| 释义 |
- Signs and symptoms
- Causes
- Pathophysiology Longitudinally extensive transverse myelitis
- Diagnosis Diagnostic criteria Investigations Differential diagnosis
- Treatment
- Epidemiology
- History
- Etymology
- See also
- References
- Further reading
- External links
{{short description|Acute transverse myelitis (ATM) is an inflammatory demyelinating disorder of the spinal cord that can be either idiopathic (IATM; see this term) or secondary to a known cause (SATM; see this term)}}{{Infobox medical condition (new)
| name = Transverse myelitis
| image = Transverse_myelitis_MRI.jpg
| caption = An MRI scan showing a transverse myelitis lesion (the lesion is the lighter, oval shape at center-right), this MRI scan was taken 3 months after patient recovered
| field = Neurology
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes = Uncertain[1]
| risks =
| diagnosis = Neurological exam[1]
| differential =
| prevention =
| treatment = Corticosteroids[1]
| medication =
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}}Transverse myelitis (TM) is a rare neurological condition in which the spinal cord is inflamed. Transverse implies that the inflammation extends across the entire width of the spinal cord.[4] Partial transverse myelitis and partial myelitis are terms used to define inflammation of the spinal cord that affects part of the width of the spinal cord.[4] TM is characterized by weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional urethral and anal sphincter activities, and dysfunction of the autonomic nervous system that can lead to episodes of high blood pressure. Signs and symptoms are variable and reflect the level of the affected spinal cord. The underlying cause of transverse myelitis is unknown. The spinal cord inflammation seen in TM has been associated with various infections, immune system disorders, or damage to nerve fibers, by loss of myelin sheaths.[4] Decreased electrical conductivity in the nervous system can result.{{citation needed|date=July 2018}} Signs and symptomsSymptoms include weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional urethral and anal sphincter activities, and dysfunction of the autonomic nervous system that can lead to episodes of high blood pressure.[4] Symptoms typically develop over the course of hours to a few weeks.[2][3] Sensory symptoms of transverse myelitis may include a sensation of pins and needles traveling up from the feet.[2] The degree and type of sensory loss will depend upon the extent of the involvement of the various sensory tracts, but there is often a "sensory level" at the spinal ganglion of the segmental spinal nerve, below which sensation to pain or light touch is impaired. Motor weakness occurs due to involvement of the pyramidal tracts and mainly affects the muscles that flex the legs and extend the arms.[2] Disturbances in sensory nerves and motor nerves and dysfunction of the autonomic nervous system at the level of the lesion or below, are noted. Therefore, the signs and symptoms depend on the area of spine involved.[12] Back pain can occur at the level of any inflamed segment of the spinal cord.[2] If the upper cervical segment of the spinal cord is involved, all four limbs may be affected and there is risk of respiratory failure – the phrenic nerve which is formed by the cervical spinal nerves C3, C4, and C5 innervates the main muscle of respiration, the diaphragm.{{citation needed|date=July 2018}} Lesions of the lower cervical region (C5–T1) will cause a combination of upper and lower motor neuron signs in the upper limbs, and exclusively upper motor neuron signs in the lower limbs. Cervical lesions account for about 20% of cases.[12] A lesion of the thoracic segment (T1–12) will produce upper motor neuron signs in the lower limbs, presenting as a spastic diplegia. This is the most common location of the lesion, and therefore most individuals will have weakness of the lower limbs.[{{cite book | vauthors = Alexander MA, Matthews DJ, Murphy KP |title=Pediatric Rehabilitation, Fifth Edition: Principles and Practice|url=https://books.google.com/books?id=Gp4sCQAAQBAJ&pg=PA523|date=28 May 2015|publisher=Demos Medical Publishing|isbn=978-1-62070-061-7|pages=523, 524}}]
5. ^{{cite journal | vauthors = Pandit L | title = Transverse myelitis spectrum disorders | journal = Neurology India | volume = 57 | issue = 2 | pages = 126–33 | date = Mar–Apr 2009 | pmid = 19439840 | doi = 10.4103/0028-3886.51278 }}
6. ^{{cite news|url=https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/transverse_myelitis/about-tm/what-is-transverse-myelitis.html|title=What is Transverse Myelitis (TM)? {{!}} Johns Hopkins Transverse Myelitis Center|access-date=2018-07-22|language=en}}
7. ^1 2 3 {{cite web|url=http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm|title=Transverse Myelitis Fact Sheet | work = National Institute of Neurological Disorders and Stroke (NINDS) |access-date=2015-08-06 }}
8. ^{{cite journal | vauthors = Levin SN, Lyons JL | title = Infections of the Nervous System | journal = The American Journal of Medicine | volume = 131 | issue = 1 | pages = 25–32 | date = January 2018 | pmid = 28889928 | doi = 10.1016/j.amjmed.2017.08.020 | type = Review }}
9. ^{{cite journal | vauthors = Blanc F, Froelich S, Vuillemet F, Carré S, Baldauf E, de Martino S, Jaulhac B, Maitrot D, Tranchant C, de Seze J | title = [Acute myelitis and Lyme disease] | language = French | journal = Revue Neurologique | volume = 163 | issue = 11 | pages = 1039–47 | date = November 2007 | pmid = 18033042 | url = http://www.masson.fr/masson/MDOI-RN-11-2007-163-11-0035-3787-101019-200703533 | doi = 10.1016/S0035-3787(07)74176-0 }}
10. ^{{cite journal | vauthors = Ross AG, Olds GR, Cripps AW, Farrar JJ, McManus DP | title = Enteropathogens and chronic illness in returning travelers | journal = The New England Journal of Medicine | volume = 368 | issue = 19 | pages = 1817–25 | date = May 2013 | pmid = 23656647 | doi = 10.1056/NEJMra1207777 | type = Review }}
11. ^Cuello JP, Romero J, de Ory F, de Andrés C "Longitudinally extensive varicella-zoster virus myelitis in a multiple sclerosis patient, Spine 2013 Sep;38(20):E1282-4. doi: 10.1097/BRS.0b013e31829ecb98, {{PMID|23759816}}
12. ^{{cite journal | vauthors = Pekcevik Y, Mitchell CH, Mealy MA, Orman G, Lee IH, Newsome SD, Thompson CB, Pardo CA, Calabresi PA, Levy M, Izbudak I | display-authors = 6 | title = Differentiating neuromyelitis optica from other causes of longitudinally extensive transverse myelitis on spinal magnetic resonance imaging | journal = Multiple Sclerosis (Houndmills, Basingstoke, England) | volume = 22 | issue = 3 | pages = 302–11 | date = March 2016 | pmid = 26209588 | pmc = 4797654 | doi = 10.1177/1352458515591069 | url = }}
13. ^{{cite journal | vauthors = Cobo-Calvo Á, Sepúlveda M, Bernard-Valnet R, Ruiz A, Brassat D, Martínez-Yélamos S, Saiz A, Marignier R | display-authors = 6 | title = Antibodies to myelin oligodendrocyte glycoprotein in aquaporin 4 antibody seronegative longitudinally extensive transverse myelitis: Clinical and prognostic implications | journal = Multiple Sclerosis | volume = 22 | issue = 3 | pages = 312–9 | date = March 2016 | pmid = 26209592 | doi = 10.1177/1352458515591071 }}
14. ^{{cite journal | author = Transverse Myelitis Consortium Working Group | title = Proposed diagnostic criteria and nosology of acute transverse myelitis | journal = Neurology | volume = 59 | issue = 4 | pages = 499–505 | date = August 2002 | pmid = 12236201 | doi = 10.1212/WNL.59.4.499 }}
15. ^{{cite journal | vauthors = Jacob A, Weinshenker BG | title = An approach to the diagnosis of acute transverse myelitis | journal = Seminars in Neurology | volume = 28 | issue = 1 | pages = 105–20 | date = February 2008 | pmid = 18256991 | doi = 10.1055/s-2007-1019132 }}
16. ^{{cite web | url = http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm | title = Transverse Myelitis Fact Sheet | publisher = National Institute of Neurological Disorders and Stroke (NINDS) | quote = About one-third of patients do not recover at all: These patients are often wheelchair-bound or bedridden, with marked dependence on others for basic functions of daily living. }}
17. ^{{cite book|title = Multiple Sclerosis Therapeutics|url = https://books.google.com/books?id=LxQkUu2tfXcC|publisher = Cambridge University Press|date = 2011-10-20 |page=625 |isbn = 978-1-139-50237-5 |first = Jeffrey A. |last = Cohen |first2 = Richard A. |last2 = Rudick | name-list-format = vanc }}
18. ^{{cite book|title = Neurology|url = https://books.google.com/?id=T5UMm9iSekwC&pg=PA417&dq=transverse+myelitis+epidemiology#v=onepage&q=transverse%2520myelitis%2520epidemiology&f=false|publisher = Thieme|date = 2011-01-01|isbn = 978-1-60406-135-2 |first = Marco|last = Mumenthaler|first2 = Heinrich|last2 = Mattle | name-list-format = vanc }}
19. ^1 2 3 4 {{cite book | vauthors = Dale RC, Vincent A |title=Inflammatory and Autoimmune Disorders of the Nervous System in Children|url=https://books.google.com/books?id=jwlt4t3GKj4C&pg=PA96|date=19 January 2010|publisher=John Wiley & Sons|isbn=978-1-898683-66-7|pages=96–106}}
20. ^{{cite book | url = https://books.google.com/?id=hi0AAAAAQAAJ&pg=PA998 |title=A Dictionary of Medicine: Including General Pathology, General Therapeutics, Hygiene, and the Diseases Peculiar to Women and Children | volume = 2 | publisher=Longmans, Green, and Company|year=1882 |editor-last=Quain|editor-first=Richard | name-list-format = vanc |location=|pages=1479–1483}}
21. ^{{cite news|url=https://myelitis.org/resources/the-history-of-tm-the-origins-of-the-name-and-the-identification-of-the-disease/|title=The History of TM: The Origins of the Name and the Identification of the Disease | first = Douglas | last = Kerr | name-list-format = vanc |work=The Transverse Myelitis Association|access-date=2018-07-22|language=en-US}}
22. ^{{cite journal |last=Morris |first=Milton H. |last2=Robbins|first2=Abner | name-list-format = vanc |date=1943-09-01 |title=Acute infectious myelitis following rubella|url=http://www.jpeds.com/article/S0022-3476(43)80017-2/fulltext |journal=The Journal of Pediatrics |volume=23 |issue=3 |pages=365–367 |doi=10.1016/S0022-3476(43)80017-2 }}
23. ^{{cite journal | vauthors = Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA | title = Transverse Myelitis: pathogenesis, diagnosis and treatment | journal = Frontiers in Bioscience | volume = 9 | issue = 1–3| pages = 1483–99 | date = May 2004 | pmid = 14977560 | doi = 10.2741/1351| url = https://www.bioscience.org/2004/v9/af/1351/2.htm }}
24. ^{{cite journal | vauthors = Berman M, Feldman S, Alter M, Zilber N, Kahana E | title = Acute transverse myelitis: incidence and etiologic considerations | journal = Neurology | volume = 31 | issue = 8 | pages = 966–71 | date = August 1981 | pmid = 7196523 | doi = 10.1212/WNL.31.8.966 }}
25. ^{{cite journal | vauthors = Ropper AH, Poskanzer DC | title = The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms | journal = Annals of Neurology | volume = 4 | issue = 1 | pages = 51–9 | date = July 1978 | pmid = 697326 | doi = 10.1002/ana.410040110 }}
26. ^{{cite journal | vauthors = Christensen PB, Wermuth L, Hinge HH, Bømers K | title = Clinical course and long-term prognosis of acute transverse myelopathy | journal = Acta Neurologica Scandinavica | volume = 81 | issue = 5 | pages = 431–5 | date = May 1990 | pmid = 2375246 | doi = 10.1111/j.1600-0404.1990.tb00990.x }}
27. ^{{cite book |veditors=Chamberlin SL, Narins B | title = The Gale Encyclopedia of Neurological Disorders | publisher = Thomson Gale | location = Detroit | year = 2005 | pages = 1859–70| isbn = 978-0-7876-9150-9 }}
Further reading {{refbegin}}- {{cite book|title = Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation|url = https://books.google.com/?id=FiMoQ-OtbB0C&pg=PA911&dq=transverse+myelitis+nih#v=onepage&q=transverse%2520myelitis%2520nih&f=false|publisher = Elsevier Health Sciences|date = 2008-01-01|isbn = 978-1-4160-4007-1 |first = Walter R. |last = Frontera |first2 = Julie K. |last2 = Silver |first3 = Thomas D. |last3 = Rizzo | name-list-format = vanc }}
- {{cite book |title = The Encyclopedia of Autoimmune Diseases |url = https://books.google.com/books?id=zKgMHabsTwMC |publisher = Infobase Publishing |date = 2003-01-01 |isbn = 978-1-4381-2094-2 |first = Dana K. |last = Cassell |first2 = Noel R. |last2 = Rose | name-list-format = vanc }}
{{refend}} External links {{Medical resources
| DiseasesDB = 13265
| ICD10 = {{ICD10|G|37|3|g|35}}
| ICD9 = {{ICD9|323.82}}, {{ICD9|341.2}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D009188
}}- The Transverse Myelitis Association
{{Diseases of the nervous system}}{{Paraneoplastic syndromes}} 5 : Autoimmune diseases|Syndromes|Central nervous system disorders|Multiple sclerosis|Rare diseases |