Akut Transvers Miyelit Olgularının Klinik, Radyolojik ve Etiyolojik Spektrumu: Tek Merkez Deneyimi ve Literatürün Gözden Geçirilmesi

Amaç: Akut transvers Miyelit (ATM), omuriliğin idiyopatik veya kordda kompresyon olmaksızın bir enfeksiyon veya sistemik hastalığa ikincil olarak fokal enflamasyonudur. Omuriliğin tam veya kısmi tutulum derecesine göre ekstremitelerde güçsüzlük, duyu kusuru, mesane ve rektumun otonomik bozukluğu ile karakterize akut veya subakut bir klinik tablo görülür. Gereç ve Yöntemler: Bu çalışmada kliniğimizde yatarak izlenen 35 akut transvers miyelit hastasının dosyası retrospektif olarak incelendi. Dejeneratif omurilik kompresyonuna yol açan kompresif miyelopati ve intramedüller neoplazili olgular ile bilinen Multiple Skleroz tanısı olup miyelit epizodu ile başvuran olgular çalışmaya dahil edilmedi. Hastaların %31,4’ünde idiyopatik akut transvers miyelit saptanırken, %68,6’sında etiyolojik tanıya ulaşıldı. Hastalar idiyopatik ATM olguları ile idiyopatik olmayan ATM olguları şeklinde iki gruba ayrılarak gruplar arası demografik ve klinik özellikler, BOS inceleme sonuçları ve spinal MRG bulguları karşılaştırıldı. Bulgular: İdiyopatik ATM’li grubun yaş ortalaması idiyopatik olmayan ATM grubuna göre istatistiksel olarak anlamlı düzeyde düşük, ortalama semptom süresi daha kısa bulundu. Miyelit klinik bulguları açısından her iki grup arasında istatistiksel anlamlı bir farklılık saptanmadı. Oligoklonal band (OKB) pozitifliği idiyopatik olmayan ATM’li 5 hastada tespit edildi. Torakal omurilik yerleşimi her iki grupta da en sık görüldü. Ancak lezyon yerleşimi açısından gruplar arasında anlamlı istatistiksel farklılık saptanmadı. Uzun segment tutulum idiyopatik olmayan ATM grubunda %66,66 oranında, idiyopatik ATM grubunda ise %27,27 oranında görülmüş olup MRG’de tutulan segment bulguları açısından her iki grup arasında anlamlı istatistiksel farklılık saptandı. Sonuç: Transvers Miyelit nadir bir durum olmasına rağmen klinik tablo nörolojik bir acil durumdur ve pratik hızlı bir yaklaşım, spesifik etiyolojiye ve uygun tedaviye yönelik ipuçlarını ortaya koyar.

Clinical, Radiological and Etiological Spectrum of Acute Transverse Myelitis Cases: A Single Center Experience and Review of the Literature

Objective: Acute Transverse Myelitis is the focal inflammation of the spinal cord either idiopathic or secondary to an infection or systemic disease without the compression of the cord. Acute or subacute clinical presentation with sensory level, weak- ness of the extremities, and autonomic invovement of the bladder and rectum can be seen completely or partially in accordance with the degree of involvement of the spinal cord. Material and Methods: In this retrospective study consisting of 35 ATM cases, idiopathic ATM was detected in 31.4% of the patients, and etiological diagnosis was provided in 68.6% of them. Demo- graphic and clinical characteristics, CSF examination results, and spinal MRI findings were compared between idiopathic and non-idiopathic ATM groups. Results: The mean age of the group with idiopathic ATM was statisti- cally significantly lower than the non-idiopathic ATM group and the mean symptom duration was shorter. There was no statistically significant difference between the two groups in terms of myelitis clinical findings. Thoracic spinal cord location was the most common in both groups. However, no statistically significant difference was found between the groups in terms of lesion location. Long segment involve- ment was observed in 66.66% of the non-idiopathic ATM group and 27.27% in the idiopathic ATM group, and a signifi- cant statistical difference was found between both groups in terms of segment findings on MRI. Conclusion: Although Transverse Myelitis is a rare condition, the clinical picture is a neurological emergency and a quick practical approach provides clues to the specific etiology and appropri- ate treatment.

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