Transverse myelitis

Transverse myelitis (TM) is a neurological condition characterized by inflammation of one segment of the spinal cord, typically affecting both sides of the cord but sometimes asymmetrically. This inflammation damages myelin, the protective covering of nerve fibers, thereby disrupting communication between the spinal cord and the rest of the body.

As a result, TM can cause pain, muscle weakness, sensory changes, paralysis, and bladder or bowel dysfunction. Symptoms often develop rapidly and can be severe. While many individuals experience partial or substantial recovery over time, some are left with lasting neurological impairments, particularly following severe initial attacks.

TM is considered an immune-mediated inflammatory disorder of the spinal cord. In some cases, it occurs as part of a confirmed autoimmune disease (such as multiple sclerosis or neuromyelitis optica), while in other cases it appears to be post-infectious or idiopathic, with no clearly identified cause.

Recovery can take months to years. Even in people who experience only a single episode, long-term complications may occur, including chronic pain, muscle stiffness or spasms, partial or complete paralysis, sexual dysfunction, and secondary mental health challenges such as depression or anxiety.

Symptoms of transverse myelitis may develop rapidly over hours to days or progress more gradually over several weeks. Common symptoms include shooting or aching pain in the lower back or radiating into the arms, legs, chest, or abdomen; numbness, tingling, burning, or loss of sensation; increased sensitivity to touch or temperature; weakness or paralysis in the arms or legs; bladder dysfunction such as urinary urgency, retention, or incontinence; bowel dysfunction including constipation; and sexual dysfunction.

Transverse myelitis may occur in association with other autoimmune or inflammatory conditions, including multiple sclerosis, neuromyelitis optica spectrum disorder (Devic’s disease), Sjögren’s syndrome, systemic lupus erythematosus, mixed connective tissue disease, antiphospholipid syndrome, Behçet’s disease, rheumatoid arthritis, ankylosing spondylitis, and sarcoidosis.

In some cases, transverse myelitis develops following an infection, although neurological symptoms often begin after the acute infection has resolved. Viral infections associated with TM include herpesviruses (including varicella-zoster), cytomegalovirus, Epstein–Barr virus, HIV, enteroviruses (such as poliovirus and coxsackievirus), West Nile virus, echovirus, Zika virus, influenza, hepatitis B, and measles, mumps, or rubella.

Bacterial infections reported as potential triggers include Lyme disease, syphilis, tuberculosis, and certain respiratory or gastrointestinal infections. Less commonly, fungal infections have been implicated.

In rare cases, transverse myelitis has been reported following vaccination. However, the available evidence does not establish a causal relationship, and these events are considered uncommon relative to the risks associated with the infections that vaccines are designed to prevent.

Transverse myelitis can occur at any age, with cases reported in both children and adults. Some studies suggest a slightly higher risk among females, though TM affects individuals of all sexes.

• Transverse myelitis in children and adults (2023)
• Comparison of acute flaccid myelitis and transverse myelitis in children and evaluation of diagnostic criteria (2023)
• Exploring the risk factors and prognosis of transverse myelitis in systemic lupus erythematosus (2022)
• A case study of longitudinally extensive transverse myelitis following vaccination against Covid-19 (2021)
• Acute flaccid myelitis: long-term outcomes recorded in the CAPTURE study compared with pediatric transverse myelitis (2021)