Materiały źródłowe

• #1 Transverse Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559302/

  Transverse myelitis (TM) is a rare, acquired focal inflammatory disorder often presenting with rapid onset weakness, sensory deficits, and bowel/bladder dysfunction. […] The most common cause of TM is idiopathic, and no causative factor is found. Infections leading to TM include but are not limited to, enteroviruses, West Nile virus, herpes viruses, HIV, human T-cell leukemia virus type 1 (HTLV-1), Zika virus, neuroborreliosis (Lyme), Mycoplasma, and Treponema pallidum. […] The histopathophysiology of TM varies and is related to the underlying etiology. Classically, most cases were characterized by perivascular infiltration, demyelination, and axonal injury by monocytes and lymphocytes at the lesion site. […] TM may be a mixed inflammatory disorder involving neurons, axons, oligodendrocytes, and myelin. Alternative histopathologic causes of TM have been reported to include molecular mimicry and super antigen-mediated disease associated with autoimmune causes.

• #1 Transverse Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559302/

  The standard of care and the first-line therapy for the treatment of TM is intravenous glucocorticoids. High-dose intravenous glucocorticoids should be initiated as soon as possible. […] Plasma exchange may be efficacious for acute central nervous system demyelinating disease, which fails to respond to glucocorticoid therapy. […] Additionally, as knowledge expands regarding TM, immunomodulatory therapy such as cyclophosphamide, mycophenolate, or rituximab might benefit chronic recurrent TM or resistant acute TM.

• #2 Transverse myelitis: pathogenesis, diagnosis and treatment

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W2094697006

  Transverse Myelitis (TM) is a clinical syndrome in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations and autonomic dysfunction. […] Additionally, we will review current concepts on the natural history, immunopathogenesis and treatment strategies for patients with TM.

• #3

  https://journals.lww.com/continuum/fulltext/2005/06000/autoimmune_transverse_myelitis.4.aspx

  Transverse myelitis (TM) is the prototype inflammatory myelopathy. TM is a clinical syndrome in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations, and autonomic dysfunction. […] With more rigorous criteria applied to distinguish acute myelopathies and with an emerging understanding of immunopathogenic events that underlie TM, it may now be possible to initiate effective treatments in many of these disorders. The investigation of TM results in a broader appreciation of the mechanisms that lead to autoimmune neurological diseases in general.

• #4

  https://step2.medbullets.com/evidence/24752988

  Transverse myelitis is an acute inflammatory disease of the spinal cord, characterized by rapid onset of bilateral neurological symptoms. […] The causes of transverse myelitis are diverse; etiologies implicated include demyelinating conditions, collagen vascular disease, and parainfectious causes, however, despite extensive diagnostic work-up many cases are considered idiopathic. […] Due to heterogeneity in pathogenesis, and the similarity of its clinical presentation with those of various noninflammatory myelopathies, transverse myelitis has frequently been viewed as a diagnostic dilemma. […] However, as targeted therapies to optimize patient outcome develop, timely identification of the underlying etiology is becoming increasingly important.

• #5 Transverse myelitis – Wikipedia

  https://en.wikipedia.org/wiki/Transverse_myelitis

  Transverse myelitis (TM) is a rare neurological condition wherein the spinal cord is inflamed. […] The underlying cause of TM 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. […] This progressive loss of the fatty myelin sheath surrounding the nerves in the affected spinal cord occurs for unclear reasons following infections or due to multiple sclerosis. Infections may cause TM through direct tissue damage or by immune-mediated infection-triggered tissue damage. […] The lesions present are usually inflammatory. Spinal cord involvement is usually central, uniform, and symmetric in comparison to multiple sclerosis which typically affects the cord in a patchy way. The lesions in acute TM are mostly limited to the spinal cord with no involvement of other structures in the central nervous system.

• #5 Transverse myelitis – Wikipedia

  https://en.wikipedia.org/wiki/Transverse_myelitis

  A proposed special clinical presentation is the „longitudinally extensive transverse myelitis” (LETM), which is defined as a TM with a spinal cord lesion that extends over three or more vertebral segments. The causes of LETM are also heterogeneous and the presence of MOG auto-antibodies has been proposed as a diagnostic biomarker.

• #6 Transverse myelitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/transverse-myelitis

  Transverse myelitis is a condition caused by inflammation of the spinal cord. As a result, the covering (myelin sheath) around the nerve cells is damaged. This disturbs the signals between spinal nerves and rest of the body. […] Transverse myelitis is a rare nervous system disorder. In many cases, the cause is unknown. However, certain conditions may lead to transverse myelitis: Bacterial, viral, parasitic, or fungal infection, such as HIV, syphilis, varicella zoster (shingles), West Nile virus, Zika virus, enteroviruses, and Lyme disease; Immune system disorders, such as multiple sclerosis (MS), Sjögren syndrome, and lupus; Other inflammatory disorders, such as sarcoidosis, or a connective tissue disease called scleroderma; Blood vessel disorders that affect the spine. […] Treatment for transverse myelitis helps to: Treat an infection that caused the condition; Reduce inflammation of the spinal cord; Relieve or reduce symptoms. […] Transverse myelitis usually only occurs once in most people. It may recur in some people with an underlying cause, such as MS. People who have involvement of only on one side of the spinal cord may be more likely to develop MS in the future.

• #7 Myelitis Transverse in Sjögren’s Syndrome and Systemic Lupus Erythematosus: Presentation of 3 Cases | Reumatología Clínica

  https://reumatologiaclinica.org/en-myelitis-transverse-in-sjgren39s-syndrome-articulo-S2173574314001142

  Transverse myelitis is a rare focal inflammation of the spinal cord. Multiple etiologies have been identified including autoimmune diseases, mainly systemic lupus erythematosus and Sjgren syndrome. […] Its etiology is multiple and among it are autoimmune diseases, showing a greater association with systemic lupus erythematosus (SLE) and Sjgren’s syndrome (SS) in 12 and 1%, respectively. […] TM is a rare neurological impairment that can occur in autoimmune diseases, particularly in SLE and SS. In SLE it is more common in patients with antiphospholipid antibodies, or secondary antiphospholipid syndrome. This raises suspicion of its involvement in the pathophysiologic mechanism of spinal cord necrosis due to arterial thrombosis, in addition to the direct interaction between antibodies and spinal phospholipids.

• #7 Myelitis Transverse in Sjögren’s Syndrome and Systemic Lupus Erythematosus: Presentation of 3 Cases | Reumatología Clínica

  https://reumatologiaclinica.org/en-myelitis-transverse-in-sjgren39s-syndrome-articulo-S2173574314001142

  From this immunological point of view, various theories have been proposed. The first is the molecular mimicry between infectious antigens and common antigens with the spinal cord that produce immune response confusion. The second is that the overstimulation of T lymphocytes by microbial superantigens is capable of activating the immune system. Finally, a specific spinal lesion could be caused by the development of abnormal antibodies, like aquaporin-4 antibodies. […] It may be the initial manifestation of SLE, presenting in the first 5 years from the diagnosis of the disease in 42%. […] Regarding diagnosis, MRI is the determining test. Studies show abnormality of signal with hyperintensity on T2, gadolinium enhancement and edema of the spinal cord. […] Treatment is not standardized. The accepted therapeutic conduct is infusion of boluses of methylprednisolone and cyclophosphamide in the acute phase, followed by oral prednisone and cyclophosphamide in monthly boluses lasting 312 months. […] The importance of early diagnosis and aggressive treatment from the onset of the disease is vital, both in the clinical process and its aftermath.

• #8 Transverse myelitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Transverse_myelitis_pathophysiology

  In the pathogenesis of transverse myelitis, a variety of immunological mechanisms may cause pathological substrate and dysfunction of neural cells within the spinal cord. […] Transverse myelitis is the result of progressive demyelination and axonal loss in addition to gray matter involvement, necrosis and cavitation. […] It is understood that infections may cause transverse myelitis by: Direct tissue damage, Immune-mediated infection-triggered tissue damage. […] Multiple sclerosis is the other cause to the transverse myelitis and it sometimes transverse myelitis can appear as the first symptom of Multiple sclerosis. […] Acute partial transverse myelitis may be predictive of a subsequent diagnosis of multiple sclerosis in children. […] Invariable histopathological findings of transverse myelitis include: Perivascular spread of monocytes, Focal areas of lymphocytes infiltrating, Astroglial and microglial activation.

• #8 Transverse myelitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Transverse_myelitis_pathophysiology

  Other histopathological findings of transverse myelitis include: Infiltration of CD4+ and CD8+ T-lymphocytes, Typically preservation of the subpial parenchyma suggesting ischemia as the ultimate cause of the cord lesions in transverse myelitis. […] Infections can cause transverse myelitis through two main mechanisms: Direct tissue damage, Immune-mediated infection-triggered tissue damage which may be due to: Molecular mimicry or superantigen effect. […] A non-microbial related immune dysfunction by the presence of autoantibodies has been also proposed in the immunopathogenesis of transverse myelitis. […] In the spinal fluid of patients with transverse myelitis, Interleukin 6 (IL-6) levels were also markedly elevated.

• #9 Transverse Myelitis | Musculoskeletal Key

  https://musculoskeletalkey.com/transverse-myelitis-2/

  The mechanism of TM, although still unknown, is presumed to be an immune-mediated attack of the spinal cord. […] This is based on inflammatory signs in the CSF, such as lymphocytosis and elevated IgG index, and gadolinium enhancement by MRI which suggests breakdown of the blood-brain barrier of the spinal cord. […] One theory proposes that there is molecular mimicry and consequently stimulation of T cells and autoantibodies involved, similar to the pathogenesis of Guillain-Barr syndrome. […] Another theory involves the overactivation of lymphocytes by nonspecific superantigens. […] Much of the speculation around the pathophysiology of TM comes from related diseases, such as MS and NMO, and animal models, particularly with experimental autoimmune encephalomyelitis (EAE). […] Studies have shown increased interleukin 6 (IL-6) levels within the CSF and correlation between markedly elevated IL-6 levels with worsening neurological disability.

• #10 Transverse Myelitis (TM): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8980-transverse-myelitis

  Transverse myelitis (TM) is a rare neurological condition caused by inflammation of your spinal cord. […] Due to inflammation, the covering (myelin sheath) around the nerve cells in your spinal cord is damaged. This interrupts the signals between spinal nerves and the rest of your body, causing issues such as loss of sensation, movement and bladder control. […] In the case of TM, the covering around the nerve cells in your spinal cord is damaged due to inflammation. […] Scientists think idiopathic TM results from an abnormal and excessive immune response against your spinal cord that results in inflammation and tissue damage. But they cant figure out the exact cause or trigger. […] When your body encounters an offending agent (like viruses, bacteria or toxic chemicals) or suffers an injury, it activates your immune system.

• #11 Transverse Myelitis (TM): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8980-transverse-myelitis

  Your immune system sends out its first responders: inflammatory cells and cytokines (substances that stimulate more inflammatory cells). […] These cells begin an inflammatory response to trap bacteria and other offending agents or start healing injured tissue. While this inflammatory response is necessary in a lot of cases, sometimes, your immune system can send out its first responders for no known reason and attack healthy tissue. Or the inflammatory response to an offending agent can be excessive and damage tissues in your body in the process.

• #12 Transverse Myelitis | PM&R KnowledgeNow

  https://now.aapmr.org/transverse-myelitis/

  Histopathology of TM is characterized by lymphocytes and monocytes infiltrating focal areas of the cord with varying degrees of inflammation, demyelination, axonal injury, and astroglial and microglial activation. Necrosis and cavitation can result in more severe cases. […] This may occur because of direct tissue damage or immune mediated infection-triggered tissue damage. The latter may involve mechanisms such as molecular mimicry, autoantibody development, or superantigen effect. […] The cord involvement in most cases of TM occurs in a central, uniform, and symmetric pattern in comparison with MS, which has patches of peripheral lesions.

• #13 Transverse Myelitis | Musculoskeletal Key

  https://musculoskeletalkey.com/transverse-myelitis-2/

  IL-6, synthesized mainly by astrocytes in response to inflammatory cytokines, may worsen spinal cord demyelination and axonal degeneration by activating the Janus kinase (JAK)/Signal Transducer and Activator of Transcription proteins (STAT) pathway and increasing inducible nitric oxide synthase (iNOS) activity.

• #14 Transverse Myelitis — a Review of the Presentation, Diagnosis, and Initial Management – Timothy W West – Discovery Medicine

  https://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/

  When myelitis is the first presentation of suspected MS, and thus represents an initial demyelinating event, the myelitis is then referred to in the medical literature as a clinical isolated syndrome (CIS). […] The pattern, location, and extent of the signal abnormality on MRI of the spinal cord can be very helpful in deciphering the etiology of the myelitis. […] Once clinical history, physical examination, neuroimaging, and CSF studies confirm the diagnosis of myelitis, the first clinical decision must be whether or not infection is considered to be the likely etiology. […] Acute management of myelitis is aimed at stopping the inflammatory process that is occurring within the spinal cord (Beh et al., 2013). […] Determining the etiology of transverse myelitis can be challenging, but with effective interpretation of clinical signs and symptoms, neuroimaging, serological and CSF studies, the cause of the myelitis and the treatment course can be guided to provide the patient with the optimal chance for a good outcome.

• #15 Neuroimaging in Acute Transverse Myelitis | Radiology Key

  https://radiologykey.com/neuroimaging-in-acute-transverse-myelitis/

  Transverse myelitis is an acute inflammatory condition. Its pathogenesis can be grouped into four categories. […] Owing to the heterogeneous pathogenesis and prognosis of transverse myelitis, it is vitally important that there be uniformly applied criteria for diagnosis and classification. […] The pathogenesis of transverse myelitis in this population is not well understood. Scarce autopsy studies in SLE patients have described ischemic necrosis, infarction, or myelomalacia of the cord, and perivascular inflammatory cells and occasionally thrombi in small vessels. Historically, the favored hypothesis has been that vasculitis and arterial thrombi related to autoimmunologic phenomena result in ischemic necrosis within the cord. […] Advances in the understanding of the pathogenesis of NMO have given rise to an alternative hypothesis. Pointing to the well-documented high incidence of optic neuritis and the more recent evidence of NMO-IgG positivity in many cases, it has been suggested that, in most cases, myelitis in patients with a connective tissue disorder may represent coexistent NMO instead of a direct complication of the autoimmune disorder. […] This suggests that although coexistent NMO is an important cause of myelopathy in the setting of systemic autoimmune diseases, there is a separate entity of transverse myelitis related to the underlying vasculitic process.

• #16 Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings | Spinal Cord

  https://www.nature.com/articles/sc2008143

  The diagnosis of acute transverse myelitis syndromes is based on the clinical symptoms and signs of a spinal cord syndrome in conjunction with evidence of inflammation within the spinal cord such as cerebrospinal fluid (CSF) abnormalities or lesions visible on magnetic resonance imaging (MRI). […] Evidence for an inflammatory pathogenesis can also be derived from CSF analysis, which may show mild pleocytosis, elevated protein levels or oligoclonal bands (OCB). […] The diagnostic criteria proposed by the Working Group for Idiopathic Transverse Myelitis require either the evidence of inflammation in gadolinium-enhanced MRI or CSF. […] Cerebrospinal fluid diagnostics are the mainstay for ruling out infectious causes, and may support the diagnosis of transverse myelitis by providing evidence for inflammation. Abnormal CSF findings were less frequent than evidence for MRI lesions during workup. OCB (83.6%) and abnormal IgG index (82.0%) were the most common pathological CSF findings.

• #16 Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings | Spinal Cord

  https://www.nature.com/articles/sc2008143

  This study confirms and expands earlier findings in acute transverse myelitis. In our cohort with a high percentage of presumably MS-related myelitis, most patients presented with sensory deficits and mild functional impairment, but the clinical presentation can be highly variable. Signal abnormalities on spinal cord MRI that mostly extend less than the height of one vertebral body, are rarely located anteriorly and rarely cover the entire cord cross section. Oligoclonal bands are the most frequent abnormal CSF finding. Nevertheless, in a few patients ancillary investigations will rule out most spinal cord disorders and leave the clinician with a suspicion but no proof of an inflammatory lesion. In the future, new serological markers may help to distinguish between specific myelitis subtypes and assist in the diagnostic workup.

• #17 Acute Transverse Myelitis – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/acute-transverse-myelitis

  Acute transverse myelitis is acute inflammation of gray and white matter in one or more adjacent spinal cord segments, usually thoracic. […] The mechanism of transverse myelitis is often unknown, but some cases follow viral infection or vaccination, suggesting an immune-mediated reaction. Inflammation tends to involve the spinal cord diffusely at one or more levels, affecting all spinal cord functions. […] Treatment of acute transverse myelitis is directed at the cause or associated disorder if identified but is otherwise supportive. […] In idiopathic cases, high-dose intravenous corticosteroids are often given and sometimes followed by plasma exchange because the cause may be autoimmune.

• #18 (PDF) Transverse myelitis: pathogenesis, diagnosis and treatment

  https://www.academia.edu/10155157/Transverse_myelitis_pathogenesis_diagnosis_and_treatment

  Transverse Myelitis (TM) is an immune-mediated neurological disorder that results in spinal cord damage, leading to motor, sensory, and autonomic dysfunction. […] The mechanisms of neural injury may involve multiple pathways including T lymphocyte killing of neural cells, cytokine injury, activation of toxic microglial pathways, immune-complex deposition, excitotoxic or apoptotic neural injury. […] In TM patients, it is likely that there is abnormal activation of the immune system resulting in inflammation and injury within the spinal cord.

• #19 Clinical Approach to Pediatric Transverse Myelitis, Neuromyelitis Optica Spectrum Disorder and Acute Flaccid Myelitis

  https://www.mdpi.com/2227-9067/6/5/70

  Acute management of transverse myelitis has been informed primarily by case series and expert opinion, as no randomized controlled trials have been done in this population. […] Neuromyelitis optica spectrum disorder (NMOSD)-related myelitis is classically described to be longitudinally extensive, involving three or more vertebral segments. […] Our understanding of pediatric TM has grown significantly with the discoveries of antibody-mediated forms of myelitis and the identification of new potential infectious etiologies.

• #20 Spine Inflammation & Stem Cell Therapy for Transverse Myelitis

  https://stemcellthailand.org/therapies/transverse-myelitis/

  Transverse myelitis is a rare neurological impairment caused by inflammation in both sides of the spinal cord, resulting in damage to the myelin sheath, an insulating material covering nerve cell fibers. […] Our work focuses on using modern cell-based therapeutics to repair demyelinated spinal cords. Our research has led to a much greater understanding of the underlying mechanisms responsible for damaging the myelin sheath. It offers patients a viable means to prevent and treat transverse myelitis, reduce relapse rate, and diminish harmful inflammatory activities. […] Much work remains to understand the pathogenesis of transverse myelitis fully.

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