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Transverse Myelitis, Pediatric

Benjamin M. Greenberg, MD, MHS and Cynthia X. Wang, MD Reviewed 10/2018
 


BASICS

DESCRIPTION

An acquired, immune-mediated inflammatory process in the spinal cord presenting as rapid onset (acute to subacute) weakness, sensory change, and/or autonomic dysfunction. Classically...

DIAGNOSIS

HISTORY

  • Children may present with:

    • Sensory changes (positive and/or negative) (91%)

    • Extremity weakness (89%)

    • Urinary and bowel dysfunction (85%)

    • Pain (75%)

    • Gait disturbance

  • A sensory level may not ...

TREATMENT

GENERAL MEASURES

  • Most patients will have urinary and bowel dysfunction so this should be assessed proactively and an appropriate regimen (i.e., intermittent catheterization, bowel regimen) be...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Respiratory and autonomic dysfunction may require ICU level monitoring.

  • Outpatient neurology follow frequency typically ranges from 6 to 12 month...

ADDITIONAL READING

  • Absoud M, Greenberg BM, Lim M, et al. Pediatric transverse myelitis. Neurology.  2016;87(9 Suppl 2):S46–S52. [View Abstract on OvidInsights]

  • Deiva K, Absoud M, Hemingway C, et a...

CODES

ICD9

  • 341.20 Acute (transverse) myelitis NOS

  • 341.22 Idiopathic transverse myelitis

  • 341.21 Acute (transverse) myelitis in conditions classified elsewhere

  • 049.9 Unspecified non-arthropod-borne viral di...

FAQ

  • Q: What is the typical clinical timeline of TM?

  • A: TM symptoms typically begin over 2 to 3 days. Functional nadir can occur within hours to 1 month of onset. This nadir averages 7 days before recov...

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