Natural history of longitudinally extensive transverse myelitis in 35 Hispanic patients with systemic lupus erythematosus: good short-term functional outcome and paradoxical increase in long-term mortality.

Background and objective Acute transverse myelitis (TM) is an infrequent neurological complication of systemic lupus erythematosus (SLE). Short-term outcome varies widely between cohorts. Little is known about the epidemiology and long-term functional outcome of TM associated to SLE. Methods Patients with SLE and acute TM were identified during hospital admission, visits to the Emergency Room or the Neurology Outpatient Clinic. We evaluated ambispectively those patients with SLE presenting with clinical myelopathy and corroborated with spinal MRI. Cases were divided as partial (non-paralyzing) or complete (paralyzing). We determined long-term functional outcome as well as mortality in those patients with follow-up periods of at least five years. Results We identified 35 patients (partial, n = 15; complete, n = 20) in which complete clinical and imaging data were available (26 with follow-up ≥ 5 years). Patients with complete TM were significantly older than those with partial forms. Positive antiphospholipid antibodies were observed in 80% of patients, suggesting a possible mechanistical role. Surprisingly, functional recovery at one year was in general good; however, we observed a five-year mortality of 31% because of sepsis (in 10 cases) or pulmonary embolism (in one case). Conclusions Short-term outcome of SLE-related TM is generally good, and recurrence rate is low. However, we observed a long-term fatality rate of 31% for reasons unrelated to TM, suggesting that TM is a manifestation of severe immune dysregulation and a predictor of severity and mortality in patients with SLE.

Patients with transverse myelitis who developed venous thromboembolism while hospitalized have increased rate for inpatient mortality.

The rate of venous thromboembolism (VTE) in patients with transverse myelitis (TM) is not known. Using the National Inpatient Sample database (NIS), from 2006-2010, the rate of VTE in TM patients was 1.3%, which included patients with both deep vein thrombosis (DVT) and pulmonary embolism (PE). The in-hospital mortality was higher in this group compared to TM patients without DVT and PE (11% and 0.5% respectively), and after adjusting for age, sex, presence of DVT and/or PE (odds ratio [OR], 21; 95% CI (2.2-207.0); p<0.008). The data supports the prompt initiation of VTE prophylaxis in patients hospitalized with TM.

Survival in traumatic transverse myelitis.

Spinal cord injury resulting in paraplegia or tetraplegia has from time immemorial led to early death. Mortality figures as high as 80% over a few years have been noted. Following World War II as a consequence of the intensive care extended to these casualties, the mortality has been significantly diminished. The mortality has been studied on three occasions by the authors and two previous papers have been published, the first in 1961 and the second in 1968. The present paper is based on a mortality and longevity study which covers the period from 1 January 1945 to 30 November 1973, an interval of 29 years less one month. It deals with the mortality of spinal cord injured persons following treatment in Lyndhurst Lodge Hospital and reveals that there has been significant improvement over the period of study.

Concurrent effect of morphine on thalamic nociceptive neurons and medullary on and off cells

On-and off-cells of the rostral ventromedial medulla project to the spinal cord, where off-cells are postulated to inhibit, and on-cell facilitate, nociceptive transmission. In the present experiments, unitary recordings were made from ventrobasal (VB) thalamic neurons and, simultaneously, on-or off-cells in lighhtly anesthetized rats. When the tail was heated (45-55ºC) off-cells stopped firing (pause) and on-cells began to fire (burst) 0.5-06s before VB neurons responded to the tail stimulus. Administration of morphine sulfate (2mg/kg i.v) concurrently prevented the off-cell pause, the on-cell burts an the VB neuronal response. Naloxone (1mg/kg i.v) recersed these effects. The results are consistent with the notion that prevention of the off-cell pause and the on-cell burst by morphine is responsible for the lack of nociceptive information flow towards the thalamus