Transverse myelitis is an inflammation of both sides of the spinal cord in one region. This neurological condition frequently causes damage to the insulating membrane that covers nerve cell fibers (myelin).
Transverse myelitis disrupts the messages sent throughout the body by the spinal cord nerves. Pain, muscular weakness, paralysis, sensory issues, and bladder and bowel dysfunction can all result from this.
Transverse myelitis can be caused by a variety of factors, including infections and immune system problems that assault the body's tissues. Other myelin illnesses, such as multiple sclerosis, might also be to blame. Other illnesses, such as a spinal cord stroke, are also misdiagnosed with transverse myelitis, and therefore require distinct treatment techniques.
Medication and rehabilitative treatment are used to treat transverse myelitis. The majority of patients who have transverse myelitis recover at least partially. Those who suffer from severe assaults may be permanently disabled.
WHAT ARE THE SYMPTOMS OF TRANSVERSE MYELITIS?
Transverse myelitis symptoms often appear within a few hours to a few days and may grow progressively over several weeks.
Transverse myelitis often affects both sides of the body below the damaged portion of the spinal cord, however symptoms might appear on only one side of the body at times.
The following are typical indications and symptoms:
Pain: Transverse myelitis pain might strike you unexpectedly in the lower back. Sharp pains may radiate down your legs or arms, as well as around your chest or abdomen. Pain symptoms differ depending on which portion of your spinal cord is afflicted.
Abnormal sensations: Some persons with transverse myelitis experience numbness, tingling, coldness, or burning feelings. Some people are extremely sensitive to clothes, as well as excessive heat or cold. You may get the sensation that something is firmly wrapping around the flesh of your chest, abdomen, or legs.
Arm or leg weakness: Some people experience leg heaviness, as well as tripping or dragging one foot. Others may experience significant weakness or even complete paralysis.
Problems with the bladder and bowels: This might involve having to pee more frequently, having urine incontinence, having difficulties urinating, and being constipated.
WHAT ARE THE CAUSES OF TRANSVERSE MYELITIS?
The cause of transverse myelitis is unknown. There are occasions when there is no recognized reason.
Transverse myelitis can be caused by viral, bacterial, or fungal infections of the spinal cord. In most situations, the inflammatory condition occurs after the infection has been treated.
Viruses linked to transverse myelitis include:
- Herpes viruses, including the one responsible for shingles and chickenpox (zoster)
- Enteroviruses like the coxsackievirus and poliovirus
- Rubella, measles, and mumps
- Cytomegalovirus
- Epstein-Barr
- West Nile
- Echovirus
- Zika
- HIV
- Influenza
- Hepatitis B
- Rubella, measles, and mumps
Other viruses may cause an autoimmune response without invading the spinal cord.
Transverse myelitis is connected with the following bacterial infections:
- Lyme disease
- Syphilis
- Tetanus
- Diphtheria
- Tuberculosis
- Actinomyces
- Pertussis
Transverse myelitis can also be caused by bacterial skin infections, gastroenteritis, and some kinds of bacterial pneumonia.
Parasites and fungal diseases can rarely invade the spinal cord.
The illness appears to be caused by a number of inflammatory disorders, including:
- Multiple sclerosis is a neurological illness in which the immune system damages the myelin that surrounds neurons in the spinal cord and brain. Transverse myelitis may be the first symptom of multiple sclerosis or a recurrence. Transverse myelitis, a symptom of multiple sclerosis, generally affects just one side of the body.
- Neuromyelitis optica (Devic's disease) is an inflammatory ailment that causes myelin loss and inflammation surrounding the spinal cord and the nerve in your eye that conveys information to the brain. Transverse myelitis, which is linked to neuromyelitis optica, typically affects both sides of the body.
In addition to transverse myelitis, you may encounter signs of optic nerve myelin damage, such as discomfort in the eye with movement and transient vision loss. This can occur concurrently or independently of transverse myelitis symptoms. However, some persons with neuromyelitis optica do not have visual issues and may simply have recurring bouts of transverse myelitis.
- Autoimmune diseases are likely to have a role in transverse myelitis in certain patients. Lupus, which may impact various bodily systems, and Sjogren's disease, which causes extreme dryness of the mouth and eyes, are examples of these conditions.
Transverse myelitis caused by an autoimmune condition may be a precursor to neuromyelitis optica. Neuromyelitis optica is more common in patients who have other autoimmune illnesses.
- Vaccinations for infectious illnesses have been mentioned as a probable cause on occasion. However, at this moment, the link is not strong enough to justify restricting any vaccination.
- Sarcoidosis is a disease that causes inflammation throughout the body, including the spinal cord and optic nerve. It may resemble neuromyelitis optica, although sarcoidosis symptoms normally develop more slowly. The etiology of sarcoidosis is unknown.
WHAT ARE THE COMPLICATIONS OF TRANSVERSE MYELITIS?
Most people with transverse myelitis only have one episode. However, issues such as the following frequently persist:
- Pain is one of the disorder's most prevalent devastating long-term effects.
- Muscle stiffness, tightness, or painful spasms (muscle spasticity). This most commonly occurs in the buttocks and legs.
- Complete or partial paralysis of your arms, legs, or both. This may continue after the initial symptoms have subsided.
- A typical consequence of transverse myelitis is sexual dysfunction. Men may have difficulties obtaining an erection or experiencing orgasm. Women may find it harder to achieve orgasm.
- Depression or anxiety are frequent in people with long-term difficulties as a result of considerable changes in lifestyle, the stress of chronic pain or disability, and the impact of sexual dysfunction on relationships.
HOW IS TRANSVERSE MYELITIS DIAGNOSED?
Transverse myelitis is diagnosed by a clinician based on your responses to questions about your signs and symptoms, your medical history, a clinical evaluation of nerve function, and test findings.
These tests, which may show spinal cord inflammation and rule out other illnesses, include the following:
- Magnetic resonance imaging (MRI): To make 3D pictures of soft tissues, a magnetic field and radio waves are used. An MRI can detect spinal cord inflammation as well as other probable causes of symptoms, such as spinal cord or blood vessel abnormalities.
- Lumbar puncture (spinal tap): utilizes a needle to take a little quantity of cerebrospinal fluid (CSF), the protective fluid that protects your spinal cord and brain.
CSF from certain persons with transverse myelitis may include abnormally high levels of white blood cells or immune system proteins, indicating inflammation. In addition, spinal fluid can be analyzed for viral infections and some malignancies.
- Blood tests: A test for antibodies linked with neuromyelitis optica, a disorder in which inflammation arises in both your spinal cord and the nerve in your eye, may be performed. People who have a positive antibody test are more likely to have several incidents of transverse myelitis and will need therapy to avoid future attacks.
Other blood tests can detect infections that may be causing transverse myelitis or rule out other possible causes of symptoms.
WHAT ARE THE TREATMENTS FOR TRANSVERSE MYELITIS?
Several treatments are available to treat the acute symptoms of transverse myelitis:
- Intravenous steroids: Over the course of many days, you will most likely be given steroids through a vein in your arm. Steroids aid in the reduction of inflammation in the spinal column.
- Plasma exchange therapy: Patients who do not react to intravenous steroids may benefit from plasma exchange treatment. This entails extracting the straw-colored fluid (plasma) in which blood cells are floating and replacing it with specific fluids.
It is unclear how this therapy benefits persons suffering from transverse myelitis, however it is possible that plasma exchange eliminates inflammatory antibodies.
- Antiviral medication: Some persons with a viral infection of the spinal cord may be treated with antiviral medicines.
- Pain medication: Transverse myelitis is frequently associated with chronic discomfort. Common pain medicines such as acetaminophen (Tylenol, and others), ibuprofen (Advil, Motrin IB, and others), and naproxen sodium may help with muscular pain (Aleve.)
Antidepressants such as sertraline (Zoloft) and anticonvulsants such as gabapentin (Neurontin, Gralise) or pregabalin can be used to relieve nerve pain (Lyrica).
- Medications to treat other complications: Other drugs may be prescribed by your doctor as needed to address symptoms such as muscular stiffness, urinary or bowel dysfunction, depression, or other consequences of transverse myelitis.
- Medications to prevent repeated transverse myelitis attacks: People who have antibodies linked to neuromyelitis optica require continued therapy, such as corticosteroids and/or immunosuppressants, to lower their risks of having another transverse myelitis attack or developing optic neuritis.
Other treatments
Long-term rehabilitation and care are the focus of other therapies:
- Physical therapy: This aids in the development of strength and coordination. Any necessary assistance devices, such as a wheelchair, canes, or braces, can be taught to you by your physical therapist.
- Occupational therapy: This assists patients with transverse myelitis in learning new ways to accomplish daily chores such as bathing, cooking, and cleaning.
- Psychotherapy: Talk therapy can be used by a psychotherapist to address anxiety, sadness, sexual dysfunction, and other emotional or behavioral disorders associated with transverse myelitis.
Prognosis
Although most persons with transverse myelitis recover to some extent, it may take a year or more. The majority of healing occurs within three months after the event and is highly dependent on the source of transverse myelitis.
Following an attack, around one-third of persons with transverse myelitis fall into one of three categories:
- No or little disability: These individuals have just minor lingering effects.
- Moderate disability: These patients can move about, but they may have trouble walking, numbness or tingling, and bladder and bowel issues.
- Severe disability: Some persons may require a wheelchair on a permanent basis and continuous support with daily care and activities.
The course of transverse myelitis is difficult to predict. The origin of the illness, as well as how early therapy is delivered, has a substantial influence on prognosis and response to treatment. People who have a quick start of severe signs and symptoms and a positive test for a specific antibody have a poorer prognosis than those who have a later onset, milder symptoms, and a negative antibody test.