Woman Wakes Up With Bilateral Leg Numbness

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Woman Wakes Up With Bilateral Leg Numbness - Page #4

Working Diagnosis: Idiopathic transverse myelitis Treatment: A 5-day course of oral steroids, and physical rehabilitation. Outcome: Following her treatment with steroids, she endorsed improvement of her symptoms with mild residual numbness in her heels and soles of her feet that presented as heaviness. A repeat thoracic spine MRI showed improvement in the enhancing lesion identified previously. She continued her rehabilitation with exercise/physical therapy. Author's Comments: Transverse myelitis consists of inflammation of the spinal cord, often secondary to demyelination, infections, or inflammatory disorders. It may present with ascending paresthesia, with or without back pain. Motor weakness, and autonomic dysfunction including hypertensive episodes are also common. Emergent rule-out diagnosis is cord compression using MRI. Other diagnostic criteria includes: bilateral sensory, motor, or autonomic dysfunction attributable to the spinal cord, spinal cord inflammation (evidenced by CSF or gadolinium enhancement), and progression to nadir from 4 hours to 21 days from onset. Editor's Comments: Transverse myelitis can affect people of any age, gender, or race. It does not appear to be genetic or run in families. The disorder typically occurs between ages 10 and 19 years and 30 and 39 years. There is no cure for transverse myelitis, but there are treatments to prevent or minimize permanent neurological deficits. References: Jacob A, Weinshenker BG. An approach to the diagnosis of acute transverse myelitis. Semin Neurol 2008;28:105-20 West TW. Transverse myelitis--a review of the presentation, diagnosis, and initial management. Discov Med 2013;16:167-77 Return To The Case Studies List.		Back
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