergic reactions. Numerous deaths occur annually in the United States from immediate hypersensitivity (anaphylactic) reactions characterized by urticaria, angioedema, bronchospasm, and shock. Most anaphylactic reactions occur within 15 minutes of envenomation. Rarely, delayed-onset reactions may occur, including Arthus reactions (arthralgias and fever), nephritis, transverse myelitis, and Guillain-Barre syndrome. Cross-sensitivity to tire ant venom can exist in some patients with apid or vespid allergies. 

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