Transverse myelitis is a rare neurological disorder that affects the spinal cord, causing inflammation and damage to the nerve fibers. It can lead to symptoms such as weakness, numbness, or tingling in the arms or legs, loss of bladder or bowel control, and pain. The severity of the symptoms can vary depending on the extent of the damage to the spinal cord.

Transverse myelitis is typically caused by an autoimmune response, in which the body's immune system attacks its own tissues, including the spinal cord. It can also be caused by viral or bacterial infections, or as a complication of other medical conditions such as multiple sclerosis or lupus.

Diagnosis of transverse myelitis involves a physical exam, imaging tests such as an MRI of the spine, and other tests to rule out other possible causes of the symptoms. Treatment may include medications to suppress the immune system and reduce inflammation, as well as physical therapy to improve mobility and strengthen muscles.

While some people with transverse myelitis may experience a complete recovery, others may have long-term neurological symptoms and disability. Prompt diagnosis and treatment are important to minimize the damage to the spinal cord and improve the chances of a good outcome.

The exact reason for transverse myelitis is not known. Sometimes there is no known cause.

Viral, bacterial and fungal infections affecting the spinal cord may cause transverse myelitis. In most cases, the inflammatory disorder appears after recovery from the infection.

Viruses associated with transverse myelitis are:

• Herpes viruses, including the one that causes shingles and chickenpox (zoster)
• Cytomegalovirus
• Epstein-Barr
• HIV
• Enteroviruses such as poliovirus and coxsackievirus
• West Nile
• Echovirus
• Zika
• Influenza
• Hepatitis B
• Mumps, measles and rubella

Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.

Bacterial infections that are associated with transverse myelitis include:

• Lyme disease
• Syphilis
• Tuberculosis
• Actinomyces
• Pertussis
• Tetanus
• Diphtheria

Bacterial skin infections, gastroenteritis and certain types of bacterial pneumonia also may cause transverse myelitis.

Rarely, parasites and fungal infections may infect the spinal cord.

There are a number of inflammatory conditions that appear to cause the disorder:

• Multiple sclerosis is a disorder in which the immune system destroys myelin surrounding nerves in your spinal cord and brain. Transverse myelitis can be the first sign of multiple sclerosis or represent a relapse. Transverse myelitis as a sign of multiple sclerosis usually causes symptoms on only one side of your body.
• Neuromyelitis optica (Devic's disease) is a condition that causes inflammation and myelin loss around the spinal cord and the nerve in your eye that transmits information to your brain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body.
• In addition to transverse myelitis, you may experience symptoms of damage to myelin of the optic nerve, including pain in the eye with movement and temporary vision loss. This can happen with or separately from transverse myelitis symptoms. However, some people with neuromyelitis optica don't experience eye-related problems and might have only recurrent episodes of transverse myelitis.
• Autoimmune disorders probably contribute to transverse myelitis in some people. These disorders include lupus, which can affect multiple body systems, and Sjogren's syndrome, which causes severe dryness of the mouth and eyes.
• Transverse myelitis associated with an autoimmune disorder may be a warning sign of neuromyelitis optica. Neuromyelitis optica occurs more frequently in people with other autoimmune diseases.
• Vaccinations for infectious diseases have occasionally been associated as a possible trigger. However, at this time the association is not strong enough to warrant limiting any vaccine.
• Sarcoidosis is a condition that leads to inflammation in many areas of the body, including the spinal cord and optic nerve. It may mimic neuromyelitis optica, but typically sarcoidosis symptoms develop more slowly. The cause of sarcoidosis isn't understood.

Several therapies target 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. Steroids help reduce the inflammation in your spinal column.
• Plasma exchange therapy. People who don't respond to intravenous steroids may need plasma exchange therapy. This involves removing the straw-colored fluid in which blood cells are suspended (plasma) and replacing the plasma with special fluids.
• It's not certain how this therapy helps people with transverse myelitis, but it may be 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.
• Pain medication. Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve.)
• Nerve pain may be treated with antidepressant drugs, such as sertraline (Zoloft), and anticonvulsant drugs, such as gabapentin (Neurontin, Gralise) or pregabalin (Lyrica).
• Medications to treat other complications. Your doctor may prescribe other medications as needed to treat problems such as muscle spasticity, urinary or bowel dysfunction, depression, or other complications associated with transverse myelitis.
• Medications to prevent recurrent attacks of transverse myelitis. People who have antibodies associated with neuromyelitis optica need ongoing medications, such as corticosteroids and/or immunosuppressants, to reduce their chances of more transverse myelitis attacks or developing optic neuritis.

Other therapies

Additional therapies focus on long-term recovery and care:

• Physical therapy. This helps improve strength and coordination. Your physical therapist can teach you how to use any needed assistive devices, such as a wheelchair, canes or braces.
• Occupational therapy. This helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
• Psychotherapy. A psychotherapist can use talk therapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioral issues from coping with transverse myelitis.

Prognosis

Although most people with transverse myelitis have at least partial recovery, it may take a year or more. Most recovery occurs within the first three months after the episode and strongly depends on the cause of transverse myelitis.

About one-third of people with transverse myelitis fall into one of three categories after an attack:

• No or slight disability. These people experience only minimal lingering symptoms.
• Moderate disability. These people are mobile, but may have difficulty walking, numbness or tingling, and bladder and bowel problems.
• Severe disability. Some people may permanently need a wheelchair and require ongoing assistance with daily care and activities.

It's difficult to predict the course of transverse myelitis. The prognosis and responsiveness to treatment is strongly determined by the cause of the syndrome and to some extent by how early treatment is administered. Generally, people who experience a rapid onset of severe signs and symptoms and those who have a positive test for a particular antibody have a worse prognosis than do those with a relatively slower onset, milder symptoms and negative antibody test.