Transverse Myelitis
Transverse myelitis is a rare neurological disorder caused by inflammation across a segment of the spinal cord, disrupting the transmission of nerve signals. The inflammation damages the myelin sheath covering nerve fibers and can affect motor function, sensation, and autonomic functions below the level of injury. The condition can develop rapidly over hours to weeks, causing varying degrees of weakness, sensory loss, and bladder or bowel dysfunction. While some patients recover completely, others experience permanent neurological deficits. The exact cause is often unknown, though it may follow infections, autoimmune conditions, or occur as part of other neurological diseases.
What is it?
Transverse myelitis involves inflammation of a complete horizontal segment of the spinal cord, affecting nerve pathways on both sides. The term “transverse” refers to the pattern of inflammation across the width of the spinal cord, and “myelitis” means inflammation of the spinal cord. The inflammation damages myelin (the protective sheath around nerve fibers) and sometimes the nerve fibers themselves, disrupting the transmission of signals between the spinal cord and the rest of the body. This can affect motor neurons (controlling movement), sensory neurons (transmitting touch, pain, and temperature sensations), and autonomic neurons (controlling bladder, bowel, and sexual function).
Transverse myelitis can be classified as idiopathic (no identifiable cause, accounting for many cases), post-infectious (following viral or bacterial infections such as herpes viruses, influenza, or mycoplasma), autoimmune or inflammatory (associated with conditions like multiple sclerosis, neuromyelitis optica spectrum disorder, systemic lupus erythematosus, or Sjögren’s syndrome), post-vaccination (rarely, following certain vaccines), or paraneoplastic (associated with cancer, very rare). The thoracic spine is most commonly affected, followed by cervical and lumbar regions. The condition can occur at any age but has two peak incidence periods: between ages 10-19 and 30-39. There is no clear gender predominance. The inflammation typically develops over hours to several weeks, with most patients experiencing their worst symptoms within 10 days of onset.
Important to Know
The classic symptom triad of transverse myelitis includes motor weakness (ranging from mild leg weakness to complete paralysis below the affected spinal level), sensory changes (numbness, tingling, burning sensations, or band-like tightness around the torso), and autonomic dysfunction (bladder urgency, retention, or incontinence; bowel dysfunction; sexual dysfunction). Additional symptoms include back pain or sharp, shooting pains radiating around the torso or down the legs; muscle spasms and stiffness (spasticity); and respiratory difficulty if cervical segments are involved. Symptoms usually begin suddenly and progress over hours to days. Diagnosis requires spinal MRI showing inflammation (bright signal on T2-weighted images with gadolinium enhancement) spanning most of the cross-sectional area of the spinal cord at one or more levels. Lumbar puncture reveals elevated white blood cells and protein in cerebrospinal fluid in most cases. Blood tests screen for underlying autoimmune conditions and infections. It’s crucial to distinguish transverse myelitis from compressive spinal cord lesions (tumors, herniated discs, epidural abscess) that require urgent surgical intervention. Treatment begins with high-dose intravenous corticosteroids (methylprednisolone) for 3-5 days to reduce inflammation, followed by a tapering course of oral steroids. If steroids are ineffective, plasma exchange (plasmapheresis) may be used to remove harmful antibodies from the blood. Some patients receive intravenous immunoglobulin (IVIG) therapy. Treatment of underlying conditions is essential if identified. Comprehensive rehabilitation including physical therapy, occupational therapy, and bladder/bowel management programs is critical for recovery. Prognosis is variable—approximately one-third of patients recover with minimal or no residual symptoms, one-third have moderate residual deficits, and one-third have severe permanent disability. Better outcomes are associated with rapid treatment, incomplete initial symptoms, and younger age. Most recovery occurs within the first 3-6 months, though some improvement can continue for up to 2 years. Some patients (10-20%) experience recurrent episodes, which may indicate an underlying condition like neuromyelitis optica or multiple sclerosis requiring long-term immunosuppressive therapy.