This neurological disorder occurs when a section of the spinal cord is inflamed, causing pain, weakness, sensory problems and dysfunction in the body.
Transverse myelitis is an inflammation of both sides of one section of the spinal cord. This neurological disorder often damages the insulating material covering nerve cell fibers (myelin).
Transverse myelitis interrupts the messages that the spinal cord nerves send throughout the body. This can cause pain, muscle weakness, paralysis, sensory problems, or bladder and bowel dysfunction.
There are many different causes of transverse myelitis, including infections and immune system disorders that attack the body's tissues. It could also be caused by other myelin disorders, such as multiple sclerosis. Other conditions, such as a stroke of the spinal cord, are often confused with transverse myelitis, and these conditions require different treatment approaches.
Treatment for transverse myelitis includes medications and rehabilitative therapy. Most people with transverse myelitis recover at least partially. Those with severe attacks sometimes are left with major disabilities.
Signs and symptoms of transverse myelitis usually develop over a few hours to a few days and may sometimes progress gradually over several weeks.
Transverse myelitis usually affects both sides of the body below the affected area of the spinal cord, but sometimes there are symptoms on just one side of the body.
Typical signs and symptoms include:
Call your doctor or get emergency medical care if you're experiencing signs and symptoms of transverse myelitis. A number of neurological disorders can cause sensory problems, weakness, and bladder or bowel dysfunction including compression of the spinal cord, which is a surgical emergency.
Another less common cause is a stroke of the spinal cord due to impaired blood circulation. This can be caused by blockage of a blood vessel that supplies blood to the spinal cord, which may occur with surgery of the aorta or increased clotting of the blood. It's important to get a prompt diagnosis and appropriate treatment.
The exact reason for transverse myelitis is not known. Sometimes there is no known cause.
Viral, bacterial and fungal infections affecting the spinal cord may cause transverse myelitis. In most cases, the inflammatory disorder appears after recovery from the infection.
Viruses associated with transverse myelitis are:
Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.
Bacterial infections that are associated with transverse myelitis include:
Bacterial skin infections, gastroenteritis and certain types of bacterial pneumonia also may cause transverse myelitis.
Rarely, parasites and fungal infections may infect the spinal cord.
There are a number of inflammatory conditions that appear to cause the disorder:
Neuromyelitis optica (Devic's disease) is a condition that causes inflammation and myelin loss around the spinal cord and the nerve in your eye that transmits information to your brain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body.
In addition to transverse myelitis, you may experience symptoms of damage to myelin of the optic nerve, including pain in the eye with movement and temporary vision loss. This can happen with or separately from transverse myelitis symptoms. However, some people with neuromyelitis optica don't experience eye-related problems and might have only recurrent episodes of transverse myelitis.
Autoimmune disorders probably contribute to transverse myelitis in some people. These disorders include lupus, which can affect multiple body systems, and Sjogren's syndrome, which causes severe dryness of the mouth and eyes.
Transverse myelitis associated with an autoimmune disorder may be a warning sign of neuromyelitis optica. Neuromyelitis optica occurs more frequently in people with other autoimmune diseases.
People with transverse myelitis usually experience only one episode. However, complications often linger, including the following:
A doctor will diagnose transverse myelitis based on your answers to questions about your signs and symptoms, your medical history, a clinical assessment of nerve function, and test results.
These tests, which may indicate inflammation of the spinal cord and rule out other disorders, include the following:
Lumbar puncture (spinal tap) uses a needle to draw a small amount of cerebrospinal fluid (CSF), the protective fluid that surrounds your spinal cord and brain.
In some people with transverse myelitis, CSF may have abnormally high numbers of white blood cells or immune system proteins that indicate inflammation. Spinal fluid can also be tested for viral infections or certain cancers.
Blood tests may include a test that checks for antibodies associated with neuromyelitis optica, a condition in which inflammation occurs both in your spinal cord and in the nerve in your eye. People with a positive antibody test are at increased risk of experiencing multiple attacks of transverse myelitis and require treatment to prevent future attacks.
Other blood tests can identify infections that may contribute to transverse myelitis, or rule out other causes of symptoms.
Several therapies target the acute signs and symptoms of transverse myelitis:
Plasma exchange therapy. People who don't respond to intravenous steroids may need plasma exchange therapy. This involves removing the straw-colored fluid in which blood cells are suspended (plasma) and replacing the plasma with special fluids.
It's not certain how this therapy helps people with transverse myelitis, but it may be that plasma exchange removes inflammatory antibodies.
Pain medication. Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve.)
Nerve pain may be treated with antidepressant drugs, such as sertraline (Zoloft), and anticonvulsant drugs, such as gabapentin (Neurontin, Gralise) or pregabalin (Lyrica).
Additional therapies focus on long-term recovery and care:
Although most people with transverse myelitis have at least partial recovery, it may take a year or more. Most recovery occurs within the first three months after the episode and strongly depends on the cause of transverse myelitis.
About one-third of people with transverse myelitis fall into one of three categories after an attack:
It's difficult to predict the course of transverse myelitis. The prognosis and responsiveness to treatment is strongly determined by the cause of the syndrome and to some extent by how early treatment is administered. Generally, people who experience a rapid onset of severe signs and symptoms and those who have a positive test for a particular antibody have a worse prognosis than do those with a relatively slower onset, milder symptoms and negative antibody test.
Signs and symptoms that might indicate transverse myelitis are usually severe and sudden. You'll likely need emergency or urgent care.
Questions that the attending doctor is likely to ask include the following:
January 22nd, 2020