A myelitis of uncertain origin

Key words: Transverse myelitis, Paresthesia, Weakness, Spinal cord MRI

Transverse myelitis is a neurologic syndrome caused by acute or subacute inflammation of the spinal cord. Since its incidence is about 0.5/100,000 children/year, transverse mielitis is included in the group of rare diseases. The pathogenesis of the disease includes an abnormal activation of the immune system of the spinal cord, which leads to axonal demyelination. Transverse mielitis occurs expecially after infections or vaccines; it is often due to autoimmune diseases; rarely, it is a paraneoplastic syndrome. When a direct cause cannot be found, it is called idiopathic. The clinic includes limb and leg weakness, sensory disturbance, bowel and bladder dysfunction, back and radicular pain. The prognosis is extremely variable: about one third of the patients recovers without consequences, one third has some disability left, one third gets an important rate of disability without recovery. We report a case of a 13-year-old girl affected by transverse myelitis who rapidly developed leg paresthesia and weakness, difficulty in deambulation, sensor and sphincter deficits. Since all the tests made during the hospitalization to find a possible cause were negative, no pathogenetic association could be done.