Idiopathic Transverse Myelitis: An Experience in A Tertiary Care Setup

Abstract

Objective: To observe the clinical, laboratory and radiological features of idiopathic transverse myelitis in patients presenting to the Department of Neurology Civil Hospital Karachi, and to assess the outcome in terms of clinical recovery at four weeks. Methodology: A prospective observational study in which patients were identified according to a Performa developed on the basis of diagnostic criteria provided by Transverse Myelitis Consortium Working Group. 1 Patients presenting with acute myelopathy other than Idiopathic transverse myelitis were excluded clinically and radiologically on the basis of same diagnostic criteria. 1 MRI Spinal Cord, MRI brain, visual evoked potentials and CSF analysis of all patients were done. Data was analyzed on Microsoft excel 2007. Results: Seventy two patients, 58.3% males and 41.6% females with a mean age of 28 years were identified as idiopathic transverse myelitis over a period of seven years, from July 2003- June 2010. Weakness of limbs was the commonest first symptom at onset, occurring in 27(37.5%) patients and duration of onset from the beginning of symptoms to completed weakness ranged from 10 hours (< 1day) to 28 days, with a mean of 5.04 days. Paraplegia was commoner than quadriplegia occurring in 69.4% of patients. Four (5.5%) patients had no imaging abnormalities. Normal MRI brain and normal visual evoked potentials were mandatory for the selection of patients for the study to rule out other causes of spinal cord demyelination. Eleven (15.3%) patients had normal CSF examination.. Elevated protein ranging from 50mg% to 128mg% was present in all subjects with abnormal CSF. Mild lymphocytic Pleocytosis was present in 33 (54.09%) patients. Oligoclonal bands were absent in all patients. Response to methyl-prednisolone was judged in terms of recovery in motor power, improvement in sphincter control and resolution of sensory signs and symptoms. Twenty seven patients (37.5%) made complete recovery or were left with minimal residual deficit at the end of four weeks (MRC grades 5-4), 31(43%) made partial recovery with moderate disability (MRC grade 3) and 14 (19.4%) patients were left with severe disability or did not improve at all (MRC grades 0-2). Factors associated with poor recovery included delayed presentation after achieving maximum deficit, syrinx formation and extensive MRI lesions. Conclusion: Idiopathic transverse myelitis is not an uncommon disease in our population. It did not behave very differently from what is reported in the international literature, with myelitis most commonly involving the dorsal spine, spanning over more than two spinal segments and showing complete or partial recovery in majority of cases with timely presentation for treatment