How to define transverse myelitis?
is a rare neurological condition in which both sides of one section of the spinal cord
are inflamed. It often damages the insulating material covering nerve cell fibers (myelin).
Signs and symptoms of transverse myelitis are variable and reflect the level of the affected spinal cord. The underlying cause of transverse myelitis is unknown, but it is usually related to various infections, immune system disorders
What causes transverse myelitis?
The exact cause of transverse myelitis is unknown in many cases, but there do exist several conditions which appear to cause it, including:
Associated viruses include herpes viruses
such as varicella zoster, herpes simplex, cytomegalovirus, and Epstein-Barr; flaviviruses
such as West Nile and Zika, influenza, echovirus, hepatitis B, mumps, measles, rubella, etc.
Associated autoimmune conditions include lupus, Sjogren's syndrome
(severe dryness of the mouth and eyes), etc.
include toxoplasmosis, cysticercosis, shistosomiasis, angtiostrongyloides, etc.
Immune System Disorders
Associated immune system disorders
include neuromyelitis optica, multiple sclerosis, antibody-mediated conditions, systemic lupus erythematosus, Bechet's syndrome, etc.
Associated vascular disorders
include dural arteriovenous fistula, intra spinal cavernous malformations, arteriovenous malformation, disk embolism, etc.
Associated fungal infections
include aspergillus, blastomyces, coccidioides, cryptococcus, etc.
Associated bacterial infections
include tuberculosis, diphtheria, Lyme disease, middle-ear infections, syphilis, actinomyces, etc.
What are the symptoms of transverse myelitis?
Signs and symptoms of transverse myelitis usually develop over a few hours to a few days
and may sometimes progress gradually over several weeks. Typical signs and symptoms are:
- Pain in lower back
- Loss of appetite
- Sensory alterations
- Muscle spasms
- Weakness or paralysis in the legs and arms
- Bowel and bladder dysfunction
How to diagnose transverse myelitis?
Doctors diagnose transverse myelitis by taking a medical history and performing a thorough neurological examination
. Tests that can evaluate underlying causes include:
It is performed to rule out
various disorders like vitamin B12 deficiency, HIV infection
and many others.
Magnetic Resonance Imaging (MRI)
It can present detailed images of your insides, and shows
whether there exists something that may affect nerves, like a tumor, a slipped disk
Lumbar Puncture (Spinal Tap)
Use a needle to remove a small sample of the cerebrospinal fluid
that surrounds the brain and spinal cord. For people with transverse myelitis, the cerebrospinal fluid contains more protein
What are the treatments for transverse myelitis?
The followings are the therapies that target the acute signs and symptoms of transverse myelitis:
They may help those who have a viral infection of the spinal cord.
Intravenous Immunoglobulin (IVIG)
from healthy donors into the patient's system
Pain medicines that can be used to alleviate muscle pain and nerve pain
, which include naproxen, cetaminophen, ibuprofen, antidepressant drugs, anticonvulsant drugs, etc.
Plasma Exchange Therapy
It may be used for people who don't respond well to intravenous steroids
. It removes plasma and replaces it with special fluids.
If your symptoms affect your breathing, respirator can help you breath
Intravenous Corticosteroid Drugs
They may decrease swelling in the spine and reduce immune system activity, like methylprednisolone or dexamethasone
What is the prognosis of transverse myelitis?
Most people can recover from transverse myelitis within the first 3 months
after the attack. For some people, recovery may continue for up to 2 years
and in some cases even longer.
If there is no improvement within the first 3 to 6 months
, complete recovery is unlikely. Some patients are left with moderate disability while others may have permanent complications.
include nerve sensitivity, bladder and bowel problems, walking problems and so on. Permanent complications
may include sexual dysfunction, depression, total paralysis, etc.
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