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Hi All,
16 months post T-8. No movement or feeling below this level. Docs first thought I had Transverse Myelitis. Went to Johns Hopkins TM center and they dismissed it. Didn't know what was causing the cord swelling. Been on Imuran about 6 months and the latest MRI shows the swelling is subsiding slowly. This has revealed some narrowing of the cord at T-8 and below in places. But not that much according to the Doc. He thought this indicated nerve damage but couldn't be sure since you cant biopsy a cord Any thoughts are appreciated. Thanks
SCI-Nurse
12-22-2003, 01:22 PM
Death or destruction of neurons will cause some narrowing of the cord both above and below the actual injury level. On what basis did they say you did not have TM? I am assuming you had fairly rapid onset and that it was not traumatic? Was a vascular cause also ruled out?
Dr. Young may be able to add more to this.
(KLD)
Wise Young
12-22-2003, 02:33 PM
JMD,
I agree with KLD.
The first item on my differential diagnosis list (from your description) would be transverse myelitis. Did they tell you why they dismissed that diagnosis at Johns Hopkins? It is surprising but they are the best clinic (in my opinion) with the most experience on this condition.
The second would be ischemia, due to an embolus or inflammation to the Artery of Adamkiewicz.
The next item is multiple sclerosis, viral infection, tumor, or other problem but these are less likely given the absence of other signs.
Wise.
They dismissed the TM diagnosis because the cord swelling lasted longer than normal and I also had swelling in my brain stem. They said neither were indicative of TM. MS, viral infections, vasular & tumors were also ruled out. Yes the onset was rapid, no trauma. Artery of Adamkiewicz was never mentioned. How can I find out more about this?
Thanks
JMD
SCI-Nurse
12-22-2003, 11:51 PM
Your MRI would be able to indicate cord ischemia, and if so, generally an arteriogram would be done to confirm an infarction of the cord. Was this done?
(KLD)
Wise Young
12-23-2003, 05:59 AM
JMD, you are a diagnostic dilemma. You did not mention the swelling in your brainstem. I agree that this would raise questions concerning all the diagnoses that I mentioned.
To find out more about the Artery of Adamkiewics, just do a google search. It is the main artery that goes from your aorta to the spinal cord, usually at T6-T8.
Wise.
A diagnostic dilemma huh...lol Thats me! Infarction of the cord was ruled out. Also, no stroke or blood clots. So far I haven't been able to get any clues as to why this happened or if it will get any better. Its very frustrating. Other than this I am in good health and fitness (42.yo.) I have 3 more months of the Imuran therapy left then if there is no improvement I'm not sure what to do next. Any suggestions?