Transverse myelitis
Myelitis is an inflammation of both sides of one section of the spinal cord. This disorder can damage the protective material covering nerve cells (myelin).
Myelitis is an illness that interrupts the messages sent by spinal cord nerves throughout the body. This can cause pain, muscle weakness, paralysis, sensory problems, and bladder and bowel dysfunction.
Transverse myelitis is caused by many different things, including infections and immune system problems that attack body tissues. It could also be caused by other myelin disorders, such as multiple sclerosis. Other conditions, such as a stroke of the spinal cord, can often be confused with transverse myelitis. Myelitis and these conditions require different treatment approaches.
Treatment for transverse myelitis includes medications and rehabilitation. Most people with transverse myelitis improve at least partially, although some experience severe attacks that can leave them with significant disabilities.
Symptoms
Transverse myelitis usually develops slowly over a few hours to a few days, and it may sometimes progress gradually over several weeks.
Myelitis usually affects both sides of the body below the area of the spinal cord that is affected. Sometimes, however, only one side of the body may be affected.
Typical signs and symptoms include:
- Pain.If you experience pain in your lower back, legs, arms, or chest, it may be due to myelitis. Pain symptoms can vary depending on which part of your spinal cord is affected.
- Abnormal sensations.Some people with transverse myelitis have sensations of numbness, tingling, coldness, or heat. Some are particularly sensitive to the touch of clothing or extreme temperatures. You may feel as if something is tightly wrapping your chest, abdomen, or legs.
- Weakness in your arms or legs.Some people experience heaviness or stumbling when walking; others may develop severe weakness or even total paralysis.
- Bladder and bowel problems.People with urinary incontinence may have difficulty urinating and may experience constipation.
When to see a doctor
If you are experiencing any signs or symptoms of transverse myelitis, please call your doctor or go to the emergency room. Transverse myelitis is a serious neurological disorder that can cause problems with your sense of smell, touch, and movement.
A stroke can occur for a variety of reasons, such as an obstruction of a blood vessel that supplies blood to the brain (due to surgery or increased clotting), which can be caused by a stroke in the spinal cord. It's important to get medical help as soon as possible after experiencing any type of stroke. Diagnosis and treatment of a disease is an important part of healthcare.
Causes
The cause of transverse myelitis is not known. Sometimes it happens without any known cause.
Viral and bacterial infections that affect the spinal cord may cause transverse myelitis. In most cases, the disorder appears after a person recovers from the infection.
Some viruses that can cause transverse myelitis are:
- Shingles and chickenpox are caused by herpes viruses.
- Cytomegalovirus
- Epstein-Barr
- HIV
- Enteroviruses are viruses that include poliovirus and coxsackievirus.
- West Nile
- Echovirus
- Zika
- Influenza
- Hepatitis B
- Mumps, measles and rubella
Other viruses may trigger an autoimmune reaction without directly attacking the spinal cord.
Bacterial infections that are associated with transverse myelitis include: - upper respiratory tract infections, such as colds and flu - skin infections, such as impetigo and cellulitis - urinary tract infections
- Lyme disease
- Syphilis
- Tuberculosis
- Actinomyces
- Pertussis
- Tetanus
- Diphtheria
Transverse myelitis may be caused by bacterial skin infections, gastroenteritis, and pneumonia.
Parasites and fungal infections are rare in people's spinal cords.
There are a number of conditions that may cause this disorder:
- Multiple sclerosis Multiple sclerosis is a disease in which the immune system destroys myelin around nerves in your spinal cord and brain. When transverse myelitis (a sign of multiple sclerosis) is the first symptom of the disease, it usually causes symptoms on only one side of your body. If transverse myelitis is a relapse, it will cause symptoms on both sides of your body. The body is a part of the.
Neuromyelitis optica is a condition that affects the optic nerve.Transverse myelitis is a condition that causes inflammation and damage to the myelin sheath around the spinal cord and the nerve in your eye that transmits information to your brain. Neuromyelitis optica, which is usually a condition affecting both sides of your body, is a result of this inflammation.
Neuromyelitis optica can cause symptoms that include damage to the myelin sheath of the optic nerve, such as pain with movement and temporary loss of vision. This can happen along with symptoms of transverse myelitis, but not always. People who experience eye-related problems might have recurrent episodes of transverse myelitis.
Autoimmune disordersTransverse myelitis is likely to occur in people who have lupus or Sjogren's syndrome. These disorders can affect multiple body systems.
Neuromyelitis optica is a more common form of neuritis associated with an autoimmune disorder. People with other autoimmune diseases are more likely to experience neuromyelitis optica.
- VaccinationsThere is a possible connection between infectious diseases and the MMR vaccine, but at this time the connection is not strong enough to recommend that any children be prevented from receiving the vaccine.
- SarcoidosisSarcoidosis is a condition that leads to inflammation in many parts of the body, including the spinal cord and optic nerve. It can be confused with neuromyelitis optica, but typically sarcoidosis symptoms develop more slowly. The cause of sarcoidosis is not fully understood.
Complications
People with transverse myelitis usually experience only one episode.However, sometimes problems continue to linger after a conflict is resolved, including:
- Pain,One of the most common long-term complications of the disorder is debilitating.
- Stiffness, tightness or painful spasmsSpasms or clonic movements may occur in your muscles (muscle spasticity). This is most common in the buttocks and legs.
- Partial or total paralysisYou may experience symptoms on both your arms, legs, or both. These symptoms may persist even after the first ones have gone away.
- Sexual dysfunction,Transverse myelitis is a complication that can affect men and women in different ways. For men, it can be difficult to achieve an erection or have an orgasm. For women, it may be difficult to reach orgasm.
- Depression or anxiety,Chronic pain and disability can have a significant impact on a person's lifestyle, which can lead to complications.
Diagnosis
Your doctor will diagnose transverse myelitis based on your answers and symptoms, as well as a medical history and clinical assessment of nerve function and test results.
These tests which can indicate inflammation of the spinal cord and rule out other disorders include the following:
- Magnetic resonance imaging (MRI)MRI scans use a magnetic field and radio waves to create images of soft tissues. This can reveal inflammation or abnormalities in the spinal cord that may be causing the symptoms.
Lumbar puncture (spinal tap)A doctor will use a needle to extract a small amount of cerebrospinal fluid (CSF). This fluid surrounds your spinal cord and brain and protects them.
Some people with transverse myelitis may have high numbers of white blood cells or immune system proteins that indicate inflammation. Spinal fluid can also be checked for infections or certain cancers.
Blood tests A test can be done to check for antibodies that are associated with neuromyelitis optica, a condition in which inflammation occurs in both your spinal cord and the nerve in your eye. People who have a positive antibody test are at increased risk of experiencing multiple attacks of transverse myelitis. If the pests are not treated, they will attack again in the future.
Other blood tests can identify infections that may be causing symptoms of transverse myelitis or disproving other causes of the symptoms.
Treatment
Several therapies are aimed at the acute signs and symptoms of transverse myelitis:
- Intravenous steroids.You'll probably receive steroids through a vein in your arm over the course of several days. This will help reduce the inflammation in your spinal column.
Plasma exchange therapy.If someone doesn't respond to intravenous steroids, they may need plasma exchange therapy. This involves removing the fluid in which blood cells are suspended (plasma) and replacing it with special fluids.
There is not yet a clear understanding of how this therapy helps people with transverse myelitis, but it is possible that plasma exchange removes inflammatory antibodies.
- Antiviral medication.Some people who have a viral infection of the spinal cord may be treated with medications to treat the virus. These medications can help to reduce the amount of virus in the body.
Pain medication.Chronic pain is a common complication of transverse myelitis. Some medications that may lessen muscle pain include common pain relievers such as acetaminophen (Tylenol others) ibuprofen (Advil Motrin IB others) and naproxen sodium (Aleve.).
antidepressant drugs such as sertraline (Zoloft) and anticonvulsant drugs such as gabapentin (Neurontin Gralise) or pregabalin (Lyrica) may be used to treat nerve pain.
- If you are having other complications treated, medications are needed.Your doctor may prescribe other medications to help you with problems such as muscle spasticity, urinary or bowel dysfunction, depression, or other complications that can occur as a result of transverse myelitis.
- There are medications that can be taken to prevent recurrent attacks of transverse myelitis.People who have antibodies related to neuromyelitis optica (an autoimmune disease that can cause optic neuritis) will need to take medications to reduce their chances of more transverse myelitis attacks or developing optic neuritis.
Other therapies
Additional therapies focus on long-term recovery and care. This includes things like therapy, medication, and counseling.
- Physical therapy.This will help improve your strength and coordination. Your therapist can show you how to use any needed assistive devices, such as canes or braces.
- Occupational therapy.This helps people with transverse myelitis learn new ways of performing everyday activities, such as bathing, preparing a meal, and cleaning one's house.
- Psychotherapy.A psychotherapist can treat anxiety, depression, sexual dysfunction, and other emotional or behavioral issues related to coping with transverse myelitis with talk therapy.
Prognosis
Most people with transverse myelitis have at least partial recovery, but it may take a year or more. Recovery usually starts within the first three months after the episode and depends on the cause of transverse myelitis.
After an attack of transverse myelitis, about one-third of people fall into one of three categories: 1) People who have no symptoms. 2) People who have mild symptoms. 3) People who have severe symptoms.
- No or slight disability.These people have only minimal lingering symptoms.
- Moderate disability.These people are mobile, but may experience numbness or tingling and bladder and bowel problems.
- Severe disability.Some people may need a wheelchair for the rest of their lives and will require assistance with basic daily activities.
The severity of transverse myelitis is difficult to predict. The prognosis and responsiveness to treatment is strongly determined by the cause of the syndrome and by how early treatment is administered. Generally, people who experience a rapid onset of severe symptoms and signs have a poorer prognosis than people who experience the syndrome more slowly. People who have a positive test for a particular antibody have a worse prognosis than do those who have a relatively slower onset and milder symptoms, and have no detectable antibodies.
Preparing for your appointment
If you have transverse myelitis, symptoms can be severe and sudden. You may need emergency or urgent care.
The doctor is likely to ask questions such as the following:
- When did you first begin to experience symptoms?
- How soon have your symptoms started developing?
- Do you feel pain or unusual sensations?
- How badly does the pain feel to you? On a scale of 1 to 10, with 10 being the most painful, how would you rate it?
- Do you have trouble with strength or coordination?
- Do you have problems with your bowel or bladder control?
- Are you having difficulty breathing?
- Do you have any other medical conditions?
- Have you recently had any infections?
- Have you recently had any vaccinations?
- Have you traveled abroad lately? Where?
- Do you have any recent medical procedures?
- What prescription and over-the-counter medications do you take on a regular basis? What is the dosage of each one?