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Pathology
Inflammatory demyelinating disease of the spinal cord with associated axonal loss with symptoms evolving over several hours-days.
Aetiology
Idiopathic: Nearly two-third of cases
Infective: Viral (CMV, EBV, HIV, coxsackie, HTLV-1, hepatitis C, HSV, VZV)
Bacterial (Mycoplasma, Lyme’s, brucellosis, tuberculosis)
Parasitic
Inflammatory: Multiple Sclerosis, Neuromyelitis Optica and Acute Disseminated
Encephalo Myelitis
Autoimmune: SLE, Sarcoid, Sjogren’s, Behcet’s
Neoplastic: Glioma, Lymphoma, Secondary Metastasis, Paraneoplastic Myelitis
Metabolic: Vitamin B12 Deficiency, Vitamin E Deficiency, Copper Deficiency
Signs
Paresis, sensory level, parasthesia, sphincter dysfunction and hyperesthesia at the dermatome above the sensory level
Symptoms
Back pain, motor weakness, urinary symptoms
Investigations
Bloods: FBC, U&E, Autoantibodies
Imaging: MRI Brain or Spine
Lumbar Puncture: To screen for infection
Treatment
Medical: IV methyl prednisolone, IV immunoglobulins, plasma exchange and
possible long term immunosuppression
Symptom control with neuropathic analgesia (gabapentin, amitriptyline), Muscle relaxants (baclofen)
Long term urinary catheter
Prognosis
One third will make full recovery, one third will have some residual disability and one third will have severe disability
Motor Weakness, Spasticity, Neuropathic Pain, Bladder Dysfunction and DVT
Key Facts
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Key Images
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Key References
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