Transverse Myelitis: Causes, Symptoms, Diagnosis, Treatment and Complications

It is an inflammation of the spinal cord. It is the result of damage to nerve cells in a particular area.

A fatty tissue called myelin protects these nerve fibers. It conforms to them like the insulation that covers an electrical cable.

When myelin is damaged, the nerves underneath can also be injured. Once your nerves are marked, it is more difficult for them to send signals to other parts of your body as they should. This often brings pain, weakness, or paralysis.

When this happens in the nerves on both sides of the spinal cord, it is known as transverse myelitis.


More than half the time, doctors are not sure what causes it. But they know what can happen when your body tries to fight disease. Or when your immune system attacks healthy cells for some reason. It is often linked to:

  • Autoimmune diseases like lupus and Sjogren’s syndrome cause inflammation.
  • Bacterial infections such as Lyme disease, tuberculosis, and syphilis.
  • Fungal infections of the spinal cord include aspergillus, Blastomyces, coccidioides, and cryptococcus.
  • Parasites such as toxoplasmosis, cysticercosis, schistosomiasis, and angtostrongyloid.
  • Viral infections such as chickenpox, which causes chickenpox and shingles; enterovirus; and the West Nile Virus.
  • Multiple sclerosis (MS): Transverse myelitis may be the first sign of multiple sclerosis, which destroys the brain and spinal cord myelin. It can also indicate a relapse. If it’s early MS, you likely only have symptoms on one side of your body.
  • Neuromyelitis Optica: This disease causes inflammation and loss of myelin in the nerves of your brain, spinal cord, and optic nerve, which send information to your brain. If you have this type, symptoms will appear on both sides of your body.
  • Vascular disorders: such as arteriovenous malformation, dural arteriovenous fistula, intraspinal cavernous malformations, or disc embolism.


Symptoms can appear within hours or days (your doctor will call this an acute attack). Or you may notice them gradually over a few weeks (this is called subacute). Although the condition is not chronic, it can recur if you have a history of autoimmune disease.

The first symptoms are usually:


  • Pain in the lower back.
  • Sharp pain going down your legs and arms or around your chest and belly.
  • Weakness or paralysis in your legs or arms.
  • Tenderness to touch, to the point where slight pressure on the fingertip causes pain.
  • Numbness or a tingling sensation in the toes, feet, or legs.
  • Muscle spasms.
  • Fever.
  • Loss of appetite
  • Bladder and bowel control problems.

Once they start, symptoms can worsen within hours—most of the time, the peak within ten days.

At that point, about half of people with transverse myelitis lose control of their legs. Most have numbness, tingling, or burning sensation in the back, belly, arms, or legs. Almost everyone loses some bladder control.

How much of your body is affected depends on which part of your spinal cord has the problem. The higher it is, the more problems you will have.


Your doctor will do tests to determine if you have transverse myelitis or other conditions.

  • Magnetic Resonance Tomography (MRI) or Computed Tomography (CT): These tests will create detailed images of yourself. They will show the doctor if something else is affecting your nerves, such as a tumor, slipped disc, or narrowing the canal containing your spinal cord.
  • Spinal tap: For this test, your doctor places a needle between two vertebrae (backbones) to sample the fluid surrounding the brain and spinal cord. If you have more disease-fighting white blood cells or specific proteins than you should, you may have an infection.
  • Blood tests: Your doctor will test your blood for signs of illnesses with similar symptoms, such as lupus, HIV, or another form of myelitis. They will try to determine if transverse myelitis is a sign of a related disease, such as multiple sclerosis.


There is no cure, so your doctor will try to control the disease and relieve your symptoms. She may suggest:

  • Antiviral medicines – You will take these if your doctor thinks a virus is causing your illness.
  • Intravenous Immunoglobulin (IVIG): Your doctor will inject antibodies from healthy donors into your system. They will bind to the antibodies causing problems and remove them from the circulation.
  • Medications for symptoms and complications: You can get drugs to relieve muscle spasms, help control bladder or bowels, ease stiffness, control depression, and help with sexual problems.
  • Over-the-counter pain relievers: Acetaminophen, ibuprofen, and naproxen can help.
  • Plasma exchange therapy: If steroids don’t reduce inflammation, this treatment, also called plasmapheresis, might. The doctor will replace your blood plasma. This could get rid of something causing your immune system to attack your body and prevent it from damaging other organs.
  • Prescription pain relievers: Medications that treat depression can also help relieve nerve pain. You can get medicine for depression or treatment that stops seizures.
  • Respirator: If your symptoms affect your breathing, this machine can help you breathe. It will ensure that your body receives enough oxygen.
  • Steroids – These will relieve inflammation in your spine. You can get pills or put them directly into your veins.

Non-medical treatments for transverse myelitis

Your doctor might also suggest:

  • Rest – You may need to stay in bed while fighting the illness.
  • Ways to keep your muscles strong and your limbs flexible while you recover.
  • Techniques to control your bowels and bladder.
  • Occupational therapy:  This will teach you new ways to do daily tasks, such as cooking, taking a bath, getting dressed, or cleaning the house.
  • Psychotherapy: This will help you manage the mental effects of anxiety, depression, sexual dysfunction, and other emotional or behavioral problems.
  • Vocational therapy: can help you find a job that suits your abilities or work with your employer to make the changes you need.

Are there complications?

Sometimes. The most commons are:

  • Pain: it is both a symptom and a long-lasting complication.
  • Spasticity: This includes stiff, tense, and spasmodic muscles. It is most common on the legs and butt.
  • Sexual problems – Men can have trouble getting an erection. Both genders may have difficulty reaching orgasm.
  • Depression or anxiety: Between the changes that this disease causes to your body, the stress of living with it, pain, and sexual problems, there is a lot to deal with.

About 1,400 people a year get transverse myelitis, and as a result, about 33,000 people have some form of disability.

About a third of people with transverse myelitis get better, and there is not much permanent damage. They can walk normally and have only minor persistent problems.

Another third have trouble walking. They may also have muscle spasms, a less sensitive sense of touch, or difficulty controlling their bladder.

The remaining third can no longer walk and need help with many daily activities.

Doctors do not know why transverse myelitis affects some people more than others. They believe that the faster symptoms appear, the more difficult it will be for you to recover. Early treatment and physical therapy can help.

Diseases associated with transverse myelitis

Several diseases can lead to TM or mimic the presentation of myelitis and should be investigated during acute symptoms. The following is a list of some conditions to consider when evaluating a patient for transverse myelitis:

  • Optic neuromyelitis.
  • Multiple sclerosis.
  • Systemic lupus erythematosus.
  • Sjogren’s syndrome.
  • Sarcoidosis.
  • Infectious diseases.
  • Metabolic disorders and dietary deficiencies.
  • Vascular disease

Rehabilitation and physical therapy for TM

Rehabilitation is an integral part of the recovery and treatment of transverse myelitis (TM) patients.

Patients with transverse myelitis often have permanent weakness and spasticity, limiting the extent of recovery. Patients often report painful stiffness, tightness, or spasms in the buttocks and legs.

What is the Lower Extremity Spasticity Measurement System (SMEEI)?

The SMEEI measures the qualities of the muscles around the ankle, such as muscle tone.

The subject relaxes in the prone position on an adjustable bed with the tested foot mounted on the boot oscillating for approximately five to ten minutes.

The SMEEI oscillates the ankle joint in a sinusoidal motion at a fixed range of motion of five degrees.

A computer measures the muscle’s torsional response (passive stretch and resistance) as the ankle moves in a controlled pattern. To ensure that only the passive (non-voluntary and non-reflex) qualities of the muscle are measured, electromyography (EMG) of the power is monitored and recorded using two surface electrodes (no needles).

What is the GAITRite Portable Gateway System?

The GAITRite portable walkway system has been commercially available for several years as an inexpensive tool used internationally to obtain quantitative gait parameters.

The walkway is a thin roll-up vinyl mat that encapsulates an active grid area of ​​two by 12 to 24 feet.

The laptop pad or mat is laid out on a solid, flat, slope-free surface and connects to a laptop with easy setup and operation.

The minimum test area is five feet wide by 35 feet long, allowing one assistant to walk and five feet of acceleration and deceleration zones with an additional turning area. The input data includes the sex, height, weight, and lengths of the right and left feet (used in normalized calculations).

As the subject travels the runway, the system captures each footprint’s relative arrangement, geometry, and applied pressure as a function of time and derives objective spatial and temporal parameters along with their coefficient of variation.

The data is stored in a database, and a variety of individual and group analyzes and reports are possible, along with progress comparisons to eigenvalues ​​and normals.

The system can evaluate subjects with or without shoes and allows assistive or ambulatory aids, such as crutches, canes, or walkers. Differentiated outcome measures include the following:

  • Step, cycle, swing, and posture time.
  • Speed.
  • Cadence.
  • Long step.
  • Dynamic base, single and double support.
  • Step/limb ratio.
  • Functional ambulation performance score.

These measurements quantify gait speed, stride length, stride length, symmetry, base width, step-by-step consistency, and stride-to-stride variability (one-sided heel strike to the same heel strike). Side).

Long-term transverse myelitis care

Many patients diagnosed with transverse myelitis will need rehabilitative care to prevent secondary complications of immobility and improve their functional abilities.

It is crucial to start therapy early during the recovery course to avoid problems related to inactivity (such as skin breakdown and soft tissue contractures) that result in loss of range of motion.

Spasticity and immobility/paralysis of transverse myelitis

Spasticity means muscle stiffness or spasms, and it is often a complicated problem to manage.

We all need a little muscle tone to control our movement. Still, when muscles become too tight, the result can range from mildly annoying stiffness (particularly upon waking) to painful and uncontrollable spasms.

When the latter occurs, small triggers such as changes in position, temperature, humidity, or the presence of infections can cause this painful spasticity. The key goal is to remain flexible with exercise, a daily stretching routine, and a bracing program with splints, as needed.

These splints are commonly worn on the ankles, wrists, or elbows. Medication options to relieve spasticity can be used in conjunction with these techniques and therapeutic botulinum toxin injections and serial treatment.

The therapeutic goal is to improve the patient’s function in performing specific activities of daily living (i.e., feeding, dressing, bathing, hygiene, mobility) by enhancing the range of available joint mobility, teaching effective compensatory strategies, and relieving pain.

If left untreated, severe spasticity can shorten the affected muscle or a joint called contractures, further affecting mobility, rehabilitation, and independence.

Management of bowel and bladder complications of transverse myelitis

Another critical area of ​​concern is the effective management of bowel and bladder function. Constipation is the most common bowel elimination problem.

A high-fiber diet, adequate and timely fluid intake, medications to regulate bowel movements, and regular exercise contribute significantly to gastrointestinal motility.

Common bladder problems include incontinence, frequency, nocturia (frequent urination at night), hesitancy, and retention. Treating incontinence, frequency, and nocturia is often easier than treating hesitancy and retention, where clean intermittent urinary catheterizations are the building block for success.

Working with a good urologist is essential to avoid possible serious complications.

Depression and other psychological complications of transverse myelitis

During the early recovery period, family education is essential to develop a strategic plan to meet the challenges of independence after returning to the community.

Ongoing issues generally include ordering the appropriate equipment, dealing with re-entry to school, work, and the community, and dealing with the psychological effects of this condition on patients and their families.

While it is an appropriate response to feel saddened by the idea of ​​having to adjust to an altered lifestyle due to residual complications of TM, patients may be unable to overcome this pain in a reasonable amount of time.

When it interferes with your relationships and your life, it needs to be addressed and treated. Many patients fear that depression is reflected as an inadequate ability to cope with their diagnosis.

But it is not a problem of personal strength, and depression is very treatable. Talking to a psychiatrist/psychologist and administering medications can be beneficial, and some studies indicate a synergistic effect of combining the two.

When taking the drug route, the key is not to go off the drug too soon but as soon as you feel better. Depression can rebound and can sometimes become more resistant to treatment.


Fatigue is a lack of mental and physical energy. Fatigue is a prevalent symptom of TM. Fatigue can directly result from TM (primary fatigue) or an indirect result (secondary fatigue).

Examples of secondary fatigue include drug fatigue, depression, stress, poor sleep patterns, infections, or changes in gait. The key is identifying the underlying cause of fatigue – if a patient is not sleeping well due to pain, bladder dysfunction, or depression, it needs to be identified and addressed.

Not getting consistent sleep will make any other aspect of your TM worse. If too much energy is exerted due to changes in gait, physical therapy can help identify better body mechanics that will help conserve energy. When nothing else can be identified as contributing to fatigue, the patient should rest.

Conserving energy to plan and stimulate activities can make these activities more enjoyable rather than stressful. Also, rearranging your home and office can help reduce the amount of wasted energy used so that energy can be saved for activities you enjoy.

Additionally, patients should remember to incorporate exercise routines into their day, which can help build endurance and reduce fatigue in the long run.

Neuropathic pain

Changes in sensitivity often occur in patients with TM. This can happen in the form of lack of sensation or numbness, as well as in the form of painful feelings called neuropathic pain.

This pain is described in many ways, including burning, squeezing, stabbing, or tingling. Having the sensation of pain means that the nerve signal is coming through but inappropriately.

While this may improve over time, there is a long list of medications to treat these symptoms so that patients do not suffer through them.

The same drug doesn’t work for everyone, so the trial and error of finding the proper medication can be frustrating. Alternative therapies such as acupuncture and meditation have also been used, with variable success.

Keep in mind that while the body of a TM patient is constantly working to repair itself, once the central nervous system is damaged, there will always be symptoms associated with such damage.

An example of this occurs clinically when patients re-experience the fluctuations of old symptoms, particularly in infection, stress, heat, the menstrual cycle, or anything that increases core body temperature or drives the body out of its ordinary course.

It is important to note that this is not driven by inflammation and therefore in no way represents the worsening of the disease.