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February 1953, Vol 85, No. 2 >
Article | February 1953

TRANSVERSE MYELOPATHY IN CHILDHOOD FREE

RICHMOND S. PAINE, M.D.; RANDOLPH K. BYERS, M.D.
AMA Am J Dis Child. 1953;85(2):151-163. doi:10.1001/archpedi.1953.02050070160004.
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CURRENT impressions and present-day pediatric texts generally regard transverse myelopathy as primarily an infectious process, that is to say, as so-called "transverse myelitis." There is considerable evidence, however, that a vascular etiology is actually involved in many, if not the majority of, cases, although in others the correlation with acute infections is too striking to be coincidental. The purpose of the present article is to present 25 cases of transverse myelopathy in childhood, and to consider their implications as to etiology, prognosis, and plan of management.

The concept of a vascular basis for transverse myelopathy is actually not a new one; it was emphasized by Bastian1 as early as 1886. Bastian subsequently proposed three possible causes for vascular thrombosis involving the spinal cord, namely, syphilis, arteriosclerosis, and infections (of the central nervous system or elsewhere).2 This type of causation and the absence of leucocytic infiltration microscopically were also

REFERENCES

1 +
Bastian, H. C.:  Inflammation of Spinal Cord , in Quain, R., editor: A Dictionary of Medicine , New York, Appleton-Century-Crofts, Inc., 1862;, p. 1474.
2 +
Bastian, H. C.:  Thrombotic Softening of the Spinal Cord: A Case of So-Called "Acute Myelitis," Lancet 2:1531, 1910;.
3 +
Singer, H. D.:  The Pathology of So-Called Acute Myelitis , Brain 25:332, 1902;.
4 +
Preobraschenski, P. A.:  Ein Beitrag zur Lehre von der akuten syphilitischen Poliomyelitis , Neurol. Centralbl. 27:1069, 1908;.
5 +
Spiller, W. G.:  Thrombosis of the Cervical Anterior Median Spinal Artery , J. Nerv. & Ment. Dis. 36:601, 1909;.
6 +
Ornsteen, A. M.:  Thrombosis of the Anterior Spinal Artery , Am. J. M. Sc. 181:654, 1931;.
7 +
Schaller, W. F.; Roberts, A. M., and Stadtherr, E. F.:  Acute Myelitis (Myelomalacia): Syndrome of Occlusion of Anterior Spinal Artery at the Fifth Cervical Cord Segment , J.A.M.A. 99:1572, 1932;.
8 +
Hogan, B. W.:  Acute Myelitis: Syndrome of Occlusion of the Anterior Spinal Artery at the First Thoracic Cord Segment with Softening of the Cord , U. S. Nav. M. Bull. 40:175, 1942;.
9 +
Steegman, A. T.:  Syndrome of the Anterior Spinal Artery , Neurology 2:15, 1952;.
10 +
Senseman, L. A.:  Myelitis Complicating Measles , Arch. Neurol. & Psychiat. 53:309, 1945;.
11 +
Morris, M. H., and Robbins, A.:  Acute Infectious Myelitis Following Rubella , J. Pediat. 23:365, 1943;.
12 +
Lightwood, R.:  Myelitis from Mumps , Brit. M. J. 1:484, 1946;.
13 +
Silverman, A. C.:  Mumps Complicated by a Preceding Myelitis: Report of Fatal Case , New England J. Med. 241:262, 1949;.
14 +
Lhermitte, J., and Bussiere de Robert, J.:  L'hyperpathie thoracique et les modifications du régime des réflexes superficiels et profonds consécutives à la myélite zostérienne , Rev. neurol. 74:85, 1942;.
15 +
Suchette-Kaye, A. I.:  Acute Transverse Myelitis Complicating Pneumonia , Lancet 2:417, 1948;.
16 +
Dixonn, J. G.:  Myelitis Due to Vaccination , J. Neurol., Neurosurg. & Psychiat. 7:18, 1944;.
17 +
Ansell, I.:  A Fatal Case of Myelitis After Anti-Rabic Vaccine , Brit. M. J. 2:338, 1948;.
18 +
Scott, R. W., and Sancetta, S. M.:  Dissecting Aneurysm of Aorta with Hemorrhagic Infarction of the Spinal Cord and Complete Paraplegia , Am. Heart J. 38:747, 1949;.
19 +
Antoni, N., and Lindgren, E.:  Steno's Experiment in Man as a Complication in Lumbar Aortography , Acta chir. scandinav. 98:230, 1949;.
20 +
Blankenhorn, D., and Wolff, H. G.:  Myelitis Following Administration of Neoarsphenamine , J. Lab. & Clin. Med. 33:1165, 1948;.
21 +
Kadyi, H.: Über die Blutgefässe des menschlichen Rückenmarkes , Lemberg, Gubrynowicz u. Schmidt, 1889;.
22 +
Tureen, L. L.:  Circulation of the Spinal Cord and the Effect of Vascular Occlusion , A. Res. Nerv. & Ment. Dis., Proc. 18:394, 1938;.
23 +
Suh, T. H., and Alexander, L.:  Vascular System of the Human Spinal Cord , Arch. Neurol. & Psychiat. 41:659, 1939;.
24 +
Herren, R. Y., and Alexander, L.:  Sulcal and Intrinsic Blood Vessels of Human Spinal Cord , Arch. Neurol. & Psychiat. 41:678, 1939;.
25 +
Boshes, B.; Brown, M., and Crouch, R. L.:  Sensory Return in Partial and Recovery Spinal Cord Lesions , Neurology 2:81, 1952;.
26 +
Adamkiewicz, A.:  Die Blutgefässe des menschlichen Rückenmarkes: II. Die Gefässe der Rückenmarksoberfläche , Sitzungsb. d. k. Akad. d. Wissensch. Math.-naturw. Cl. 85:469, 1882;.
27 +
Grinker, R. R., and Guy, C. C.:  Sprain of Cervical Spine Causing Thrombosis of Anterior Spinal Artery , J. A. M. A. 88:1140, 1927;.
28 +
Wyburn-Mason, R.: The Vascular Abnormalities and Tumors of the Spinal Cord and Its Membranes , St. Louis, C. V. Mosby Company, 1943;.
29 +
Buchanan, D. N., and Walker, A. E.:  Vascular Anomalies of the Spinal Cord in Children , Am. J. Dis. Child. 61:928, 1941;.
30 +
Black, W. C., and Faber, H. K.:  Blood Vessel Tumor of the Spinal Cord in a Boy Aged 9 Years, with Special Reference to a New Diagnostic Syndrome , J. A. M. A. 104:1889, 1935;.
31 +
Margulis, M. S.:  Pathologische Anatomie und Klinik der akuten thrombotischen Erweichungen bei spinaler Lues , Deutsche Ztschr. Nervenh. 113:113, 1930;.
32 +
Vogel, P., and Meyer, H. H.:  Über eine akute Querlähmung des Rückenmarks und ihre anastomische Grundlage (Verschluss der vorderen Spinalarterie) , Deutsche Ztschr. Nervenh. 143:217, 1937;.
33 +
 Case records of the Massachusetts General Hospital, Case 38012 , New England J. Med. 246:30, 1952;.
34 +
Hassin, G. B., and Broder, S. B.:  Acute Myelitis, a Clinical-Pathological Study , J. Neuropath. & Exper. Neurol. 5:106, 1946;.
35 +
Jaffe, D., and Freeman, W.:  Spinal Necrosis and Softening of Obscure Origin: Necrotic Myelitis Versus Myelomalacia; Review of Literature and Clinico-Pathologic Case Studies , Arch. Neurol. & Psychiat. 49:683, 1943;.
36 +
Davison, C., and Brock, S.:  Subacute Necrotic Myelopathy , J. Neuropath. & Exper. Neurol. 3:271, 1944;.
37 +
Davison, C., and Keschner, M.:  Myelitic and Myelopathic Lesions: A Clinico-Pathologic Study: I. Myelitis; II. Toxic Myelopathy; III. Arteriosclerotic and Arteritic Myelopathy , Arch. Neurol. & Psychiat. 29:332, 600, and 702, 1933;.
38 +
Kabat, E. A.; Wolf, A., and Bezer, A. E.:  The Rapid Production of Acute Disseminated Encephalomyelitis in Rhesus Monkeys by Injection of Heterologous and Homologous Brain Tissue with Adjuvants , J. Exper. Med. 85:117, 1947;.
39 +
Kabat, E. A.; Wolf, A., and Bezer, A. E.:  Effect of Cortisone on Experimental Acute Disseminated Encephalomyelitis , Tr. Am. Neurol. A. , p. 128, 1951;.

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References

1 +
Bastian, H. C.:  Inflammation of Spinal Cord , in Quain, R., editor: A Dictionary of Medicine , New York, Appleton-Century-Crofts, Inc., 1862;, p. 1474.
2 +
Bastian, H. C.:  Thrombotic Softening of the Spinal Cord: A Case of So-Called "Acute Myelitis," Lancet 2:1531, 1910;.
3 +
Singer, H. D.:  The Pathology of So-Called Acute Myelitis , Brain 25:332, 1902;.
4 +
Preobraschenski, P. A.:  Ein Beitrag zur Lehre von der akuten syphilitischen Poliomyelitis , Neurol. Centralbl. 27:1069, 1908;.
5 +
Spiller, W. G.:  Thrombosis of the Cervical Anterior Median Spinal Artery , J. Nerv. & Ment. Dis. 36:601, 1909;.
6 +
Ornsteen, A. M.:  Thrombosis of the Anterior Spinal Artery , Am. J. M. Sc. 181:654, 1931;.
7 +
Schaller, W. F.; Roberts, A. M., and Stadtherr, E. F.:  Acute Myelitis (Myelomalacia): Syndrome of Occlusion of Anterior Spinal Artery at the Fifth Cervical Cord Segment , J.A.M.A. 99:1572, 1932;.
8 +
Hogan, B. W.:  Acute Myelitis: Syndrome of Occlusion of the Anterior Spinal Artery at the First Thoracic Cord Segment with Softening of the Cord , U. S. Nav. M. Bull. 40:175, 1942;.
9 +
Steegman, A. T.:  Syndrome of the Anterior Spinal Artery , Neurology 2:15, 1952;.
10 +
Senseman, L. A.:  Myelitis Complicating Measles , Arch. Neurol. & Psychiat. 53:309, 1945;.
11 +
Morris, M. H., and Robbins, A.:  Acute Infectious Myelitis Following Rubella , J. Pediat. 23:365, 1943;.
12 +
Lightwood, R.:  Myelitis from Mumps , Brit. M. J. 1:484, 1946;.
13 +
Silverman, A. C.:  Mumps Complicated by a Preceding Myelitis: Report of Fatal Case , New England J. Med. 241:262, 1949;.
14 +
Lhermitte, J., and Bussiere de Robert, J.:  L'hyperpathie thoracique et les modifications du régime des réflexes superficiels et profonds consécutives à la myélite zostérienne , Rev. neurol. 74:85, 1942;.
15 +
Suchette-Kaye, A. I.:  Acute Transverse Myelitis Complicating Pneumonia , Lancet 2:417, 1948;.
16 +
Dixonn, J. G.:  Myelitis Due to Vaccination , J. Neurol., Neurosurg. & Psychiat. 7:18, 1944;.
17 +
Ansell, I.:  A Fatal Case of Myelitis After Anti-Rabic Vaccine , Brit. M. J. 2:338, 1948;.
18 +
Scott, R. W., and Sancetta, S. M.:  Dissecting Aneurysm of Aorta with Hemorrhagic Infarction of the Spinal Cord and Complete Paraplegia , Am. Heart J. 38:747, 1949;.
19 +
Antoni, N., and Lindgren, E.:  Steno's Experiment in Man as a Complication in Lumbar Aortography , Acta chir. scandinav. 98:230, 1949;.
20 +
Blankenhorn, D., and Wolff, H. G.:  Myelitis Following Administration of Neoarsphenamine , J. Lab. & Clin. Med. 33:1165, 1948;.
21 +
Kadyi, H.: Über die Blutgefässe des menschlichen Rückenmarkes , Lemberg, Gubrynowicz u. Schmidt, 1889;.
22 +
Tureen, L. L.:  Circulation of the Spinal Cord and the Effect of Vascular Occlusion , A. Res. Nerv. & Ment. Dis., Proc. 18:394, 1938;.
23 +
Suh, T. H., and Alexander, L.:  Vascular System of the Human Spinal Cord , Arch. Neurol. & Psychiat. 41:659, 1939;.
24 +
Herren, R. Y., and Alexander, L.:  Sulcal and Intrinsic Blood Vessels of Human Spinal Cord , Arch. Neurol. & Psychiat. 41:678, 1939;.
25 +
Boshes, B.; Brown, M., and Crouch, R. L.:  Sensory Return in Partial and Recovery Spinal Cord Lesions , Neurology 2:81, 1952;.
26 +
Adamkiewicz, A.:  Die Blutgefässe des menschlichen Rückenmarkes: II. Die Gefässe der Rückenmarksoberfläche , Sitzungsb. d. k. Akad. d. Wissensch. Math.-naturw. Cl. 85:469, 1882;.
27 +
Grinker, R. R., and Guy, C. C.:  Sprain of Cervical Spine Causing Thrombosis of Anterior Spinal Artery , J. A. M. A. 88:1140, 1927;.
28 +
Wyburn-Mason, R.: The Vascular Abnormalities and Tumors of the Spinal Cord and Its Membranes , St. Louis, C. V. Mosby Company, 1943;.
29 +
Buchanan, D. N., and Walker, A. E.:  Vascular Anomalies of the Spinal Cord in Children , Am. J. Dis. Child. 61:928, 1941;.
30 +
Black, W. C., and Faber, H. K.:  Blood Vessel Tumor of the Spinal Cord in a Boy Aged 9 Years, with Special Reference to a New Diagnostic Syndrome , J. A. M. A. 104:1889, 1935;.
31 +
Margulis, M. S.:  Pathologische Anatomie und Klinik der akuten thrombotischen Erweichungen bei spinaler Lues , Deutsche Ztschr. Nervenh. 113:113, 1930;.
32 +
Vogel, P., and Meyer, H. H.:  Über eine akute Querlähmung des Rückenmarks und ihre anastomische Grundlage (Verschluss der vorderen Spinalarterie) , Deutsche Ztschr. Nervenh. 143:217, 1937;.
33 +
 Case records of the Massachusetts General Hospital, Case 38012 , New England J. Med. 246:30, 1952;.
34 +
Hassin, G. B., and Broder, S. B.:  Acute Myelitis, a Clinical-Pathological Study , J. Neuropath. & Exper. Neurol. 5:106, 1946;.
35 +
Jaffe, D., and Freeman, W.:  Spinal Necrosis and Softening of Obscure Origin: Necrotic Myelitis Versus Myelomalacia; Review of Literature and Clinico-Pathologic Case Studies , Arch. Neurol. & Psychiat. 49:683, 1943;.
36 +
Davison, C., and Brock, S.:  Subacute Necrotic Myelopathy , J. Neuropath. & Exper. Neurol. 3:271, 1944;.
37 +
Davison, C., and Keschner, M.:  Myelitic and Myelopathic Lesions: A Clinico-Pathologic Study: I. Myelitis; II. Toxic Myelopathy; III. Arteriosclerotic and Arteritic Myelopathy , Arch. Neurol. & Psychiat. 29:332, 600, and 702, 1933;.
38 +
Kabat, E. A.; Wolf, A., and Bezer, A. E.:  The Rapid Production of Acute Disseminated Encephalomyelitis in Rhesus Monkeys by Injection of Heterologous and Homologous Brain Tissue with Adjuvants , J. Exper. Med. 85:117, 1947;.
39 +
Kabat, E. A.; Wolf, A., and Bezer, A. E.:  Effect of Cortisone on Experimental Acute Disseminated Encephalomyelitis , Tr. Am. Neurol. A. , p. 128, 1951;.

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