Transverse myelitis 

Transverse myelitis (TM) occurs when part of your spinal cord is inflamed. This neurological disorder commonly causes sudden pain in your back or neck and a “pins and needles” sensation in your arms or legs. TM is a rare type of demyelinating disease.

Transverse myelitis causes are sometimes unknown, but it may appear after a viral or bacterial infection or with an immune system disorder. Transverse myelitis recovery is possible with or without treatment, but it may lead to life-long complications.

What is transverse myelitis?

Transverse myelitis is inflammation in a section of your spinal cord, which is in your central nervous system. Your spinal cord contains nerves cells that send motor commands, sensory information and reflexes from your brain to other parts of your body.

Your nerve cell communication is supported by a protective covering (myelin sheath). When a disorder like TM impacts the function of your myelin, your nerve cells can’t communicate effectively. Your nerve cells start to die, causing the inflammation that leads to transverse myelitis.

Transverse myelitis symptoms

The symptoms of transverse myelitis can come on quickly (acute transverse myelitis) or they may develop within a few days or weeks. You may experience one symptom or several that vary in severeness and location, depending on which part of your spinal cord is affected. Both sides of your body are usually impacted, but sometimes it may be on only one side (partial transverse myelitis).

Common symptoms include:

• 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.
• Muscle weakness: Muscles may feel heavy, causing movement issues like stumbling. Some people may experience total paralysis.
• Bladder or bowel issues: Includes urinary incontinence, frequent urination, urinary retention or constipation.

Symptoms may improve over time with or without treatment. For some – especially in acute cases – symptoms are permanent and may lead to further complications such as partial or total paralysis or painful spasms in your muscles (muscle spasticity).

Transverse myelitis risk factors

Transverse myelitis can affect anyone. Children ages 10-19 and adults ages 30-39 are most affected.

TM commonly appears after recovering from a viral or bacterial infection. It can also happen after a fungal infection, although this is rarer. Sometimes, the cause is unknown (idiopathic transverse myelitis).

Common infections associated with transverse myelitis include:

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

Autoimmune diseases or central nervous system diseases that also affect your myelin may also cause transverse myelitis. Sometimes, TM may be a sign of these diseases. Conditions include multiple sclerosis (MS), rheumatoid arthritis (RA) and neuromyelitis optica (Devic’s disease). Acute transverse myelitis is often associated with MS.

Diagnosing transverse myelitis

If you are experiencing symptoms of transverse myelitis, your doctor will perform a physical examination and a series of tests to identify the inflammation in your spine. Tests will look for the source of TM and rule out other related conditions that also cause abnormal inflammation in your spinal cord.

Tests to diagnose transverse myelitis include:

• Lumbar puncture (spinal tap): Collects a sample of your cerebrospinal fluid (CSF) to confirm inflammatory markers that are present in TM.
• 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.

Transverse myelitis treatment

Treatment of transverse myelitis focuses on relieving your symptoms and reducing the inflammation in your spine. This will help avoid long-term complications.

Your doctor will work with you to develop a personalized treatment plan based on the severity of your symptoms, known causes of TM and any underlying health conditions. Treatment plans may be short-term or long-term.

Short-term treatments for transverse myelitis

Often, the first choice in treating acute cases of TM includes a high dose of IV (intravenous) glucocorticoids. Glucocorticoids are a type of steroid hormone that will help reduce the inflammation in your spine.

Other short-term treatments include:

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

Long-term treatments for transverse myelitis

Long-term transverse myelitis treatments may include a combination of methods to improve functional skills and manage any complications.

Long-term treatments include:

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