17yr F with Post infections Transverse Myelitis with residual bladder incontinence
Diagnosis:
Transverse myelitis
Chief complaints and Hopi:
C/o mumps 15 days ago,
C/O fever 3 days ago,
C/O bilateral lower limb weakness since 2 days
C/O difficulty in voiding since 2days
HOPI:-
Here is a 17-year-old female child, developmentally normal, with history of mumps 15 days ago, subsided now. Complaints of fever, 1 episode, 3 days ago, low grade, and relieved on taking medications.
Complaints of bilateral lower limb weakness since 2 days, sudden in onset, unable to walk since 2 days, but can lift both legs.
C/o bladder retention since 2days
No h/o back pain
Birth History:
Antenatal-Uneventful,
Natal-LSCS/Baby Cried Immediately After Birth/ Birth Weight-3.5 Kg/Term. Postnatal-No NICU Admission.
Developmental History:
All milestones are attained appropriate to age.
Past History: No history of any previous admission.
Family History: NCM,No history of stroke in the family.
Immunization history: last vaccine taken at 18 months.
Systemic examination:
Conscious, Oriented
HMF- Normal
Speech- Normal
Cranial nerves - Normal
Power of right upper limb -5/5
left upper limb - 4/5
right lower limb- 3/5
left lower limb - 3/5
Reflexes right upper limb +
left upper limb +
right lower limb 3+exaggerated
left lower limb 3+exaggerated
Investigations :
Contrast MRI Cervico-dorsal spine :
17 yr old female with Bilateral lower limb weakness & difficulty in micturition since 1 Day. Contrast MRI of Cervico-dorsal spine demonstrates: Long Segment intramedullary altered Signal spinal Cord Intensity with mild Cord expansion and homogenous post Contrast enhancement in cervical, dorsal and upper Lumbar levels as described - features suggative of "ACUTE TRANSVERSE MYELITIS"
Treatment:
Inj Methylprednisolone IV 500 mg 1-0-1 x5 days
Inj Ceftriaxone IV 2g 1-0-1
Inj Pantop IV 40 mg 1-0-0
Course:
A 17-year-old female who is developmentally normal with history of mumps 15 days ago was brought with the complaints of fever 1 episode, 3 days prior to admission, and complaints of bladder retention since 2 days, complaints of bilateral lower limb weakness since 2 days, unable to walk which was sudden in onset. At presentation, patient was hemodynamically stable, was conscious, and oriented. Systemic examination showed no cranial nerve involvement with decreased tone in both lower limbs and left upper limb, exaggerated reflexes and plantar is extensor, power of both lower limbs 3/5, left lower limb 4/5, and left upper limb 5/5. Suspected lesion at spinal cord level,? transverse myelitis, planned for MRI spine.
MRI spine showed Long Segment intramedullary altered Signal spinal Cord Intensity with mild Cord expansion and homogenous post Contrast enhancement in cervical, dorsal and upper Lumbar levels as described - features suggative of "ACUTE TRANSVERSE MYELITIS"
Patient was started on injection methyl prednisolone as per the guidelines and injection ceftriaxone in view of suspected infectious cause. Neurology opinion taken, diagnosed as post-infectious transverse myelitis and advised for nerve conduction studies and CSF analysis. Ophthalmology opinion taken to rule out neuritis.
Patient received 5 days course of injection methylprednisolone ,Patient had improvement in power and attained bladder control, was able to walk. Patient was heamodymamically stable and discharged with following advice.
Advice on discharge:
- Plan to give oral prednisolone for 2 months in tapering manner.
1.Tab prednisolone 60 mg per day for 1 month ( 20 mg 1-0-1 + 10 mg tablet 1-0-1 for 1 month.)->
2.Tab prednisolone 40 mg per day for 15 days(20 mg tablet 1-0-1 for 15 days). ->
3.Tab prednisolone 20 mg 1-0-0 for 15 days. -> Stop.
- Plan to send CSF analysis MOG-NMO, SD (Pannel with NMO aquaporin 4 + MOG antibodies) and to do nerve conduction studies and follow-up.
-Review on Thursday(14-03-2024) in Pediatrics OPD.
-Review SOS if symptoms worsens.