Complications
Acute partial TM commonly heralds or accompanies multiple sclerosis (MS), which affects up to 0.3% of people of Northern European ancestry.[18]
In people with a characteristic brain magnetic resonance imaging (MRI), the acute partial variant suggests high future risk of developing MS.
If no other disease is found responsible for the acute partial myelitis attack, the risk of recurrence (or other central nervous system attack) is best predicted by brain MRI. The presence of one or more white matter lesions typical of demyelination predicts >80% risk for the patient having another event, and therefore developing confirmed MS, within 10 years.[7]
About two-thirds of patients with TM are left with a significant motor deficit, and most of those interfere with ambulation. Neurologic rehabilitation including physical therapy and control of other problems such as spasticity can optimize strength and its functional consequences.
Spasticity usually accompanies chronic weakness and requires treatment if it is severe, is associated with pain or spasms, or interferes with function. Oral agents such as baclofen or tizanidine are usually helpful. Refractory spasticity may respond to onabotulinumtoxinA injections or an intrathecal baclofen pump.
Neuropathic pain often responds to anticonvulsants or tricyclic antidepressant drugs.
Acute urinary retention may be managed by bladder catheterization. Residual neurogenic bladder symptoms may include urge incontinence, retention, or a mixed disorder, each of which requires specific treatment.[79]
Immobilized patients are at increased risk for deep vein thrombosis (DVT). Extrapolation of data from general medical and orthopedic surgery patients indicates that subcutaneous heparin or enoxaparin plus use of lower extremity compression stockings or devices reduces the risk of DVT.
Patients with severe TM with paraplegia or quadriplegia have an increased risk of pressure ulcers of the skin. These can be prevented by skilled nursing care, frequent repositioning, and vigilance in treating lesions as early as possible.
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