Transverse myelitis

Description

Transverse myelitis is an inflammation of both sides of a section of the spinal cord. This neurological disorder often damages the insulating material covering nerve cell fibers (myelin).

Transverse myelitis interrupts the messages that the spinal cord nerves send throughout the body. This can cause pain, muscle weakness, paralysis, sensory problems, or bladder and bowel dysfunction.

There are many different causes of transverse myelitis, including infections and immune system disorders that attack the tissues of the body. It can also be caused by other disorders of myelin, such as multiple sclerosis. Other conditions, such as a stroke of the spinal cord, which are often confused with transverse myelitis, and these conditions require different treatment approaches.

The treatment for transverse myelitis includes medicines and rehabilitation therapy. The majority of people with transverse myelitis recover, at least partially. In serious cases attacks are sometimes left with major disabilities.

Symptoms

The signs and symptoms of transverse myelitis usually develop over a few hours to a few days, and sometimes it can happen gradually over several weeks.

Transverse myelitis usually affects both sides of the body below the affected area of the spinal cord, but sometimes there are symptoms of one side of the body.

The characteristic signs and symptoms include:

  • Pain. Transverse myelitis pain may begin suddenly in the lower part of his back. Acute pain may shoot down your legs or arms, or around your chest or abdomen. The symptoms of pain vary depending on the part of the spinal cord affected.
  • Abnormal sensations. Some people with transverse myelitis report sensations of numbness, tingling, coldness or burning. Some of them are especially sensitive to the light, the feel of the clothing or in extreme heat or cold. You may feel as if something is right by wrapping the skin of your chest, abdomen, or legs.
  • Weakness in the arms or legs. Some people notice the feeling of heaviness in the legs, or that they are stumbling or dragging a foot. Others can develop severe weakness or even complete paralysis.
  • Bladder and bowel problems. This may include the need to urinate more often, urinary incontinence, difficulty urinating, and constipation.

When to see a doctor

Call your doctor or seek emergency medical attention if you are experiencing the signs and symptoms of transverse myelitis. A number of neurological disorders that can cause sensory problems, weakness, and bladder or bowel dysfunction, including compression of the spinal cord, which is a surgical emergency.

Another less common cause is a stroke of the spinal cord due to the alteration of the circulation of the blood. This can be caused by the blockage of a blood vessel that supplies blood to the spinal cord, which may occur with the surgery of the aorta or the increase of the coagulation of the blood. It is important to obtain a rapid diagnosis and adequate treatment.

Causes

The exact reason for the transverse myelitis is not known. Sometimes the cause is not known.

Viral, bacterial and fungal infections that affect the spinal cord can cause transverse myelitis. In most cases, the inflammatory disorder that appears after recovery from the infection.

The virus associated with transverse myelitis are:

  • Herpes viruses, such as the one that causes herpes zoster and varicella (zoster)
  • Cytomegalovirus
  • The Epstein-Barr Virus
  • HIV
  • Enteroviruses, such as poliovirus and coxsackievirus
  • West Nile
  • Echovirus
  • Zika
  • The flu
  • Hepatitis B
  • Mumps, measles and rubella

Other viruses may trigger an autoimmune reaction without infecting directly to the spinal cord.

The bacterial infections that are associated with transverse myelitis include:

  • Lyme disease
  • Syphilis
  • Tuberculosis
  • Actinomyces
  • Whooping cough
  • Tetanus
  • Diphtheria

Bacterial skin infections, gastroenteritis, and certain types of bacterial pneumonia can also cause transverse myelitis.

Rarely, parasites, and infections by fungi can infect the spinal cord.

There are a number of inflammatory conditions that appear to cause the disease:

  • Multiple sclerosis is a disorder in which the immune system destroys the myelin that surrounds the nerves in the spinal cord and the brain. Transverse myelitis may be the first sign of multiple sclerosis, or represent a relapse. Transverse myelitis as a sign of multiple sclerosis usually causes symptoms in only one side of your body.
  • Neuromyelitis optica disease (devic's)is a condition that causes inflammation and loss of myelin around the spinal cord and the nerve of the eye that transmits the information to the brain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body. In addition to the transverse myelitis, you may experience the symptoms of damage to the myelin of the optic nerve, including pain in the eye with the movement and temporary vision loss. This can occur with or separately from the transverse myelitis symptoms. However, some people with neuromyelitis optica not experience eye-related problems and only have recurrent episodes of transverse myelitis.
  • Autoimmune disordersprobably contribute to the transverse myelitis in some people. These disorders include lupus, which can affect multiple systems of the body, and Sjogren's syndrome, which causes severe dryness of the mouth and the eyes. Transverse myelitis associated with an autoimmune disorder can be a warning sign of neuromyelitis optica. Neuromyelitis optica occurs more frequently in people with other autoimmune diseases.
  • Vaccines for infectious diseases have sometimes been associated as a possible trigger. However, at this time the association is not strong enough to justify the limitation of the application of any vaccine.
  • Sarcoidosis is a condition that leads to inflammation in many areas of the body, including the spinal cord and the optic nerve. You can imitate neuromyelitis optica, but in general, sarcoidosis symptoms develop more slowly. The cause of sarcoidosis is not fully understood.

Neuromyelitis optica disease (devic's) is a condition that causes inflammation and loss of myelin around the spinal cord and the nerve of the eye that transmits the information to the brain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body.

In addition to the transverse myelitis, you may experience the symptoms of damage to the myelin of the optic nerve, including pain in the eye with the movement and temporary vision loss. This can occur with or separately from the transverse myelitis symptoms. However, some people with neuromyelitis optica not experience eye-related problems and only have recurrent episodes of transverse myelitis.

Autoimmune disorders likely contribute to the transverse myelitis in some people. These disorders include lupus, which can affect multiple systems of the body, and Sjogren's syndrome, which causes severe dryness of the mouth and the eyes.

Transverse myelitis associated with an autoimmune disorder can be a warning sign of neuromyelitis optica. Neuromyelitis optica occurs more frequently in people with other autoimmune diseases.

Complications

People with transverse myelitis, usually only experience a single episode. However, the complications that often remain, including the following:

  • The pain, one of the most common debilitating long-term complications of the disease.
  • The stiff, stiff or painful spasms in the muscles (muscle spasticity). This is most common in the buttocks and legs.
  • Partial or total paralysis of the arms, the legs, or both. This may persist after the first symptoms.
  • Sexual dysfunction, a common complication of transverse myelitis. Men may experience difficulty achieving an erection or reaching orgasm. Women can have difficulty reaching orgasm.
  • Depression or anxiety, which is common in those with long-term complications due to the significant changes in life style, stress, chronic pain or disability, and the impact of sexual dysfunction on relationships.

Transverse myelitis

Diagnosis

A doctor will make the diagnosis of transverse myelitis, based on their responses to questions about your signs and symptoms, your medical history, a clinical evaluation of the function of the nerves, and the results of the test.

These tests, which can indicate inflammation of the spinal cord and to rule out other disorders, include the following:

  • Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create 3D images of the soft tissues. A Magnetic resonance imaging (MRI) may show inflammation of the spinal cord, and other potential causes of the symptoms, including abnormalities that affect the spinal cord or the blood vessels.
  • Lumbar puncture (spinal tap)uses a needle to remove a small amount of cerebrospinal fluid (CSF), the protective fluid that surrounds the spinal cord and the brain. In some people with transverse myelitis, cerebrospinal fluid (CSF) may have abnormally high number of white blood cells or immune system proteins that indicate inflammation. Spinal fluid can also be tested by viral infections or certain types of cancer.
  • The blood testsmay include a test that checks for antibodies associated with neuromyelitis optica, a condition in which inflammation occurs in the spinal cord and the nerve in your eye. People with a positive test result, antibodies are at greater risk of suffering several attacks of transverse myelitis and require treatment to prevent future attacks. Other blood tests can identify the infections that may contribute to the transverse myelitis, or rule out other causes of symptoms.

Lumbar puncture (spinal tap) uses a needle to remove a small amount of cerebrospinal fluid (CSF), the protective fluid that surrounds the spinal cord and the brain.

In some people with transverse myelitis, cerebrospinal fluid (CSF) may have abnormally high number of white blood cells or immune system proteins that indicate inflammation. Spinal fluid can also be tested by viral infections or certain types of cancer.

Blood tests may include a test that checks for antibodies associated with neuromyelitis optica, a condition in which inflammation occurs in the spinal cord and the nerve in your eye. People with a positive test result, antibodies are at greater risk of suffering several attacks of transverse myelitis and require treatment to prevent future attacks.

Other blood tests can identify the infections that may contribute to the transverse myelitis, or rule out other causes of symptoms.

Treatment

Several therapies are focused on the acute phase of the signs and symptoms of transverse myelitis:

  • Intravenous steroids. You will likely to receive steroids through a vein in your arm over the course of several days. Steroids help to reduce inflammation in the spine.
  • Plasma exchange therapy.People who do not respond to intravenous steroids may need plasma exchange therapy. This consists of removing the straw-colored fluid in which blood cells are suspended (plasma) and the replacement of plasma with special liquids. It is not clear how this therapy helps people with transverse myelitis, but it may be that plasma exchange removes inflammatory antibodies.
  • The antiviral drugs. Some people who have a viral infection of the spinal cord can be treated with medications to treat the virus.
  • Medication for pain.Chronic pain is a common complication of transverse myelitis. Medications that can decrease the muscle pain include analgesics, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) Nerve pain can be treated with antidepressant medications, such as sertraline (Zoloft), and anti-seizure medications, such as gabapentin (Neurontin, Gralise) or pregabalin (Lyrica).
  • Medications for the treatment of other complications. Your doctor may prescribe other medications as needed to treat problems such as muscle spasticity, urinary or bowel dysfunction, depression, or other complications associated with transverse myelitis.
  • Medications to prevent recurrent attacks of transverse myelitis. People who have antibodies associated with neuromyelitis optica continuous need of medications, such as corticosteroids and/or immunosuppressive drugs, to reduce their chances of more transverse myelitis attacks or the development of optic neuritis.

Plasma exchange therapy. People who do not respond to intravenous steroids may need plasma exchange therapy. This consists of removing the straw-colored fluid in which blood cells are suspended (plasma) and the replacement of plasma with special liquids.

It is not clear how this therapy helps people with transverse myelitis, but it may be that plasma exchange removes inflammatory antibodies.

Medication for pain. Chronic pain is a common complication of transverse myelitis. Medications that can decrease the muscle pain include analgesics, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)

Nerve pain can be treated with antidepressant medications, such as sertraline (Zoloft), and anti-seizure medications, such as gabapentin (Neurontin, Gralise) or pregabalin (Lyrica).

Other therapies

Additional therapies are focused on the long-term recovery and care:

  • The physical therapy. This helps to improve strength and coordination. Your physical therapist can teach you how to use any necessary assistive devices, such as a wheelchair, crutches or braces.
  • Occupational therapy. This helps people with transverse myelitis learn new ways of carrying out day-to-day activities, such as bathing, preparing food and cleaning the house.
  • Psychotherapy. A psychotherapist may use psychotherapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioral problems of coping with transverse myelitis.

Prognosis

Although the majority of people with transverse myelitis have at least partial recovery, it can take a year or more. Most of the recovery occurs within the first three months after the episode, and it strongly depends on the cause of transverse myelitis.

Around a third of people with transverse myelitis fall into one of three categories after the attack:

  • No or mild disability. These people experience only a minimum of persistent symptoms.
  • Moderate disability. These people are mobile, but they may have difficulty walking, numbness or a tingling sensation, and bladder and bowel problems.
  • Severe disability. Some people may permanently in need of a wheelchair and require ongoing assistance for the daily care and activities.

It is difficult to predict the course of the transverse myelitis. The prognosis and response to treatment is heavily determined by the cause of down syndrome and, to a certain extent why so early treatment is administered. Generally, people who experience a rapid onset of severe signs and symptoms and who have a positive test for a specific antibody have a worse prognosis than those with a slow start, the milder symptoms and a negative test for antibodies.

Preparing for your appointment

The signs and symptoms that may indicate the transverse myelitis are usually sudden and intense. You will likely need urgent or emergency care.

The questions that the treating doctor is likely to ask include the following:

  • When did you begin experiencing symptoms?
  • How quickly the symptoms developed?
  • Do you have pain, tingling or other unusual sensations?
  • How would you rate the pain on a scale of 1 to 10, with 10 being the most painful?
  • Have you experienced the weakness or lack of coordination?
  • Has had problems with bowel or bladder control?
  • Are you having difficulty breathing?
  • Have you been diagnosed with other medical conditions?
  • Have you recently had an infection?
  • Has recently had a vaccine?
  • Have you traveled abroad recently? Where?
  • Have you had any medical procedures recently?
  • What prescription or over-the-counter medications that you take regularly? What is the dosage of each one of them?
Symptoms and treatment of transverse myelitis