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Neurology (Expert Forum)
Transverse myelitis, MS, or NMO?
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Transverse myelitis, MS, or NMO?
by Winnie2, Oct 15, 2006 12:00AM
I am a 30 yr-old female who was diagnosed with TM in July. I had a URI for 1 wk and was getting better. On a Sat, I woke up with a horrible headache which also resulted in N/V that evening. Felt some better, though tired, the next day. Sunday night I could not sleep well b/c my whole body felt like it was hurting and I couldn't get comfortable. The next morning (Monday) I noticed increased sensitivity to temp and anything that touched my body seemed to hurt - even clothes. Throughout the day I noticed I wasn't urinating and finally someone at the place I work had to straight cath me. I was unable to urinate again all night and was therefore sent for an MRI (w/ and w/out contrast) of brain, cervical and thoracic spine. Showed "extensive signal abnormalities" involving C-spine and T-spine. Multiple lesions throughout - some spanning multiple spinal cord levels. Brain normal. CSF showed > 100 WBCs, no oligoclonal bands, myel basic prot 94.7, CSF IgG 11.1, IgG Index 0.67, IgG Syn 13.9, prot 80, glu 54. Other findings: ANA 1:160. I never lost much strength. Most of my sx are sensory-related and have mostly resolved. Recent exam still shows clonus and hyperreflexia. Still some bladder/bowel control problems
My questions: In your experience, is TM the correct dx? What are my chances of developing MS? Is this NMO even though I did not have optic neuritis? Is it safe to get a flu shot (I do work in the medical profession and will certainly be exposed)? What further w/u, if any, do you recommend? Currently, I am scheduled for repeat MRI of C-spine only in Dec.?
My questions: In your experience, is TM the correct dx? What are my chances of developing MS? Is this NMO even though I did not have optic neuritis? Is it safe to get a flu shot (I do work in the medical profession and will certainly be exposed)? What further w/u, if any, do you recommend? Currently, I am scheduled for repeat MRI of C-spine only in Dec.?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Oct 23, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story that you have provided is most consistent with NMO (neuromyelitis optica- also refered to as 'Devic's'). This disease is similar to MS, but the brain is generally spared and it involves multiple spinal cord levels (as you described) and eye involvement is common (but is sometimes not appreciated by the patient). A CSF pleocytosis (WBCs in the spinal fluid) is also more common in NMO. A transverse myelitis should be a single lesion, and usually does not involve multiple levels. There is now an NMO antibody test that can be sent off, that I would recomend for you. I would also recommend a visual evoked potential to look for changes consistent with optic nerve inflammation/demyelination that may have caused no symptoms. It is important to make the distinction between NMO and TM/possible MS, because they are treated differently. NMO responds to plasmapheresis, while MS/TM responds to steroids and other immune modulating medications.
I hope this has been helpful.
The symptoms and story that you have provided is most consistent with NMO (neuromyelitis optica- also refered to as 'Devic's'). This disease is similar to MS, but the brain is generally spared and it involves multiple spinal cord levels (as you described) and eye involvement is common (but is sometimes not appreciated by the patient). A CSF pleocytosis (WBCs in the spinal fluid) is also more common in NMO. A transverse myelitis should be a single lesion, and usually does not involve multiple levels. There is now an NMO antibody test that can be sent off, that I would recomend for you. I would also recommend a visual evoked potential to look for changes consistent with optic nerve inflammation/demyelination that may have caused no symptoms. It is important to make the distinction between NMO and TM/possible MS, because they are treated differently. NMO responds to plasmapheresis, while MS/TM responds to steroids and other immune modulating medications.
I hope this has been helpful.
