Symptoms and causes

Symptoms

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:

  • Pain. Transverse myelitis pain may begin suddenly in your lower back. Sharp pain may shoot down your legs or arms or around your chest or abdomen. Pain symptoms vary based on on the part of your spinal cord that's affected.
  • 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 notice that they're stumbling or dragging one foot, or heaviness in the legs. Others may develop severe weakness or even total paralysis.
  • Bladder and bowel problems. This may include needing to urinate more frequently, 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 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 injury, surgery of the aorta or increased blood clotting tendency. It's important to get a prompt diagnosis and appropriate treatment.

Causes

The exact reason for transverse myelitis is not known. Sometimes there is no known cause. 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 may cause transverse myelitis. In most cases, the inflammatory disorder appears after recovery from the infection.

    Viruses that can infect the spinal cord directly are herpes viruses, including the one that causes shingles and chickenpox (zoster), enteroviruses, 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 causes symptoms on only one side of your body.
  • 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.

  • Vaccinations for infectious diseases — including hepatitis B, measles-mumps-rubella and diphtheria-tetanus vaccines — have occasionally been associated as a possible trigger. However, at this time the association is not strong enough to warrant limiting any vaccine.

Complications

People with transverse myelitis usually experience only one episode. However, complications often linger, including the following:

  • Pain, one of the most common debilitating long-term complications of the disorder.
  • Stiffness, tightness or painful spasms in your muscles (muscle spasticity). This is most common in the buttocks and legs.
  • Partial or total paralysis of your arms, legs or both. This may persist after the first symptoms.
  • Sexual dysfunction, a common complication of transverse myelitis. Men may experience difficulty achieving an erection or reaching orgasm. Women may have difficulty reaching orgasm.
  • Depression or anxiety, which 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.