Transverse myelitis:A disease of the spinal cord in which there is demyelination (erosion of the myelin sheath that normally protects nerve fibers). The onset of the disorder is typically sudden. Symptoms include back pain followed by ascending weakness in the legs. There is no cure. Many patients are left with permanent disabilities or paralysis. Transverse myelitis occurs alone and in combination with demyelination of other parts of the nervous system. It may be associated with multiple sclerosis.
Transverse myelitis can cause low back pain, spinal cord dysfunction, muscle spasms, a general feeling of discomfort, headache, loss of appetite, and numbness or tingling in the legs. Almost all patients develop leg weakness. The arms are involved in a minority of cases. (This depends upon the level of spinal cord involvement.) Sensation, pain and temperature sensation are typically diminished below the level of spinal cord involvement. Appreciation of vibration and joint position sense may also be decreased. Bladder and bowel sphincter control is disturbed in the majority of cases. Many patients with transverse myelitis report a tight banding or girdle-like sensation around the trunk and that area may be very sensitive to touch.
Transverse myelitis may be caused by viral infections, spinal cord injuries, immune disorders (including systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis and multiple sclerosis) or insufficient blood flow through the blood vessels in the spinal cord. It may occur as a complication of such disorders as optic neuromyelitis, multiple sclerosis, smallpox, and measles, or as a complication of chickenpox or rabies vaccinations.
The infectious agents associated with transverse myelitis include viruses and bacteria: herpes simplex, herpes zoster, cytomegalovirus, Epstein-Barr virus, enteroviruses (poliomyelitis, Coxsackie virus, echovirus), human T-cell leukemia virus, human immunodeficiency virus (HIV), influenza, measles, and rabies, Mycoplasma pneumoniae, Lyme borreliosis, syphilis, and tuberculosis.
There is no specific treatment for transverse myelitis. The prognosis for complete recovery from transverse myelitis is generally not good. Although recovery usually begins between 2 and 12 weeks after onset and may continue for up to 2 years, most individuals are left with considerable disability. Some individuals may have minor or no deficits, while others may have significant motor, sensory, and sphincter (bowel) deficits or no recovery at all.
