BIOGRAPHY
Advanced trainee in General Medicine, Queensland Health , Australia ABSTRACT
Transverse myelitis: Is this all viral? Treat first, decide later – Our experience in a general medical ward.
S Leow1,2, D Roberts1
1 Department of Medicine, Logan Hospital, Meadowbrook, QLD, AUSTRALIA
2 School of Medicine, Logan Campus, Griffith University, QLD, AUSTRALIA
Abstract
The reported incidence rate of transverse myelitis (TM) in the western literature ranges from one to four per hundred thousand to one to eight per million (1). Its presentation can take variable forms and therefore, diagnosis is often delayed. The paucity of clinical guidelines in the management of TM in the local and international scenes clearly has not helped . Early recognition and appropriate treatment of the underlying aetiology are critical components in the management of this condition. We recently diagnosed a 34-year-old male with herpes simplex virus (HSV) type 2 related myelitis. The single segment enhancement on his spinal cord MRI is not one would normally relate to parainfection as the underlying cause unless the history is strongly suggestive. To complicate things further, patients with HSV-related myelitis typically demonstrate pathology at more than one spinal cord level with type 1 affecting the cervical to thoracic segments and type 2 extending beyond those levels if not limited to the lumbosacral cord (2). We would like to share with others the challenges we encountered in managing this patient and review the important aspects one should consider when dealing with this potentially debilitating illness.
References:
1) Berman M, Feldman S, Alter M, Zilber N, Kahana E. Acute transverse myelitis: Incidence and etiologic considerations. Neurology 1981;31:966-71.
2) Azuma K1, Yoshimoto M, Nishimura Y, Fujimoto H, Ayabe M, Shoji H, Eizuru Y. Herpes simplex virus type 1 myelitis with a favorable outcome. Intern Med 2001 Oct;40(10):1068-9
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