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Description

Transverse myelitis is an inflammatory disorder of the spinal cord leading to loss of muscle power, sensory symptoms (pins and needles) and bladder and bowel dysfunction. It may occur alone or in combination with disease elsewhere in the nervous system. Its causes include demyelination (loss of the fatty tissue around the nerves) and autoimmune mechanisms. Similar symptoms may also occur in spinal cord ischaemia (loss of blood flow).  It is uncommon but not rare and occurs in both adults and children.

Almost all patients develop leg weakness of varying degrees of severity. Fewer will experience arm problems. Pain and temperature appreciation are lessened in most patients. Progression to immobility may be rapid and patients may be immobile within hours or days of the onset of symptoms.

The diagnosis is made using a combination of clinical examination and investigations such as spinal cord MRI (magnetic resonance imaging). In the majority of patients, blood tests and a lumbar puncture will be required before a definite cause can be found.

Transverse myelitis may occur as a complication of such disorders as neuromyelitis optica, multiple sclerosis, smallpox, measles, or chickenpox. In some patients, no cause can be found despite extensive investigation.


Treatment

The treatment depends on the underlying cause and may include the use of intravenous steroids and other drugs to suppress inflammation. Pain and spasm can be treated with medication if they occur.


Prognosis

The prognosis is variable but in the majority of cases there will be some residual impairment in limb function. Recovery usually begins between 2 and 12 weeks after onset and may continue for up to 2 years. Some individuals may have minor or no deficits, while others may have significant motor, sensory, and sphincter (bladder and bowel) deficits. Some individuals show no recovery at all.

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