Transverse myelitis

Transverse myelitis is a condition caused by inflammation of the spinal cord. As a result, the covering (myelin sheath) around the nerve cells is damaged. This disturbs the signals between spinal nerves and rest of the body.

Myelin

Myelin is an insulating layer, or sheath that forms around nerves, including those in the brain and spinal cord. It is made up of protein and fatty ...

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Transverse myelitis can cause pain, muscle weakness, paralysis, and bladder or bowel problems.

Causes

Transverse myelitis is a rare nervous system disorder. In many cases, the cause is unknown. However, certain conditions may lead to transverse myelitis:

• Bacterial, viral, parasitic, or fungal infection, such as HIV, syphilis, varicella zoster (shingles), West Nile virus, Zika virus, enteroviruses, and Lyme disease

  HIV

  Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). When a person becomes infected with HIV, the ...

  

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  Syphilis

  Syphilis is a bacterial infection that is most often spread through sexual contact.

  

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  Shingles

  Shingles is a painful, blistering skin rash. It is caused by the varicella-zoster virus, a member of the herpes family of viruses. This is the viru...

  

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  Zika virus

  Zika is a virus passed to humans by the bite of infected mosquitoes. Symptoms include fever, joint pain, rash, and red eyes (conjunctivitis)....

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  Lyme disease

  Lyme disease is a bacterial infection that is spread through the bite of one of several types of ticks.

  

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• Immune system disorders, such as multiple sclerosis (MS), Sjögren syndrome, and lupus

  Multiple sclerosis (MS)

  Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord (central nervous system).

  

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  Sjögren syndrome

  Sjögren syndrome is an autoimmune disorder in which the glands that produce tears and saliva are destroyed. This causes dry mouth and dry eyes. The...

  

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  Lupus

  Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It c...

  

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• Other inflammatory disorders, such as sarcoidosis, or a connective tissue disease called scleroderma

  Sarcoidosis

  Sarcoidosis is a disease in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, and/or other tissues.

  

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  Scleroderma

  Scleroderma is a disease that involves the buildup of fibrous tissue in the skin and elsewhere in the body. It also damages the cells that line the ...

  

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• Blood vessel disorders that affect the spine

Transverse myelitis affects men and women of all ages and races.

Symptoms

Symptoms of transverse myelitis may develop within a few hours or days. Or, they may develop over 1 to 4 weeks. Symptoms can quickly become severe.

Symptoms tend to occur at or below the damaged area of the spinal cord. Both sides of the body are often affected, but sometimes only one side is affected.

Symptoms include:

Abnormal sensations:

• Numbness
• Pricking
• Tingling
• Coldness
• Burning
• Sensitivity to touch or temperature

Bowel and bladder symptoms:

• Constipation
• Inability to urinate
• Frequent need to urinate
• Difficulty holding urine
• Urine leakage (incontinence)

Pain:

• Sharp or blunt
• May start in your lower back
• May shoot down your arms and legs or wrap around your trunk or chest

Muscle weakness:

• Loss of balance
• Difficulty walking (stumbling or dragging your feet)
• Partial loss of function, which may develop into paralysis

Sexual dysfunction:

• Difficulty having an orgasm (men and women)
• Erectile dysfunction in men

Other symptoms can include loss of appetite, fever, and respiratory problems. Depression and anxiety can occur as a result of dealing with chronic pain and illness.

Exams and Tests

Your health care provider will take your medical history and ask about your symptoms. The provider will also do a nervous system examination to check for:

• Weakness or loss of muscle function, such as muscle tone and reflexes
• Pain level
• Abnormal sensations

Tests to diagnose transverse myelitis and to rule out other causes include:

• MRI of the spinal cord to check for inflammation or abnormalities

  MRI

  A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...

  

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• Spinal tap (lumbar puncture)

  Spinal tap (lumbar puncture)

  Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...

  

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• Blood tests

Treatment

Treatment for transverse myelitis helps to:

• Treat an infection that caused the condition
• Reduce inflammation of the spinal cord
• Relieve or reduce symptoms

You may be given:

• Steroid medicines through a vein (IV) to decrease inflammation.
• Plasma exchange therapy. This involves removing the liquid part of your blood (plasma) and replacing it with plasma from a healthy donor or with another fluid.
• Medicines to suppress your immune system.
• Medicines to control other symptoms such as pain, spasm, urinary problems, or depression.

Your provider may recommend:

• Physical therapy to help improve muscle strength and balance, and the use of walking aids
• Occupational therapy to help you learn new ways to do daily activities
• Counseling to help you cope with the stress and emotional issues from having transverse myelitis

Support Groups

You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

• National Organization for Rare Disorders (NORD) -- rarediseases.org/rare-diseases/transverse-myelitis/
• Christopher and Dana Reeve Foundation -- www.christopherreeve.org/todays-care/living-with-paralysis/health/causes-of-paralysis/transverse-myelitis/

Outlook (Prognosis)

The outlook for people with transverse myelitis varies. Most recovery occurs within 3 months after the condition occurs. For some, healing may take months to years. About a third of people with transverse myelitis recover completely. Some people recover with moderate disabilities, such as bowel problems and trouble walking. Others have permanent disability and need help with daily activities.

Those who may have poor chance of recovery are:

• People who have rapid onset of symptoms
• People whose symptoms do not improve within the first 3 to 6 months

Transverse myelitis usually only occurs once in most people. It may recur in some people with an underlying cause, such as MS. People who have involvement of only on one side of the spinal cord may be more likely to develop MS in the future.

Possible Complications

Ongoing health problems from transverse myelitis may include:

• Constant pain
• Partial or complete loss of muscle function
• Weakness
• Muscle tightness and spasticity
• Sexual problems

When to Contact a Medical Professional

Contact your provider if:

• You notice a sudden, sharp pain in your back that shoots down your arms or legs or wraps around your trunk
• You develop sudden weakness or numbness of arm or leg
• You have loss of muscle function
• You have bladder problems (frequency or incontinence) or bowel problems (constipation)
• Your symptoms get worse, even with treatment