Transverse Myelitis

Lim, Peter A.C.

Transverse myelitis (TM) is an inflammatory condition across the spinal cord, along one or more levels and in the absence of compression. Idiopathic acute TM is rare and with improvements in diagnostic tools and longer follow-up, the etiology which may include post-infectious, multiple sclerosis, or neuromyelitis optica often becomes clearer. The patient may present acutely with weakness, sensory impairments, or bowel and bladder changes. A careful history, physical examination, and appropriate diagnostic studies including blood tests and an MRI scan may help determine the diagnosis and etiology. Following the acute management, which may include use of steroids, immunosuppressive drugs, and plasma exchange, a comprehensive medical rehabilitation program is important to optimize recovery from the resultant impairments and disabilities and manage associated complications. Complications such as paralysis, autonomic dysfunction, neuropathic and musculoskeletal pain, spasticity, contractures, neurogenic bladder and bowels, skin breakdown, and psychological issues will benefit from the expertise of the physiatrist. Rehabilitation will include functional restoration with therapy as well as compensation of residual impairment with mobility and various other assistive devices.