Transverse myelitis

DEFINITION

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.

CAUSES

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.

SYMPTOMS

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.