Transverse Myelitis

Transverse Myelitis: Symptoms, Causes, Types, Diagnosis, and Treatments

Transverse myelitis is a rare neurological disorder that affects the spinal cord, leading to inflammation across one segment of it. This inflammation can damage or destroy myelin—the insulating sheath covering nerve fibers—leading to a wide range of neurological symptoms. While the condition can strike at any age, it most commonly affects adults between 10 and 40 years of age.

In this article, we will explore the symptoms, causes, types, diagnostic methods, and treatments for transverse-myelitis in detail. Whether you’re a patient, caregiver, or medical enthusiast, this guide aims to provide a comprehensive understanding of the condition.

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What Is Transverse Myelitis?

Transverse myelitis (TM) is a disorder characterized by inflammation of both sides of one section of the spinal cord. The term “transverse” refers to the pattern of inflammation—spanning the width of the spinal cord. This inflammation disrupts the normal function of the spinal cord, impairing the communication between nerves in the spinal cord and the rest of the body.

The condition is rare, with an estimated 1,400 new cases in the United States each year, according to the National Institute of Neurological Disorders and Stroke (NINDS). TM can occur as an isolated event or as part of another neurological condition, such as multiple sclerosis (MS) or neuromyelitis optica (NMO).

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Symptoms of Transverse Myelitis

The symptoms of transverse myelitis often develop rapidly over hours to days, though they can progress more slowly over weeks. The severity and range of symptoms depend on the area of the spinal cord affected and the extent of inflammation.

1. Sensory Symptoms

• Numbness or tingling: Often in the legs, arms, or torso.
• Altered sensation: A “band-like” tightness around the chest or abdomen.
• Coldness or burning pain: Neuropathic pain is a common complaint.
• Heightened sensitivity to touch.

2. Motor Symptoms

• Weakness in the arms or legs: This may affect one or both sides of the body.
• Muscle spasms or stiffness: Particularly in the lower limbs.
• Paralysis: In severe cases, complete loss of motor function can occur.

3. Autonomic Symptoms

• Bladder and bowel dysfunction: Urinary urgency, retention, incontinence, or constipation.
• Sexual dysfunction: Difficulty with arousal or achieving orgasm.

4. Systemic Symptoms

• Fever or malaise: If an underlying infection is present.
• Fatigue: Due to the energy demand of impaired nerve communication.

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Causes of Transverse Myelitis

The exact cause of transverse myelitis is often unknown, a condition referred to as idiopathic transverse-myelitis. However, several known triggers can lead to the condition.

1. Infections

Infections often precede transverse-myelitis by several days or weeks. These include:

• Viral infections: Herpes simplex, Epstein-Barr, HIV, Zika, cytomegalovirus.
• Bacterial infections: Lyme disease, syphilis, tuberculosis.
• Fungal and parasitic infections: Less common but possible triggers.

2. Autoimmune Disorders

The immune system may mistakenly attack spinal cord tissues, often as part of:

• Multiple Sclerosis (MS)
• Neuromyelitis Optica Spectrum Disorder (NMOSD)
• Systemic Lupus Erythematosus (SLE)
• Sarcoidosis

3. Post-Vaccination Reactions

In rare cases, transverse-myelitis may develop following immunizations (e.g., for hepatitis B, influenza, or COVID-19 vaccines), likely due to an immune response.

4. Other Triggers

• Spinal cord ischemia
• Paraneoplastic syndromes
• Idiopathic (no identifiable cause)

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Types of Transverse Myelitis

Understanding the types of transverse myelitis can help in selecting appropriate treatment strategies and in understanding the prognosis.

1. Acute Partial Transverse Myelitis

• Involves a section of the spinal cord.
• Symptoms may be mild to moderate.
• Often associated with multiple sclerosis.

2. Acute Complete Transverse Myelitis

• Inflammation affects the entire width of the spinal cord.
• Results in more severe symptoms including paralysis.
• Typically idiopathic or infection-triggered.

3. Recurrent Transverse Myelitis

• Multiple episodes over time.
• Associated with underlying autoimmune conditions like NMO.

4. Longitudinally Extensive Transverse Myelitis (LETM)

• Inflammation extends over three or more vertebral segments.
• Strongly associated with NMOSD.

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Diagnosis of Transverse Myelitis

Early and accurate diagnosis is crucial to managing transverse myelitis effectively. The diagnostic process involves multiple clinical, imaging, and laboratory evaluations.

1. Medical History and Neurological Exam

The first step includes:

• Reviewing recent illnesses, infections, or vaccinations.
• Identifying patterns of neurological deficits.
• Evaluating muscle strength, reflexes, coordination, and sensation.

2. MRI Scan

• MRI of the spinal cord: Reveals inflammation and helps differentiate TM from other conditions like tumors.
• MRI of the brain: Done to check for signs of MS or other CNS involvement.

3. Lumbar Puncture (Spinal Tap)

• Cerebrospinal fluid (CSF) analysis can detect:
  • Elevated white blood cells (indicating inflammation)
  • Oligoclonal bands (often seen in MS)
  • Infectious agents (bacteria or viruses)

4. Blood Tests

• To identify autoimmune antibodies (AQP4-IgG for NMO, MOG-IgG for MOGAD)
• Screen for systemic autoimmune diseases and infections.

5. Evoked Potentials

• Tests how well electrical signals travel through the spinal cord.
• Helps to assess the extent of nerve damage.

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Treatment Options for Transverse Myelitis

Treatment aims to reduce inflammation, manage symptoms, and improve long-term outcomes. Interventions vary depending on the underlying cause and the severity of symptoms.

1. Acute Treatment

These are usually initiated as soon as TM is diagnosed.

a. High-Dose Corticosteroids

• IV methylprednisolone is commonly used.
• Reduces inflammation and immune activity.
• Typically given over 3–5 days.

b. Plasma Exchange (Plasmapheresis)

• Used if corticosteroids fail.
• Helps remove harmful antibodies from the blood.

c. Intravenous Immunoglobulin (IVIG)

• May help modulate immune response.
• Used especially in cases suspected of being post-infectious or autoimmune.

2. Symptomatic Management

Addressing specific symptoms is crucial for recovery and quality of life.

a. Pain Management

• Neuropathic pain medications: Gabapentin, pregabalin, amitriptyline.
• Physical therapy to reduce muscle stiffness.

b. Bladder and Bowel Dysfunction

• Catheterization for urinary retention.
• Anticholinergic drugs for bladder control.
• High-fiber diet and laxatives for constipation.

c. Muscle Spasticity and Weakness

• Physical and occupational therapy.
• Baclofen or tizanidine for spasticity.

d. Emotional Support

• Patients may suffer from anxiety or depression.
• Counseling and support groups can help.

3. Long-Term Rehabilitation

Rehabilitation plays a central role in regaining lost function.

• Physical Therapy: Improves strength, mobility, and coordination.
• Occupational Therapy: Helps with daily activities and adaptive techniques.
• Speech Therapy: If upper spinal cord is affected.
• Assistive Devices: Walkers, braces, or wheelchairs as needed.

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Prognosis and Recovery

The outlook for transverse myelitis varies significantly.

Factors Affecting Recovery

• Severity of the initial attack
• Speed of diagnosis and treatment
• Presence of underlying conditions like MS or NMO
• Extent of spinal cord damage

Possible Outcomes

• Full Recovery: Seen in 1/3 of patients.
• Partial Recovery: In another third—some symptoms persist.
• Poor Recovery: Remaining third may have permanent neurological deficits.

Time Frame

• Recovery may begin within weeks, but often continues over 6 months to 2 years.
• Long-term monitoring may be required for associated conditions like MS or NMOSD.

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Preventive Measures and Living with Transverse Myelitis

While there’s no guaranteed way to prevent TM, certain strategies can reduce risks and aid management.

1. Early Treatment of Infections

• Promptly treat viral and bacterial infections.
• Avoid exposure to known infectious triggers when possible.

2. Managing Autoimmune Conditions

• Regular follow-up for autoimmune diseases.
• Immunosuppressive therapy for conditions like NMO or MS.

3. Lifestyle Modifications

• Healthy diet: Supports immune health and recovery.
• Regular exercise: Helps maintain mobility and strength.
• Stress management: Reduces flare-up potential in autoimmune cases.

4. Support Networks

• Joining support groups can provide emotional strength and shared coping strategies.
• Professional counseling for mental health issues arising from chronic illness.

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When to Seek Medical Attention

Immediate medical attention should be sought if you or someone you know experiences:

• Sudden weakness or paralysis in the limbs
• Numbness or loss of sensation
• Urinary or bowel dysfunction
• Sharp, stabbing back pain with neurological symptoms

Quick intervention significantly improves recovery chances.

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Conclusion

Transverse myelitis is a complex neurological condition that can drastically impact a person’s quality of life. While rare, its onset can be sudden and severe. Early diagnosis, prompt treatment, and comprehensive rehabilitation are essential to achieving the best outcomes. With the advancement of medical therapies and a multidisciplinary approach, many individuals with TM can regain significant function and lead fulfilling lives.

Frequently Asked Questions (FAQs) About Transverse Myelitis

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