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Neurology (Expert Forum)
Trying again with transverse myelitis/Brown-Sequard questions
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Trying again with transverse myelitis/Brown-Sequard questions
by Don-D, Jan 01, 1995 12:00AM
Posted By Don D. on January 22, 1999 at 14:19:38:
Thank you very much for all of the input that this forum has provided me with so far. I had first posted my story on 1/18/99 under the heading "Transverse Myelitis". I subsequently posted some further questions, some of which were answered(thank you), and one posting which has apparently been corrupted so that you are unable to read it. So I am trying again.
In researching transverse myelitis and Brown-Sequard syndrome, I have become concerned as to the characterization of my condition as transverse myelitis. It seems to me that both Brown-Sequard and Transverse Myelitis are syndromes, that is, descriptions of a set of symptoms, and are by definition different from one another.
My understanding is that Brown-Sequard syndrome, which seems to be the most accurate description of my symptoms, comes as a result of a lesion on ONE side of the spinal cord. This results in different symptoms on both sides of the body. Motor skills and strength are impacted on the side where the lesion is located. Sensory skills are impacted on the side opposite the lesion. Bladder and bowel function are typically not affected. This describes my symptoms as accurately as possible. I have weakness in my left arm and leg, am unable to manipuate my left hand and fingers properly, and am experiencing noticeable muscle wasting in my left arm. My sense of hot/cold, sharp/dull are lacking on the left side of my body. There seems to be basically no cross-over of these symptoms. My bowel and bladder function have been unaffected.
Transverse myelitis, on the other hand, describes inflammation ACROSS(hence, transverse) the spinal cord. In some descriptions I have read, symmetrical symptoms are required for something to be described as transverse myelitis. Bowel and bladder control difficulty are also a prerequisite. This is logical to me, as interruption of signals all the way across one level of the cord would seem to result in similar symptoms on both sides of the body.
My concerns are as follows. While I understand that both of these terms constitute a description of symptoms as opposed to a diagnosis of the cause, I wonder if the results of my MRI are being interpreted correctly. My symptoms are clearly consistent with Brown-Sequard syndrome. *Should the MRI not have shown the lesion to be on one side of the spinal cord, as opposed to across the cord?(The MRI report described the lesion as being consistent with transverse myelitis or MS) *Is this syndrome more often associated with a mass-occupying lesion, as opposed to an inflammatory/demyelinating process? *Is the difference in the set of symptoms at all helpful in determining the cause?
I have a couple of other questions as well.
*One neurologist referred to this as "viral myelitis." She indicated that although I was not sick prior to the onset of symptoms, she still felt it could be caused by a virus. I am married with a 10 month old son. Should I be concerned at all as to this being contagious?
*In one of your responses to a previous posting, immunization for tetanus was mentioned. In the fall of 1997, about 15 months before the onset of my symptoms, I burned my left hand on a lawn mower muffler. I went to the hospital and received a tetanus shot. That is the only tetanus shot I have ever received, to my knowledge. Could this be a factor after so long?
If so, would it impact the course of treatment?
*The muscle wasting I am experiencing in my left arm has me very concerned. Is this muscle wasting an expected result of a spinal cord lesion? I received a 3 day course of 1 gram Solumedrol IV from 1/12-1/14/99. My symptoms did not get dramatically better, but there has been some improvement in my left arm, as far as being able to hold it up over my head, etc. What would be the next treatment step you would typically try, and how long would you wait?(My symptoms developed between 12/20 - 12/26/98).
As you can imagine, I want to be as aggressive as is practical in attacking this thing. I feel much better equipped to converse intelligently with my doctors as a result of the information this forum has provided. Thank you very much.
Thank you very much for all of the input that this forum has provided me with so far. I had first posted my story on 1/18/99 under the heading "Transverse Myelitis". I subsequently posted some further questions, some of which were answered(thank you), and one posting which has apparently been corrupted so that you are unable to read it. So I am trying again.
In researching transverse myelitis and Brown-Sequard syndrome, I have become concerned as to the characterization of my condition as transverse myelitis. It seems to me that both Brown-Sequard and Transverse Myelitis are syndromes, that is, descriptions of a set of symptoms, and are by definition different from one another.
My understanding is that Brown-Sequard syndrome, which seems to be the most accurate description of my symptoms, comes as a result of a lesion on ONE side of the spinal cord. This results in different symptoms on both sides of the body. Motor skills and strength are impacted on the side where the lesion is located. Sensory skills are impacted on the side opposite the lesion. Bladder and bowel function are typically not affected. This describes my symptoms as accurately as possible. I have weakness in my left arm and leg, am unable to manipuate my left hand and fingers properly, and am experiencing noticeable muscle wasting in my left arm. My sense of hot/cold, sharp/dull are lacking on the left side of my body. There seems to be basically no cross-over of these symptoms. My bowel and bladder function have been unaffected.
Transverse myelitis, on the other hand, describes inflammation ACROSS(hence, transverse) the spinal cord. In some descriptions I have read, symmetrical symptoms are required for something to be described as transverse myelitis. Bowel and bladder control difficulty are also a prerequisite. This is logical to me, as interruption of signals all the way across one level of the cord would seem to result in similar symptoms on both sides of the body.
My concerns are as follows. While I understand that both of these terms constitute a description of symptoms as opposed to a diagnosis of the cause, I wonder if the results of my MRI are being interpreted correctly. My symptoms are clearly consistent with Brown-Sequard syndrome. *Should the MRI not have shown the lesion to be on one side of the spinal cord, as opposed to across the cord?(The MRI report described the lesion as being consistent with transverse myelitis or MS) *Is this syndrome more often associated with a mass-occupying lesion, as opposed to an inflammatory/demyelinating process? *Is the difference in the set of symptoms at all helpful in determining the cause?
I have a couple of other questions as well.
*One neurologist referred to this as "viral myelitis." She indicated that although I was not sick prior to the onset of symptoms, she still felt it could be caused by a virus. I am married with a 10 month old son. Should I be concerned at all as to this being contagious?
*In one of your responses to a previous posting, immunization for tetanus was mentioned. In the fall of 1997, about 15 months before the onset of my symptoms, I burned my left hand on a lawn mower muffler. I went to the hospital and received a tetanus shot. That is the only tetanus shot I have ever received, to my knowledge. Could this be a factor after so long?
If so, would it impact the course of treatment?
*The muscle wasting I am experiencing in my left arm has me very concerned. Is this muscle wasting an expected result of a spinal cord lesion? I received a 3 day course of 1 gram Solumedrol IV from 1/12-1/14/99. My symptoms did not get dramatically better, but there has been some improvement in my left arm, as far as being able to hold it up over my head, etc. What would be the next treatment step you would typically try, and how long would you wait?(My symptoms developed between 12/20 - 12/26/98).
As you can imagine, I want to be as aggressive as is practical in attacking this thing. I feel much better equipped to converse intelligently with my doctors as a result of the information this forum has provided. Thank you very much.
