Transverse myelitis

If you have inflammation in your spinal cord, you may have a rare type of neurological disorder called transverse myelitis (TM). The causes of TM are often unknown, but it can occur after a bacterial or viral infection. Immune system disorders may trigger TM as well.

When symptoms come on suddenly – often within a few hours – it’s called acute transverse myelitis. Symptoms range from sudden pain in your back to muscle weakness in your arms and legs.

It’s possible to make a full recovery from transverse myelitis with or without treatment. Short-term and long-term treatment plans focus on finding the cause of TM, managing symptoms and avoiding life-long complications.

What is transverse myelitis?

Transverse myelitis is a type of demyelinating disease. This group of diseases damages the myelin that protects your nerve cells in your central nervous system – which includes the nerves inside your spinal cord.

Your spinal cord includes delicate bundles of nerves cells that send motor and sensory communications from your brain to other parts of your body. When a disease or condition like TM damages the myelin that protects these nerve cells, your spinal cord can’t send messages as it should. Your nerve cells begin to die, causing the inflammation that leads to transverse myelitis.

Transverse myelitis symptoms

Both sides of your body are usually impacted by transverse myelitis, but sometimes it may be on only one side (partial transverse myelitis). You may experience one symptom or several that vary in severity and location, depending on which part of your spinal cord is affected.

With or without treatment, symptoms of transverse myelitis may improve over time. In acute cases, however, some individuals may experience permanent complications, including painful muscle spasms (muscle spasticity) or paralysis.

Common symptoms of transverse myelitis include:

• Muscle weakness: Muscles may feel heavy, causing movement issues like stumbling. Some people may experience total paralysis.
• Pain: May start in your lower back and travel to your legs, arms, chest or abdomen. Pain could be sharp, blunt or radiating.
• Altered sensations (paresthesia): Such as stabbing, burning or shooting and tingling pains in your hands, feet, legs or arms.
• Bladder or bowel issues: Includes urinary incontinence, frequent urination, urinary retention or constipation.

Transverse myelitis risk factors

Transverse myelitis commonly appears after recovering from a bacterial or viral infection. Although rare, it can also happen after a fungal infection. Sometimes, the cause is unknown (idiopathic transverse myelitis).

Common infections associated with transverse myelitis include:

• Bacterial: Lyme disease, tetanus and syphilis.
• Viral: Influenza (flu), chickenpox (varicella zoster virus) and hepatitis B.
• Fungal: Aspergillus, blastomyces and coccidioides.

Other risk factors include autoimmune diseases or other central nervous system diseases. Conditions include rheumatoid arthritis (RA), multiple sclerosis (MS) and neuromyelitis optica (Devic’s disease). Acute transverse myelitis is often associated with MS. Sometimes, TM may be an indicator of these diseases.

Anyone can be affected by transverse myelitis, but it's common in children between the ages of 10-19 and adults aged 30-39.

Diagnosing transverse myelitis

To make a transverse myelitis diagnosis, your doctor will need to confirm the presence of inflammation in your spine. They’ll also look for the cause of TM.

Your doctor will perform a physical examination and order a series of tests. Tests will also rule out other conditions that may cause inflammation in your spinal cord.

Tests to diagnose transverse myelitis include:

• MRI: This imaging test provides a clear picture of your spine and brain, allowing your provider to look for underlying causes.
• Blood tests: Help identify any infections or immune-related causes.
• Lumbar puncture (spinal tap): Collects a sample of your cerebrospinal fluid (CSF) to confirm inflammatory markers that are present in TM.

Transverse myelitis treatment

Your doctor will work with you to develop a personalized short-term or long-term treatment plan based on the severity of your symptoms. They’ll also consider the known causes of TM and any underlying health conditions.

Short-term treatments for transverse myelitis

Glucocorticoids are often the first choice in treating acute cases of TM. The high dose IV (intravenous) medication is a type of steroid hormone that will help reduce the inflammation in your spine.

Other short-term treatments include:

• Medications to manage muscle spasms
• Medications to suppress your immune system
• Intravenous immune globulin (IVIG) to reduce inflammation
• Plasma exchange therapy (plasmapheresis) to reduce inflammation

Long-term treatments for transverse myelitis

Long-term TM treatments include methods to regain functional skills and manage any complications.

Long-term treatments include:

• Pain management medications
• Occupational therapy or physical therapy
• Urinary or bowel function medications