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Archivos de Medicina de Urgencia de México

2025, Número 2-3

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Arch Med Urg Mex 2025; 17 (2-3)


Mielitis transversa en el servicio de urgencias: una revisión narrativa

Miño-Bernal JF, Serna-Trejos JS, Bermúdez-Moyano SG, Castro-Galvis CA

Idioma: Español
Referencias bibliográficas: 48
Paginas: 186-197
Archivo PDF: 597.44 Kb.


RESUMEN

La mielitis transversa (MT) es un proceso inflamatorio de la médula espinal que ocasiona alteraciones motoras, sensitivas y autonómicas. Su presentación clínica es variable y afecta tanto a adultos como a niños, con predominio en mujeres y un patrón de distribución bimodal entre la segunda y cuarta década de vida. Su origen es diverso, desde causas compresivas (traumatismos, tumores) hasta no compresivas, entre las que destacan infecciones virales, enfermedades autoinmunes y trastornos desmielinizantes. Dentro de estas últimas, sobresalen la neuromielitis óptica, el lupus eritematoso sistémico y el síndrome de Sjögren. El diagnóstico requiere descartar otras entidades mediante criterios clínicos, estudio del líquido cefalorraquídeo y resonancia magnética. El abordaje terapéutico se inicia habitualmente con corticosteroides intravenosos, reservando opciones como plasmaféresis o ciclofosfamida para casos refractarios. El desenlace depende de factores como la edad y la forma de inicio, siendo más favorable en pacientes jóvenes con curso agudo. La investigación futura se orienta a identificar biomarcadores pronósticos y a desarrollar terapias dirigidas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Gómez Argüelles JM, Sánchez Solla A, López Dolado E, Díez Dela Lastra E, Florensa Vila J. Mielitis transversa aguda: revisiónclínica y algoritmo de actuación diagnóstica. Rev Neurol [Internet]. 2009;49(10):533. Available from: https://doi.org/10.33588/rn.4910.2009414

  2. Frohman EM, Wingerchuk DM. Clinical practice. Transversemyelitis. N Engl J Med [Internet]. 2010;363(6):564–72. Availablefrom: https://doi.org/10.1056/NEJMcp1001112

  3. Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA. Transversemyelitis: Pathogenesis, diagnosis and treatment. FrontBiosci [Internet]. 2004;9(1):1483–99. Available from: https://doi.org/10.2741/1351

  4. Kerr D, Krishnan C, Pidcock FS. Acute transverse myelitis. TreatPediatr Neurol Disord [Internet]. 2005;31(8):445–51. Availablefrom: https://doi.org/10.1212/wnl.31.8.966

  5. Borchers AT, Gershwin ME. Transverse myelitis. AutoimmunRev [Internet]. 2012;11(3):231–48. Available from: https://doi.org/10.1016/j.autrev.2011.05.018

  6. Zhang C, Yao Y, Sun J, Xu Y, Wang H, Zhuo ZZ, et al. Brain corticospinaltract abnormalities in aquaporin-4 seropositive neuromyelitisoptica spectrum disorder with longitudinally extensivetransverse myelitis. Brain Commun [Internet]. 2025;7(4). Availablefrom: https://doi.org/10.1093/braincomms/fcaf257

  7. Tobin WO, Weinshenker BG, Lucchinetti CF. Longitudinallyextensive transverse myelitis. Curr Opin Neurol [Internet].2014;27(3):279–89. Available from: https://doi.org/10.1097/WCO.0000000000000093

  8. Shadravan MM, Farshchian F, Rajaei A, Alavi Darazam I, NaseriR, Maghsudloo F. Post Varicella-Zoster virus transverse myelitis:Diagnostic and therapeutic challenges – A case report and literaturereview. IDCases [Internet]. 2025;41. Available from: https://doi.org/10.1016/j.idcr.2025.e02336

  9. Kitley JL, Leite MI, George JS, Palace JA. The differential diagnosisof longitudinally extensive transverse myelitis. Mult SclerJ [Internet]. 2012;18(3):271–85. Available from: https://doi.org/10.1177/1352458511406165

  10. Kramarov S, Palatna L, Shpak I, Seriakova I, Zakordonets L, VerbovaL, et al. Acute Transverse Myelitis in a Child Following OralLive Polio Vaccine Administration. Int Med Case Rep J [Internet].2025;18:899–907. Available from: https://doi.org/10.2147/IMCRJ.S526156

  11. John N, Lim A, Sunthar SR, Zhang L, Cheng J, Boktor J, et al.Immunotherapies in neuromyelitis optica: Bayesian network meta-analysis. J Neurol [Internet]. 2025;272(9). Available from: https://doi.org/10.1007/s00415-025-13279-7

  12. Flanagan EP, McKeon A, Lennon VA, Kearns J, WeinshenkerBG, Krecke KN, et al. Paraneoplastic isolated myelopathy: Clinicalcourse and neuroimaging clues. Neurology [Internet].2011;76(24):2089–95. Available from: https://doi.org/10.1212/WNL.0b013e31821f468f

  13. Kim SM, Waters P, Vincent A, Kim SY, Kim HJ, Hong YH, et al.Sjögren’s syndrome myelopathy: Spinal cord involvement in Sjögren’ssyndrome might be a manifestation of neuromyelitis optica.Mult Scler [Internet]. 2009;15(9):1062–8. Available from: https://doi.org/10.1177/1352458509106636

  14. Wen J, Dwyer S, Syed B, Badhan S, Khalil R, Elahi F. A Case ofTransverse Myelitis With an Intrathecal Pump : A Case Report.Pain Med Case Rep [Internet]. 2025;9(3):2025. Available from:https://www.painmedicine-casereports.com/current/pdf?article=ODAw

  15. Karki P, Pahari S, Neupane N, Poudel K, Asharaf N. NeuromyelitisOptica Spectrum Disorder: A Case Report. J Nepal MedAssoc [Internet]. 2024;62(277):602–4. Available from: https://doi.org/10.31729/jnma.8748

  16. Mukherjee A, Roy D, Chakravarty A. Uncommon Non-MS DemyelinatingDisorders of the Central Nervous System. Curr NeurolNeurosci Rep [Internet]. 2025;25(1). Available from: https://doi.org/10.1007/s11910-025-01432-8

  17. Keegan BM, Pittock SJ, Lennon VA. Autoimmune myelopathy associatedwith collapsin response-mediator protein-5 immunoglobulinG. Ann Neurol [Internet]. 2008;63(4):531–4. Available from:https://doi.org/10.1002/ana.21324

  18. Waldrop G, Sisodia N, Poole S, Pleasure S, Wilson MR, Guo CY,et al. Neutropenia Associated with B Cell-Depleting Therapies inMultiple Sclerosis and Neuromyelitis Optica Spectrum Disorder.Neurol Neuroimmunol NeuroInflammation [Internet]. 2025;12(4).Available from: https://doi.org/10.1212/NXI.0000000000200430

  19. Beh SC, Greenberg BM, Frohman T, Frohman EM. TransverseMyelitis. Neurol Clin [Internet]. 2013;31(1):79–138. Available from:https://doi.org/10.1016/j.ncl.2012.09.008

  20. Given KS, Acker EG, Macklin WB, Carlin D, Owens GP, BennettJL. Complement inhibition rapidly blocks lesion extension andfacilitates remyelination in neuromyelitis optica. Acta NeuropatholCommun [Internet]. 2025;13(1):1–2. Available from: https://doi.org/10.1186/s40478-025-02019-7

  21. Holian AH, Weinshenker BG. Emerging Role of Targeted MonoclonalAntibodies in Neuromyelitis Optica Spectrum Disorders. Bio-Drugs [Internet]. 2025;39(4):573–89. Available from: https://doi.org/10.1007/s40259-025-00729-x

  22. Lorefice L, Carotenuto A, Fenu G. Silent burden: recognising andmanaging invisible symptoms in neuromyelitis optica. J NeurolNeurosurg Psychiatry [Internet]. 2025;96(8):744–52. Availablefrom: https://doi.org/10.1136/jnnp-2025-336041

  23. Sá MJ. Acute transverse myelitis: A practical reappraisal. AutoimmunRev [Internet]. 2009;9(2):128–31. Available from: https://doi.org/10.1016/j.autrev.2009.04.005

  24. McColl J, Liang T, Rumsey DG. Neurological Behcet’s diseasewith transverse myelitis in an adolescent: A case report. SAGEOpen Med Case Reports [Internet]. 2025;13. Available from: https://doi.org/10.1177/2050313X251346246

  25. Michaelson NM, Chwalisz BK. Transverse myelitis followingguselkumab treatment for severe plaque psoriasis. BMJ CaseRep [Internet]. 2025;18(6):266114. Available from: https://doi.org/10.1136/bcr-2025-266114

  26. Jeffery DR, Mandler RN, Davis LE. Transverse Myelitis: RetrospectiveAnalysis of 33 Cases, with Differentiation of Cases Associatedwith Multiple Sclerosis and Parainfectious Events. ArchNeurol [Internet]. 1993;50(5):532–5. Available from: https://doi.org/10.1001/archneur.1993.00540050074019

  27. Goh C, Desmond PM, Phal PM. MRI in transverse myelitis. JMagn Reson Imaging [Internet]. 2014;40(6):1267–79. Availablefrom: https://doi.org/10.1002/jmri.24563

  28. Chan SSJ, Kaliya-Perumal AK, Yeo QY, Oh JYL. Transverse myelitismasquerading as cauda equina syndrome, stroke and cervicalmyelopathy. Biomed [Internet]. 2020;10(1):45–50. Available from:https://doi.org/10.37796/2211-8039.1005

  29. Mirbagheri S, Eckart Sorte D, Zamora CA, Mossa-Basha M, NewsomeSD, Izbudak I. Evaluation and management of longitudinallyextensive transverse myelitis: a guide for radiologists. ClinRadiol [Internet]. 2016;71(10):960–71. Available from: https://doi.org/10.1016/j.crad.2016.05.020

  30. West TW, Hess C, Cree BAC. Acute transverse myelitis: Demyelinating,inflammatory, and infectious myelopathies. SeminNeurol [Internet]. 2012;32(2):97–113. Available from: https://doi.org/10.1055/s-0032-1322586

  31. Grasso EA, Pozzilli V, Tomassini V. Transverse myelitis in childrenand adults. Handb Clin Neurol [Internet]. 2023;196:101–17. Availablefrom: https://doi.org/10.1016/B978-0-323-98817-9.00020-X

  32. Pittock SJ, Lucchinetti CF. Inflammatory transverse myelitis: Evolvingconcepts. Curr Opin Neurol [Internet]. 2006;19(4):362–8. Availablefrom: https://doi.org/10.1097/01.wco.0000236615.59215.d3

  33. Wen Z, Chen M, Xia C, Sun Y, Zhang Y. Acute transverse myelitiscaused by Paragonimus infection: a case report and review of theliterature. Front Med [Internet]. 2025;12. Available from: https://doi.org/10.3389/fmed.2025.1506201

  34. Burg E, Sharbin G, Edeson ME, Hosseini HK, Westman C, HosseiniDK, et al. Transverse myelitis as a rare paraneoplastic manifestationof a pancreatic tail adenocarcinoma: A case report. Med(United States) [Internet]. 2025;104(21):e42133. Available from:https://doi.org/10.1097/MD.0000000000042133

  35. Elovaara I, Lällä M, Spare E, Lehtimäki T, Dastidar P. Methylprednisolonereduces adhesion molecules in blood and cerebrospinalfluid in patients with MS. Neurology [Internet]. 1998;51(6):1703–8.Available from: https://doi.org/10.1212/WNL.51.6.1703

  36. Wang J, Huang J, Kang X, Dong H, Lu J. Changes in brain functionalconnectivity and clinical correlations in neuromyelitis opticaspectrum disorder: a longitudinal resting-state fMRI study. Eur JMed Res [Internet]. 2025;30(1):1–2. Available from: https://doi.org/10.1186/s40001-025-02668-3

  37. Weinshenker BG. Plasma exchange for severe attacks of inflammatorydemyelinating diseases of the central nervous system. JClin Apher [Internet]. 2001;16(1):39–42. Available from: https://doi.org/10.1002/jca.1010

  38. Wu J, Li X, Peng J, Fu W, Chen S, Wu H. Treatment update forautoimmune/immune-mediated central nervous system diseases.Folia Neuropathol [Internet]. 2025;63(1):19–29. Available from: https://doi.org/10.5114/fn.2025.149473

  39. Katsiari CG, Giavri I, Mitsikostas DD, Yiannopoulou KG, SfikakisPP. Acute transverse myelitis and antiphospholipid antibodies inlupus. No evidence for anticoagulation. Eur J Neurol [Internet].2011;18(4):556–63. Available from: https://doi.org/10.1111/j.1468-1331.2010.03208.x

  40. Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: AmericanSpinal Injury Association (ASIA) Impairment Scale. Clin OrthopRelat Res [Internet]. 2017;475(5):1499–504. Available from:https://doi.org/10.1007/s11999-016-5133-4

  41. Greenberg BM, Thomas KP, Krishnan C, Kaplin AI, CalabresiPA, Kerr DA. Idiopathic transverse myelitis: Corticosteroids,plasma exchange, or cyclophosphamide. Neurology [Internet].2007;68(19):1614–7. Available from: https://doi.org/10.1212/01.wnl.0000260970.63493.c8

  42. Absoud M, Brex P, Ciccarelli O, Diribe O, Giovannoni G, Hellier J,et al. A multicentre randomised controlled trial of intravenous immunoglobulincompared with standard therapy for the treatment oftransverse myelitis in adults and children (STRIVE). Health TechnolAssess (Rockv) [Internet]. 2017;21(31):1–50. Available from:https://doi.org/10.3310/hta21310

  43. Cavalli E, Mammana S, Nicoletti F, Bramanti P, MazzonE. The neuropathic pain: An overview of the current treatmentand future therapeutic approaches. Int J Immunopathol Pharmacol [Internet]. 2019;33. Available from: https://doi.org/10.1177/2058738419838383

  44. Sadowsky CL, Becker D, Bosques G, Dean JM, McDonald JW,Recio A, et al. Rehabilitation in transverse myelitis. Continuum(N Y) [Internet]. 2011;17(4):816–30. Available from: https://doi.org/10.1212/01.CON.0000403797.10612.d3

  45. Han JS, Ryu SM, Lim YH, Kim AR, Jung T Du. Treatment andRehabilitation of a Patient with Neuromyelitis Optica Spectrum Disorder-Induced Complete Spinal Cord Injury Following COVID-19Vaccination: A Case Report. J Clin Med [Internet]. 2024;13(4).Available from: https://doi.org/10.3390/jcm13041175

  46. Qureshi MG, Harjpal P, Nawkhare A V, Saklecha A, Seth NH. IntegratedRehabilitation of Longitudinal Extensive Transverse Myelitis:Study of a Complex Case. Cureus [Internet]. 2024;16(9). Availablefrom: https://doi.org/10.7759/cureus.68778

  47. Bhat A, Naguwa S, Cheema G, Gershwin ME. The epidemiologyof transverse myelitis. Autoimmun Rev [Internet]. 2010;9(5):2010.Available from: https://doi.org/10.1016/j.autrev.2009.12.007

  48. Zhou L, Liao Z, Long Y, Li Z, Qiu W, Tan Z, et al. Impact of TreatmentDelay and Prognostic Factors in Acute Myelitis of NeuromyelitisOptica Spectrum Disease. Brain Behav [Internet]. 2025;15(4):1–6.Available from: https://doi.org/10.1002/brb3.70472




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