Definition of Transverse myelitis
Transverse myelitis is an inflammation of the spinal cord, which often targets insulating material covering nerve cell fibers (myelin). Transverse myelitis may result in injury across the spinal cord, affecting sensation below the injury.
The disrupted transmission of nerve signals due to transverse myelitis can cause pain or other sensory problems, weakness or paralysis of muscles, or bladder and bowel dysfunction.
Several factors can cause transverse myelitis, including infections and immune system disorders that attack the body’s tissues. It may also occur because of other myelin disorders, such as multiple sclerosis.
Treatment for transverse myelitis includes anti-inflammatory drugs, medications to manage symptoms and rehabilitative therapy. Most people with transverse myelitis recover at least partially, but some people with severe attacks are left with major disabilities.
Symptoms of Transverse myelitis
Signs and symptoms of transverse myelitis usually develop over a few hours and worsen over a few days. Less commonly, signs and symptoms progress gradually over several days to weeks. Depending on the cause, one or both sides of the body may be affected.
Typical signs and symptoms include:
- Pain. Pain associated with transverse myelitis often begins suddenly in your neck or back, depending on the part of your spinal cord that’s affected. Sharp, shooting sensations may also radiate down your legs or arms or around your abdomen.
- Abnormal sensations. Some people with transverse myelitis report sensations of numbness, tingling, coldness or burning. Some are especially sensitive to the light touch of clothing or to extreme heat or cold. You may feel as if something is tightly wrapping the skin of your chest, abdomen or legs.
- Weakness in your arms or legs. Some people with mild weakness notice that they’re stumbling or dragging one foot or that their legs feel heavy as they move. Others may develop paralysis.
- Bladder and bowel problems. These problems may include an increased urinary urge, urinary incontinence, difficulty urinating and constipation.
When to see a doctor
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. It’s important to get a prompt diagnosis and appropriate treatment.
The exact reason for transverse myelitis is not known. In some cases, no cause can be found for transverse myelitis. However, there are a number of conditions that appear to cause the disorder, including:
Viral and other infections of the respiratory tract or the gastrointestinal tract have been implicated in transverse myelitis. In most cases, the inflammatory disorder appears after recovery from the viral infection.
Viruses that can infect the spinal cord directly are herpes viruses, including the one that causes shingles and chickenpox (zoster) and West Nile virus. Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.
Rarely, parasites may infect the spinal cord, and certain bacteria such as Lyme disease can cause a painful inflammation of nerve roots of the spinal cord.
- Multiple sclerosis is a disorder in which the immune system destroys myelin surrounding nerves in your spinal cord and brain. Transverse myelitis can be the first sign of multiple sclerosis or represent a relapse. Transverse myelitis as a sign of multiple sclerosis usually manifests on only one side of your body.
Neuromyelitis optica (Devic’s disease) is a condition that causes inflammation and loss of myelin 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.
You may experience symptoms of damage to myelin of the optic nerve, including pain in the eye with movement and temporary vision loss, at the same time or other times as 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 affecting other body systems likely 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, as well as other symptoms.
Transverse myelitis associated with an autoimmune disorder may indicate coexisting neuromyelitis optica, which occurs more frequently in people with other autoimmune diseases than it does in people who don’t have autoimmune disease.
- Vaccinations for infectious diseases — including hepatitis B, measles-mumps-rubella, and diphtheria-tetanus vaccines — have occasionally been implicated as a possible trigger.
Complications of Transverse myelitis
People with transverse myelitis usually experience only one acute episode. However, complications often linger, including the following:
- Pain is one of the most common debilitating long-term complications of the disorder.
- Stiffness, tightness or painful spasms in your muscles (muscle spasticity), especially in your buttocks and legs, affect most people with lingering effects of transverse myelitis.
- Partial or total paralysis of your arms, legs or both may persist after the initial onset of symptoms.
- Sexual dysfunction is a common complication arising from transverse myelitis. Men may experience difficulty achieving an erection or reaching an orgasm. Women may have difficulty reaching an orgasm.
- Depression or anxiety is common in those with long-term complications because of the significant changes in lifestyle, the stress of chronic pain or disability, and the impact of sexual dysfunction on relationships.
Preparing for your appointment
Signs and symptoms that might indicate transverse myelitis are generally severe and usually begin suddenly. So you’ll likely need emergency or urgent care.
Questions that the attending doctor is likely to ask include the following:
- When did you begin experiencing symptoms?
- How quickly have your symptoms developed?
- Do you have pain, tingling or other unusual sensations?
- How would you rate the pain on a scale of 1 to 10, with 10 being most painful?
- Have you experienced weakness or lack of coordination?
- Have you had problems with bowel or bladder control?
- Are you having difficulty breathing?
- Have you been diagnosed with other medical conditions?
- Have you recently had any infections?
- Have you recently had any vaccinations?
- Have you traveled abroad lately? Where?
- Have you had any medical procedures recently?
- What prescription or over-the-counter medications do you take regularly? What is the dosage of each?
Tests and diagnosis
A diagnosis of transverse myelitis is based on your answers to questions about your signs and symptoms, your medical history, a clinical assessment of nerve function, and the results of tests. These tests, which may indicate inflammation of the spinal cord and rule out other disorders, include the following:
- Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create cross-sectional or 3-D images of soft tissues. An MRI can show inflammation of the spinal cord, and it can identify other potential causes of the symptoms, including abnormalities causing spinal cord compression and blood vessel malformations.
Lumbar puncture (spinal tap) is the use of a needle to draw from the spinal column 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 be a contributing factor in transverse myelitis or rule out other causes of symptoms.
Treatments and drugs
Several therapies target the acute signs and symptoms of transverse myelitis:
- Intravenous steroids. After your diagnosis, you’ll likely receive steroids through a vein in your arm over the course of several days. Steroids help reduce the inflammation in your spinal column.
Plasma exchange therapy. People who don’t respond to intravenous steroids may undergo plasma exchange therapy. This therapy 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 antibodies that are involved in inflammation.
- Antiviral medication. Some people who have a viral infection of the spinal cord may be treated with antiviral medication.
Pain medication. Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, including 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).
- Medications to treat other complications. Your doctor may prescribe other medications as needed to treat problems such as muscle spasticity, urinary or bowel dysfunction, depression, or other complications associated with transverse myelitis.
- Medications to prevent recurrent attacks of transverse myelitis. People who have positive results for antibodies associated with neuromyelitis optica require ongoing immunosuppressive medications such as corticosteroids to reduce their chances of having recurrent attacks of transverse myelitis or from developing optic neuritis.
Other therapies focus on long-term recovery and care:
- Physical therapy. Physical therapy helps you increase strength and improve coordination. Your physical therapist will likely teach you how to use assistive devices, such as a wheelchair, canes or braces, if needed.
- Occupational therapy. This type of therapy helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
- Psychotherapy. A psychotherapist can use talk therapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioral issues that may be related to your coping with transverse myelitis.
Although most people with transverse myelitis have at least partial recovery, the process may take a year or more. Most of recovery occurs within the first three months after the episode and strongly depends on the cause of transverse myelitis.
People with neuromyelitis optica have a worse prognosis, although even in this situation, most experience recovery with treatment. About one-third of people with transverse myelitis fall into one of three categories after an episode of transverse myelitis:
- No or slight disability. These people experience only minimal residual symptoms.
- Moderate disability. These people are mobile, but may have difficulty walking, numbness or tingling, and bladder and bowel problems.
- Severe disability. Some people may have permanent need for a wheelchair and require ongoing assistance with care and everyday activities.
It’s difficult to predict the course of transverse myelitis. Generally, people who experience a rapid onset of signs and symptoms have a worse prognosis than do those with relatively slower onset.