Transverse Myelitis: An Inflammation of the Spinal Cord

By SWA

Transverse myelitis is a rare neurological condition characterized by inflammation of the spinal cord. This inflammation can damage or destroy the myelin, the protective sheath surrounding nerve fibers, disrupting the communication between the brain and the rest of the body. The condition is termed "transverse" because the inflammation often affects both sides of one section of the spinal cord, leading to a range of sensory, motor, and autonomic symptoms.

Causes of Transverse Myelitis

Transverse myelitis can be triggered by a variety of conditions, although in many cases, the exact cause remains unknown (idiopathic). Commonly identified causes include:

  • Autoimmune diseases: Conditions such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and MOG antibody disease can cause immune-mediated inflammation of the spinal cord.

  • Post-infectious responses: The condition can develop following viral or bacterial infections. The immune system, in fighting an infection, may mistakenly attack the spinal cord.

  • Direct infections: Infections such as herpes viruses, HIV, and Lyme disease can directly invade and inflame the spinal cord tissue.

  • Paraneoplastic syndromes: These are rare immune responses associated with certain cancers that can lead to spinal cord inflammation.

  • Vaccinations: In extremely rare cases, vaccinations have been associated with the onset of transverse myelitis, likely due to an autoimmune response.

Symptoms

The onset of symptoms can be sudden, developing over a few hours to several days, or more gradually over several weeks. Symptoms depend on the level of the spinal cord affected and the extent of inflammation.

  • Motor symptoms: These include muscle weakness, which may progress to partial or complete paralysis of the limbs.

  • Sensory symptoms: Patients often report numbness, tingling, burning, or loss of sensation, typically below the level of inflammation.

  • Autonomic dysfunction: This can include problems with bladder and bowel control, sexual dysfunction, and abnormal blood pressure or heart rate regulation.

The symptoms are usually bilateral (affecting both sides of the body), though they may be asymmetric in some cases.

Diagnosis

Diagnosing transverse myelitis involves a combination of clinical evaluation and diagnostic testing to confirm inflammation and rule out other potential causes.

  • Magnetic Resonance Imaging (MRI) is the primary imaging technique used to detect inflammation and damage within the spinal cord. It can also help identify other possible causes such as tumors or spinal cord compression.

  • Lumbar puncture (spinal tap) may be performed to examine cerebrospinal fluid for signs of inflammation or infection.

  • Blood tests can identify infections, autoimmune markers, and specific antibodies such as those related to neuromyelitis optica (NMO-IgG) or MOG antibody disease.

Treatment

The main goal of treatment is to reduce spinal cord inflammation, manage symptoms, and address the underlying cause if identified.

  • Corticosteroids are typically the first line of treatment. High-dose intravenous steroids help suppress the immune response and reduce inflammation.

  • Plasma exchange (plasmapheresis) may be used if a patient does not respond to steroids. This procedure removes harmful antibodies from the blood.

  • Intravenous immunoglobulin (IVIG) therapy is another option, particularly in cases suspected to be autoimmune in nature.

  • Rehabilitation is critical during the recovery phase. Physical and occupational therapy can help patients regain mobility and independence.

In cases where an underlying disease such as MS or NMO is identified, long-term disease-modifying treatments may be necessary to prevent future episodes.

Prognosis

Recovery from transverse myelitis varies widely. Some patients recover fully, while others experience permanent impairments. Most improvement occurs within the first three to six months after the onset of symptoms, though recovery can continue for up to two years.

Factors influencing prognosis include:

  • The severity of initial symptoms

  • The speed of receiving treatment

  • The presence of an underlying chronic condition

Prompt diagnosis and treatment are critical for improving outcomes.

Conclusion

Transverse myelitis is a serious neurological condition that can have significant effects on a person's quality of life. Although rare, it requires swift medical attention to minimize long-term damage and improve the chances of recovery. Continued research is helping to clarify its causes, improve diagnostic accuracy, and develop more effective treatments. Patients experiencing unexplained weakness, sensory changes, or bladder and bowel issues should seek immediate medical evaluation, as early intervention is key to better outcomes.

References:

Extensive information:
Transverse myelitis, also known as acute transverse myelitis
https://radiopaedia.org/articles/transverse-myelitis

Transverse Myelitis
https://www.ncbi.nlm.nih.gov/books/NBK559302/#:~:text=Infections%20leading%20to%20TM%20include%20but%20are,reported%20to%20have%20an%20association%20with%20TM

 

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9  

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