Mielitis transversa aguda en un viajero / Acute transverse myelitis in a traveler

La mielitis transversa aguda se define como un trastorno neuroinmune adquirido de la medula espinal, que ocurre como consecuencia de un evento primario o relacionado a enfermedades inflamatorias autoinmunes, infecciosas o post infecciosas. Entre los agentes etiológicos infecciosos se destaca Borrelia spp., antropozoonosis transmitida por garrapatas de la familia ixodidae. Los pacientes con enfermedad de Lyme desarrollan, entre un 10 a un 15%, manifestaciones neurológicas. El espectro clínico suele ser variado e incierto. Entre las manifestaciones clínicas de la neuroborreliosis de Lyme, la mielitis transversa aguda ha sido reportada entre el 4 al 5%. Se describe el caso de un viajero proveniente de zona endémica de enfermedad de Lyme con encefalomielitis secundaria a infección aguda por Borrelia burgdorferi que presentó resolución completa de los síntomas luego de finalizar el tratamiento antibiótico.

Acute transverse myelitis is defined as an acquired neuroimmune disorder of the spinal cord, which occurs as a consequence of a primary event, or directly related to an autoimmune inflammatory disease, an infectious or post-infectious disease. Amongst infectious etiologies, Borrelia spp., a tick-bourne anthropozoonosis of the ixodidae family, prevails. Approximately 10 to 15% of patients with Lyme disease undergo neurologic manifestations, with an assorted and uncertain array of clinical syndromes. Transverse myelitis accounts for up to 5% of Lyme neuroborreliosis. We describe the case of a traveler from endemic zone for Lyme disease, with encephalomyelitis secondary to acute infection by Borrelia burgderfori, with complete resolution of symptoms after concluding adequate antibiotic treatment.

Non-compressive myelopathy: clinical and radiological study.

Fifty seven patients (42 males and 15 females) with non-compressive myelopathy were studied from 1997 to 1999. Acute transverse myelitis (ATM) was the commonest (31) followed by Vit B12 deficiency myelopathy (8), primary progressive multiple sclerosis (5), hereditary spastic paraplegia (3), tropical spastic paraplegia (2), subacute necrotising myelitis (1), radiation myelitis (1), syphilitic myelitis (1) and herpes zoster myelitis (1). 4 cases remained unclassified. In the ATM group, mean age was 30.35 years, antecedent event was observed in 41.9% case, 25 cases had symmetrical involvement and most of the cases had severe deficit at onset. CSF study carried out in 23 patients of ATM revealed rise in proteins (mean 147.95mg%, range 20-1200 mg/dL) and pleocytosis (mean 20.78/cumm, range 0-200 mm3). Oligoclonal band (OCB) was present in 28% of cases of ATM. The most common abnormality detected was a multisegment hyperintense lesion on T2W images, that occupied the central area on cross section. In 6 patients hyperintense signal was eccentric in location. MRI was normal in 4 cases of ATM. Thus ATM is the leading cause of non-compressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of ATM.