Acute transverse myelitis: a case report

Introduction: Transverse myelitis is an inflammatory pathology affecting the spinal cord. Clinical manifestation begins with algia, paresthesia, ataxia gait and sphincter dysfunction. For diagnosis, cerebrospinal fluid and magnetic resonance imaging are essential. The treatment used is pulse therapy with corticoids. Objective: To report a case of transverse myelitis, its clinical presentation, diagnosis and outcome. Methodology: This is a descriptive observational study based on the analysis of the patient's medical record and literature review. Results: A 62-year-old woman was admitted due to vertigo followed by a fall from her own height, paresthesia of the lower limbs and loss of strength in the right lower limb. Electrocardiogram was performed without alterations. After a few hours, the patient reported loss of sensation from the epigastric region downwards, without strength in the lower limbs. In addition to loss of sphincter control for evacuation and diuresis. Neurological examination: preserved facial mimicry, upper limbs without changes and absence of plantar cutaneous sign. Magnetic resonance imaging of the thoracic spine showed a hyperintense lesion in T2 weighting, without expansive effect or gadolinium enhancement, centrally located in the thoracic spinal cord, compromising the anterior column, extending from T1 to T4, corroborating the diagnosis of transverse myelitis. Pulse therapy was performed with partial improvement of symptoms. The patient evolved with urinary infection and acute renal failure, requiring care in an intensive care bed. She remained in intensive care for a few weeks, and later remained in a ward bed, hemodynamically stable, with diuresis and evacuations present, maintaining alteration of sensitivity and grade 1 strength in the lower limbs. It evolved after a few days with vomiting, tachydyspnea and epigastric discomfort, with worsening renal function, returning to the intensive care bed, requiring vasoactive drugs, discussed with family members about the non-progression of measures, and evolved to death in a few days. Conclusion: This is a case with difficult diagnosis at the beginning, due to the manifestations in advanced age that are less common.