Transverse myelitis is an inflammation of the spinal cord that happens when the coverings that protect nerve cells in a certain area of your spinal cord are damaged. This makes it hard for those nerves to send signals to other parts of your body. That can cause pain, weakness, or paralysis.
About 1,400 people a year get transverse myelitis, and about 33,000 people have some sort of disability as a result of it. It's often the first sign of the chronic nerve disorder multiple sclerosis, or MS.
The nerve fibers in cells that take messages between your brain and your body are protected by a fatty tissue called myelin. Myelin is a sleeve around those fibers, like the insulation that covers an electrical wire.
When that insulation is damaged, the nerves underneath can be hurt, too. This can happen when your body tries to fight off a disease. It can also happen when your immune system attacks healthy cells for some reason. The nerves can get scarred, and that makes it harder for them to deliver messages.
When this happens to the nerves on both sides of part of your spinal cord, it's known as transverse myelitis.
For about 60% of people with transverse myelitis, doctors aren't sure of the cause. In other cases, transverse myelitis may be linked to other conditions. For instance, there appears to be a connection between transverse myelitis and autoimmune conditions, such as:
Other problems that may lead to transverse myelitis are:
- Viral, bacterial, or fungal infections
- Certain vascular disorders
The early symptoms of transverse myelitis usually include:
- Pain in your lower back
- Sharp pain that moves down your legs and arms or around your chest and belly
- Weakness or paralysis in your legs or arms
- Sensitivity to touch to the point where slight fingertip pressure causes pain
- Numbness or a pins-and-needles feeling in your toes, feet, or legs
- Problems controlling your bladder or bowels
- Muscle spasms
- Loss of appetite
Once they start, the symptoms can get worse within hours. But in most cases, the symptoms hit their peak within 10 days. At that point, about half the people who get transverse myelitis lose control of their legs. Most have some numbness, tingling, or a burning sensation in their back, belly, arms, or legs. Almost all lose 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 your body will be affected.
If you have symptoms, your doctor will run some tests to figure out if you have transverse myelitis or some other condition.
- Magnetic resonance imaging (MRI) or computerized tomography (CT) scan: An MRI uses powerful magnets or radio waves to make a detailed image, while a CT scan puts several X-rays together for a more complete picture than one X-ray alone. These will show whether there's something like a tumor or a slipped disk in your backbone, or whether the channel that holds the spinal cord has gotten narrow and is affecting the nerves.
- Spinal tap: Your doctor puts a needle in between two vertebrae (bones in your back) to take a sample of the fluid that surrounds your brain and spinal cord. If that fluid has more disease-fighting white blood cells or some related proteins than it should, you might have some kind of infection.
- Bloodwork: Your doctor will take a sample of your blood to look for signs of other illnesses that cause similar symptoms, like lupus, HIV, or another form of myelitis. And he'll try to find out if transverse myelitis is a sign of a related illness, like MS.
There's no cure for transverse myelitis. So your doctor will try to manage the disease and ease your symptoms:
- She may recommend that you stay in bed while you fight the illness.
- You might get steroids to help with any inflammation in your spine. You might take pills or have it put directly into your veins.
- If your doctor thinks a virus is causing your illness, she might give you antiviral drugs.
- Over-the-counter medicines like acetaminophen, ibuprofen, and naproxen can help with the pain.
- You might get other drugs to relieve muscle spasms or help control your bladder or bowels.
- Physical therapy can help keep your muscles strong and your limbs flexible while you recover.
- If an immune system disorder is causing your condition, you might be given drugs that slow down your body's natural defense system. Or your doctor might try to replace your blood plasma (the liquid part of your blood that holds the blood cells). This might get rid of something in it that's causing your immune system to attack your own body and keep it from damaging other organs.
- If your symptoms affect your breathing, you might need to be put on a respirator (a machine that helps you breathe) to make sure your body gets enough oxygen.
About a third of people with transverse myelitis get better and don't have much permanent damage. They can walk normally and have only small lingering issues.
The remaining third are no longer able to walk and need help with many everyday activities.
It's not clear why transverse myelitis affects some people more than others, but researchers say the faster your symptoms show up, the harder it may be for you to recover. Early treatment and physical therapy may help.