Transverse myelitis

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:

• 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 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 heaviness in the legs, or that they're stumbling or dragging one foot. 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.

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:

• Herpes viruses, including the one that causes shingles and chickenpox (zoster)
• Cytomegalovirus
• Epstein-Barr
• HIV
• Enteroviruses such as poliovirus and coxsackievirus
• West Nile
• Echovirus
• Zika
• Influenza
• Hepatitis B
• Mumps, measles and rubella

Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.

Bacterial infections that are associated with transverse myelitis include:

• Lyme disease
• Syphilis
• Tuberculosis
• Actinomyces
• Pertussis
• Tetanus
• Diphtheria

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:

• 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 have occasionally been associated as a possible trigger. However, at this time the association is not strong enough to warrant limiting any vaccine.
• Sarcoidosis is a condition that leads to inflammation in many areas of the body, including the spinal cord and optic nerve. It may mimic neuromyelitis optica, but typically sarcoidosis symptoms develop more slowly. The cause of sarcoidosis isn't understood.

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.