Partial Transverse Myelitis

[Ian Umland]

Hello:

I am a 30 year old male in otherwise good health.
I have been experiencing numbness in my right arm leg and right side of my trunk since June. The numbness has lessened considerably in the past weeks, although my right hand has always felt numb to some extent. Recently I noticed that I get a wave of numb-tingling shooting from my hip to my right foot down my leg when I tilt my head foward. My Neurologist ordered a Brain MRI and a C-spine MRI with contrast.The brain MRI was normal.

The C- Spine MRI, however, revealed what the neuro characterized as a "Partial transverse Myelitis". There was one relitively small lesion (he called it an area of inflammation)which was located exclusively in the white matter of my spinal cord. He said it explained perfectly why I was having the symptoms, but he couldnt be sure what the underlying illnes. He suspected it might be a condition called "acute disteminated encephelo myelitis". Other remote possibilities included syphillis (extremely remote for me, I thought) and another blood disorder I couldnt rember. He also said that I was at increased risk to develop MS, although he couldnt give me a percentage figure because there was only anectdotal data for persons who have similar conditions as to how many go on to develop MS. He felt that as there are no tests absolutley conferm MS nothig more should be done at this point except to monitor of course.

My questions are:

1. Understanding you have only limited info are you nonethless inclinded to agree with the diagnosis? Are there any other possibilities not considered?

2. Do you have any available data on what percentage of persons with conditions similar to mine go on to develop MS?

3. Does it make sense to consider getting interferon or other treatment now in case it turns out to be MS, as sort of early treatment option?

4. Will vigorous excercise increase my symptoms or slow any recover I might have from my existing symptoms?

I apologise for this second post, butI tried posting this a few days ago, but there was some problem because only part of my post made it to the board.


Many thanks for your help and this wonderful service.
Ian

[CCF Neuro[P] MD, RPS]

Dear Ian:

Sorry to hear about your condition.  Yes, ADEM is a very likely etiology for your condition.  Usually, the condition is post-viral but in many cases we do not find the culprit that incited the condition.  There are other conditions that might give you inflammatory changes in the spinal cord, things like sarcoid, vasculitis, etc.  But, given your otherwise good health prior to the event, these are not too likely.  Recovery is individual and not predictable without examining you or seeing the MRI.  I would think that the percentage is extremely low.  We see a wide age range of patients with this disorder and most, if not the vast majority never come down with MS.  We think that there is a specific genotype of HLA that can predispose one to having this disorder but there are many factors that play into this genotype and it is definitely not inherited.  Actually, the treatment, if severe is steriods and not interferon.  As you do not have MS, interferon is not called for, nor would it be benefical.  Once you completely recover, exercise, diet, getting into shape, quiting smoking etc. will be of benefit.  

Sincerely,

CCF Neuro MD

[chris]

I have had almost the exact symptoms as Ian, and am scheduled to have my brain and spine MRI on the 27th of November. I am in the worry stage of thinking that it is MS, but also looking for other possible answers. My questions are:

1) With Partial Transverse Myelitis, will heat increase symptoms (hot shower)?

2) Is there a ceertain time frame for the onset or dissipation of the symptoms? Mine started slowly in the fingertips of my right hand and grew to my whole arm and since have receeded to my hand again, but not as intense.

3) Will there also be a tingling in the leg with increased activity? My leg will tingle after walking sometimes, and the more strenuous the pace the more the tingle.

Thanks for your time.
Chris

[CCF Neuro[P] MD, RPS]

Dear Chris:

Usually with transverse myelitis, the symptoms are acute, meaning that they occur rapidly.  However, I suppose that they could be alittle slower in onset, but this would not be the norm.  No, the likelihood is that symptoms would be both sides or more localized to one side (upper right arm for instance).  To have one arm and leg would be very, very unlikely as the lesion would have to travel down only one side of the cord for several vertebrae.  Yes, a transverse myelitis might give you the feeling you describe.

Sincerely,

CCF Neuro MD

[Wendy Cooper]

I have the same feeling in my right arm that is also aggravated with movement.  I have been diagnosed with a bulging disc at c5-c6.  Also show demyelination.  Could demyelination be caused by the bulging disc?  The doctor is suggesting MS, although I have no vision problems or weakness only the numbness and tingling.

[CCF Neuro[P] MD, RPS]

Dear Wendy:

No, demyelination would not be the cause of a herniated or buldging disc.  Yes, MS can be localized to the spinal cord only.  Spinal cord MS is of lower frequency of the MS patients.  But we see it commonly (I think if I remember correctly, it is somewhere around 20-30% of MS patients are spinal cord.  I may be wrong on that figure.  The CSF study would be telling, in ADEM inducing transverse myelitis I don't think you would see oligoclonal bands with increased MBP or Kappa chains.  You might see oligoclonal bands but not much MBP.  If you have more than one spot of demyelination, it would be another indication of MS.  You might also get a MRI of the brain, if you have demyelinating spots there, I would be more certain that you have MS.

Sincerely,

CCF Neuro MD

[Wendy]

Thank you for your reply.  Could you please explain neural forminal stenisos?  My MRI showed this along with the bulging disc at c5-c6 and the demyelination.  Could irratation be mistaken for demyelination?


Thank You
Wendy

[CCF Neuro[P] MD, RPS]

Dear Wendy:

Yes, irradiation can cause demyelination. However, normal x-ray irradiation is not strong enough to cause demyelination. Usually a disc buldge has no bearing, in and of itself to cause neural foramin changes.  There are areas of the spinal vertebrae that allow nerves to exit the cord.  These small spaces are neural foramin.  They are in a different spot, lateral to the cord.  A narrowing of the foramin might cause demyelination if it was severe enough to cause stenosis of the nerve.  However, this would show in muscle atrophy, profound sensory or muscle use loss.  

Sincerely,

CCF Neuro MD

[Wendy]

How is stenosis treated?  Is stenosis a problem that can be completely corrected?  Is it known what leads to stenosis(another  medical condition, maybe a use injury)?
Thank you.

[CCF Neuro[P] MD, RPS]

Dear Wendy:

The correction is surgery.  Many things, from tumors both primary and mets, vascular malformations, herniations, syrinx, congential malformations, and trauma (hematoma).

Sincerely,

CCF Neuro MD