Transverse myelitis, causes, symptoms
Overview
Transverse myelitis is an inflammation of both sides of one 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 body's tissues. It could also be caused by other myelin disorders, such as multiple sclerosis. Other conditions, such as a stroke of the spinal cord, are often confused with transverse myelitis, and these conditions require different treatment approaches.
Treatment for transverse myelitis includes medications and rehabilitative therapy. Most people with transverse myelitis recover at least partially. Those with severe attacks sometimes are left with major disabilities.
Symptoms
Signs and symptoms of transverse myelitis usually develop over a few hours to a few days and may sometimes progress gradually over several weeks.
Transverse myelitis usually affects both sides of the body below the affected area of the spinal cord, but sometimes symptoms only appear on one side of the body.
Typical signs and symptoms are:
Pain. The pain of transverse myelitis can appear suddenly in the lower back. The sharp pain can go down your legs or arms, or around your chest or stomach. Symptoms of pain vary depending on the part of the spinal cord affected.
Abnormal sensations Some people with transverse myelitis report a feeling of numbness, tingling, cold, or burning. Some are particularly sensitive to light rubbing of clothing or extreme heat or cold. You may feel like something is firmly holding the skin on your chest, stomach, or legs.
Weakness in the arms or legs Some people notice heaviness in their legs, or the trip or drag afoot. Others may develop severe weakness or even complete paralysis.
Bladder and bowel problems. These can include the need to urinate more frequently, urinary incontinence, difficulty urinating, and constipation.
When to see a doctor
Call your doctor or seek emergency medical help if signs and symptoms of transverse myelitis appear. A variety of neurological disorders can lead to sensory problems, weakness, and bladder or bowel disorders, including spinal cord compression, which is a surgical emergency.
Another less common cause is a stroke to the spinal cord due to impaired blood flow. This can be due to a blockage in a blood vessel that supplies blood to the spinal cord, which can occur during aortic surgery or increased blood clotting. It is important to get a prompt diagnosis and adequate treatment.
causes
The exact cause of transverse myelitis is unknown. Sometimes no cause is known.
Viral, bacterial, and fungal infections that affect the spinal cord can cause transverse myelitis. In most cases, an inflammatory disorder occurs after the infection has healed.
Viruses associated with transverse myelitis are:
- Herpesviruses, including the one that causes shingles and chickenpox (zoster)
- Cytomegalovirus
- Epstein-Barr
- HIV
- Enteroviruses such as poliovirus and coxsackievirus
- West Nile
- Echovirus
- Zika
- Influenza
- Hepatitis B
- Mumps, measles, and rubella
Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.
Bacterial infections that are associated with transverse myelitis include:
- Lyme disease
- Syphilis
- Tuberculosis
- Actinomyces
- Pertussis
- Tetanus
- Diphtheria
Bacterial skin infections, gastroenteritis, and some types of bacterial pneumonia can also cause transverse myelitis.
In rare cases, parasites and fungal infections can infect the spinal cord.
There are several inflammatory diseases that appear to be causing the disorder:
Multiple sclerosis is a condition in which the immune system destroys the myelin that surrounds the nerves in the spinal cord and brain. Transverse myelitis can be the first sign of multiple sclerosis or it can relapse. Transverse myelitis, a sign of multiple sclerosis, usually causes symptoms on only one side of the body.
Neuromyelitis optic (Devic's disease) is a condition that causes inflammation and loss of myelin around the spinal cord and the nerve in the eye that carries information to the brain. The transverse myelitis associated with neuromyelitis optics usually affects both sides of the body.
In addition to transverse myelitis, symptoms of optic nerve damage to the myelin may appear, including eye pain with movement and temporary loss of vision. This can appear with the symptoms of transverse myelitis or separately. However, some people with optic neuromyelitis have no eye problems and may only have recurrent episodes of transverse myelitis.
Autoimmune diseases are likely to contribute to transverse myelitis in some people. These disorders include lupus, which can affect multiple body systems, and Sjogren's syndrome, which causes severe dryness of the mouth and eyes.
Transverse myelitis associated with autoimmune diseases can be a harbinger of the optics of neuromyelitis. Optic neuromyelitis is most common in people with other autoimmune diseases.
Infectious disease vaccines have sometimes been implicated as a possible trigger. At present, however, the association is not strong enough to warrant a vaccine restriction.
Sarcoid is a disease that causes inflammation in many areas of the body, including the spinal cord and optic nerve. It can mimic the look of neuromyelitis, but sarcoid symptoms usually appear more slowly. The cause of sarcoid is not known.
Complications
People with transverse myelitis usually only have one episode. However, complications often persist,
including the following:
Pain, one of the most common long-term debilitating complications of the disorder.
Stiffness, tension, or painful cramps in the muscles (muscle spasms). This is most common on the buttocks and legs.
Partial or total paralysis of the arms, legs, or both. This can persist after the first symptoms.
Sexual dysfunction, a common complication of transverse myelitis. Men can have difficulty getting an erection or achieving orgasm. Women can find it difficult to achieve orgasm.
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