Transverse myelitis (TM) refers to a group of inflammatory spinal cord disorders with motor, sensory, and autonomic dysfunction [1,2].
It has an incidence of up to 8 in 1,000,000, with a bimodal age predilection in the second and fourth decades of life [2,3]. Females and males are equally affected . Approximately one-third of cases are idiopathic, but it also may arise in association with infections, drug/toxin exposure, or underlying autoimmune disorders including multiple sclerosis. TM has occasionally been attributed to neuraxial anaesthesia [5–10]. and general anaesthesia . The condition is characterised by accumulation of inflammatory cells in a localised region of spinal cord, with focal demyelination.
TM presents with a well-demarcated sensory level corresponding to the site of the spinal cord lesion, with associated weakness of distal spinal cord segments as well as bowel and bladder dysfunction [2,4]. The level of the lesion is most often in the thoracic or cervical spine. Neuropathic pain and allodynia are also common. Deficits are usually bilateral. The time from symptom onset to clinical nadir is usually within 3 weeks. An acute period of flaccid paralysis lasting up to 6 weeks is followed by the onset of upper motor neuron symptoms such as spasticity and hyperreflexia. Autonomic dysreflexia and orthostatic hypotension have also been described .
In the acute phase, patients may be treated with systemic corticosteroids, intravenous immunoglobulin, plasma exchange, or immunomodulating medications (i.e., mitoxantrone, methotrexate, mycophenolate, rituximab, azathioprine, cyclophosphamide) [1,12,13]. Neuro-logic recovery predominantly occurs in the first 3 months after presentation, but many patients have a protracted course over years [2,4]. Up to 25 % of the patients experience a recurrence of TM. Only one third of patients fully recover without residual sequelae .