• It is characterized by sudden onset, progressive weakness and sensory disturbances.
• It has many causes, it tends to manifest differently in the two age groups.
In the group < 3 years of age, spinal cord dysfunction occurs within hours or a few days, there is usually a history of viral infection or vaccination a few weeks ago.
It is usually clinically serious. Slow, incomplete healing takes weeks to months.
40% of patients can walk independently. In its pathology, there is infiltration with perivascular mononuclear cells. Rarely, necrosis is seen on the outer side of the spinal cord.
- In older children (>3 years), complete recovery occurs quickly, with a rapid onset of 2 days to 2 weeks. In its pathology, signs of acute demyelination are seen.
• Most of the cases have a history of viral infections before transverse myelitis.
A large number of viruses such as Epstein-Barr virus, herpes, influenza, rubella, mumps and varicella viruses have been implicated. Lyme disease agent and Mycoplasma pneumoniae are other infectious agents of concern.
• The thoracic region of the spinal cord is most commonly involved.
• The most prominent findings in the early stages are low back or abdominal pain and paresthesias in the legs. Leg muscles are weak and limp. The sensory level is usually taken at the midthoracic level. There is a loss of sensation that gives a level. The senses of pain, temperature, and light touch may be affected, but the senses of position and vibration may be preserved. Sphincter defect is common. These patients require bladder catheterization. In the early period, fever and nuchal rigidity are observed in most of the cases.
• Spasticity, hyperreflexia, clonus may be seen 1-2 weeks after paraparesis-tetraparesis.
• CSF examination reveals moderate lymphocyte pleocytosis, normal or slightly increased protein levels, and increased IgG index and myelin basic protein. In older children, investigations should also be made in terms of autoimmune diseases, especially lupus erythematosus.
• MRI is an examination that should be performed in every case where transverse myelitis is suspected to exclude compressive lesions.
• Bladder care and physiotherapy should be applied.
• High-dose steroids (especially methylprednisolone) are used in the treatment of childhood transverse myelitis. If there is no good response to steroid treatment, treatment options such as IVIG, plasma exchange, rituximab and cyclophosphamide can be tried.
