Transverse Myelitis

What is Transverse Myelitis

Transverse myelitis is a condition that causes inflammation of the spinal cord. The inflammation affects the fatty lining that covers spinal cord nerves (myelin).

Transverse myelitis is an inflammatory process that is localized over several segments of the cord and functionally transects the cord.

It may occur as an infectious or parainfectious illness or as a manifestation of multiple sclerosis, neuromyelitis optica, or other autoimmune process.

How common is Transverse myelitis?

Transverse myelitis is extremely rare with an incidence of 3 cases per 100,000 patient-years.

Unfortunately, two-thirds of patients have moderate to severe residual disability. In a significant number of cases (40%), no specific etiology is ever identified

It can cause scarring of nerves, which can interfere with nerve signals passing to and from the spinal cord.

Signs and symptoms of this condition happen at the affected level of the spinal cord and below.

Transverse myelitis most often causes weakness of the arms or legs, pain, changes in feeling (sensation), and bowel and bladder problems.

What are the causes?

The exact cause of this condition is not known. It sometimes develops after a viral infection, such as herpes, chicken pox, cytomegalovirus, HIV, or Epstein-Barr virus.

Transverse myelitis can also occur after a bacterial infection or along with diseases that make the body’s immune system mistakenly attack healthy tissues (autoimmune diseases).

What increases the risk?

This condition is more likely to develop in:

  • People who have an autoimmune disease, especially multiple sclerosis and neuromyelitis optica.
  • People 10–19 years old.
  • People 30–39 years old.

What are the symptoms of Transverse myelitis?

Symptoms of Transverse myelitis may start suddenly within hours or develop gradually over weeks.

Symptoms include:

  • Pain, especially in the neck or back, with shooting pains into the legs.
  • Headache.
  • Weakness of the arms or the legs.
  • Abnormal sensations, such as burning, prickling, numbness, or tingling in the arms or legs.
  • Increased sensitivity to touch or changes in temperature.
  • Bowel and bladder problems, including increased need to go, loss of control, and difficulty going.
  • Difficulty walking, including foot dragging and stumbling.
  • Fatigue.
  • Fever.
  • Loss of appetite.
  • Paralysis.
  • Difficulty breathing.

How is Transverse myelitis diagnosed?

Transverse myelitis may be diagnosed with a neurological exam. During this exam, your health care provider will ask about your symptoms and do a complete physical exam to check your spinal cord function.

You may need to see a nervous system specialist (neurologist) to have tests, which may include:

  • An MRI to check for inflammation or scarring.
  • Blood tests to check for infections that can trigger this condition or for neuromyelitis optica.
  • A lumbar puncture to check your spinal fluid for signs of infection or inflammation. For this procedure, a small amount of the fluid that surrounds the brain and spinal cord is removed and examined.

How is Transverse myelitis treated?

There is no cure for Transverse myelitis. You may have treatment to reduce inflammation and control symptoms.

Treatment may involve:

  • Pain medicine.
  • Corticosteroid medicines to reduce inflammation. These are usually given through an IV needle at first. Later, they may be taken by mouth.
  • Breathing support with a device called a respirator.
  • Physical therapy to:
    • Reduce the risk of bedsores.
    • Improve muscle strength, flexibility, coordination, and range of motion in affected muscles.
    • Reduce muscle spasms and muscle wasting in paralyzed arms or legs.
    • Improve control over your bladder and bowel.
  • Occupational therapy. This therapy helps you learn how to care for yourself and do everyday tasks such as bathing and dressing. It cannot reverse problems caused by this condition, but it can help you become as independent as possible.

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Rest in bed at home as told by your health care provider until you start to recover strength and movement. Ask your health care provider what activities are safe for you.
  • Perform any exercises as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your symptoms are not improving or are getting worse.
  • You have symptoms that come back after going away.
  • You are having a hard time managing at home.

Get help right away if:

  • You cannot care for yourself at home.
  • You have trouble breathing.
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