transverse myelitis

What is Transverse Myelitis?

Transverse myelitis (TM) is a rare neurological condition that occurs when a section of the spinal cord becomes inflamed, leading to various symptoms and complications.

Causes and Symptoms

The exact cause of TM is often unknown, but it can be triggered by viral or bacterial infections, autoimmune disorders, or other underlying medical conditions. The symptoms of TM can vary depending on the severity and location of the inflammation, but common signs include:

• Sudden pain in the back
• Weakness or numbness in the arms or legs
• Sensory problems, such as loss of sensation or tingling
• Dysfunction in bowel or bladder control

Effects on the Spinal Cord

When the spinal cord becomes inflamed, it can damage the myelin sheath, a protective covering around nerve cells. This damage can disrupt communication between the brain and the rest of the body, leading to various symptoms.

Types and Degrees of TM

TM can be classified into different types based on its severity and location:

• Acute TM: Sudden onset of symptoms
• Subacute TM: Gradual development of symptoms over time
• Chronic TM: Persistent symptoms that last for an extended period

The degree of weakness, sensory alterations, or other symptoms can vary from mild to severe.

References

1. [1] This neurological disorder occurs when a section of the spinal cord is inflamed, causing pain, weakness, sensory problems and dysfunction in the body.
2. Transverse myelitis (TM) is a rare neurological condition caused by inflammation of your spinal cord. It often results in sudden symptoms, such as muscle ...
3. Jul 19, 2024 — Transverse myelitis is a neurological disorder caused by inflammation of the spinal cord. When the spinal cord gets inflamed, this inflammation ...
4. Transverse myelitis is a neurological condition. It happens when the spinal cord becomes inflamed. This inflammation can damage myelin, the insulating material ...
5. Aug 7, 2023 — Transverse myelitis (TM) is a rare inflammatory disease-causing injury to the spinal cord with varying degrees of weakness, sensory alterations ...
6. Dec 31, 2023 — Transverse myelitis is a condition caused by inflammation of the spinal cord. As a result, the covering (myelin sheath) around the nerve ...
7. Dec 31, 2023 — Transverse myelitis is a condition caused by inflammation of the spinal cord. As a result, the covering ( myelin sheath) around the nerve cells ...
8. by CG Simone · 2022 · Cited by 27 — Transverse myelitis (TM) is a rare, acquired focal inflammatory disorder often presenting with rapid onset weakness, sensory deficits, and bowel ...
9. Usually, symptoms of acute transverse myelitis begin suddenly with pain in the back and a bandlike tightness around the affected area of the body (such as the ...

Symptoms of Transverse Myelitis

Transverse myelitis can cause a wide range of symptoms, which can vary in severity and duration. Here are some common signs and symptoms:

• Pain: Pain is one of the most common symptoms of transverse myelitis, often starting in the back and radiating down to the legs and arms [1].
• Muscle Weakness: Muscle weakness or paralysis in the legs, and sometimes the arms, can occur due to the interruption of nerve signals [2].
• Mobility Problems: Transverse myelitis can cause mobility problems, making it difficult to walk or move around [3].
• Unusual Sensations: Abnormal sensations such as numbness, tingling, coldness, or burning can be experienced by some people with transverse myelitis [4].
• Respiratory Problems: In severe cases, respiratory problems can occur due to the involvement of the nerves that control breathing [5].
• Constipation and Bowel Symptoms: Transverse myelitis can cause bowel symptoms such as constipation, which can be a result of the interruption of nerve signals controlling bowel function [6].

Other Possible Symptoms

In addition to these common symptoms, some people may experience:

• Muscle spasms
• A general feeling of discomfort
• Loss of appetite
• Sharp pain that moves down the legs and arms or around the chest and belly

It's essential to seek medical attention if you're experiencing any of these symptoms, as prompt treatment can help manage the condition and prevent further complications.

Diagnostic Tests for Transverse Myelitis

Transverse myelitis (TM) is a rare neurological condition that requires prompt and accurate diagnosis to initiate effective treatment. The diagnostic process involves a combination of clinical evaluation, imaging tests, and laboratory studies.

Clinical Evaluation

A doctor will conduct a thorough clinical assessment to gather information about your medical history, symptoms, and recent infections. This includes:

• A detailed review of your medical history to identify any previous conditions that may be related to TM
• Questions about your symptoms, such as muscle weakness, numbness, or paralysis
• A physical examination to assess the extent of neurological impairment

Imaging Tests

Imaging tests are essential in diagnosing TM and ruling out other causes. These include:

• MRI (Magnetic Resonance Imaging): An MRI scan is usually the first imaging test performed to check for inflammation or abnormalities in the spinal cord [1].
• CT Scans: CT scans may be used to rule out other conditions, such as tumors or abscesses, that can cause similar symptoms [5].

Laboratory Studies

Laboratory tests are also crucial in diagnosing TM and identifying underlying causes. These include:

• Blood Tests: Blood tests are often performed to check for infections, inflammation, or autoimmune disorders [4].
• Lumbar Puncture (Spinal Tap): A lumbar puncture may be done to collect cerebrospinal fluid (CSF) for analysis and to rule out other causes of neurological symptoms [5].
• Cerebrospinal Fluid Analysis: CSF analysis is essential in diagnosing TM and ruling out infectious causes [8].

Additional Tests

In some cases, additional tests may be recommended to support the diagnosis of TM. These include:

• Nasopharyngeal Swab for Enteroviral PCR: This test may be performed to rule out enteroviral infections as a cause of TM [7].
• Serum and CSF Studies: Serum and CSF studies may be done to evaluate for paraneoplastic syndromes or other conditions that can mimic TM [7].

References

[1] Context 1: A doctor will diagnose transverse myelitis based on your answers to questions about your signs and symptoms, your medical history, a clinical assessment of...

[2] Context 2: Diagnosing transverse myelitis · Medical history: Your doctor will ask about symptoms and recent history of infection.

[3] Context 3: Transverse myelitis (TM) is a rare neurological condition caused by inflammation of your spinal cord.

[4] Context 5: Imaging tests that may be done are MRI or CT scans. Blood tests and a lumbar puncture (spinal tap) may also be done to rule out other diseases or causes for...

[5] Context 6: Dec 31, 2023 — Tests to diagnose transverse myelitis and to rule out other causes include: MRI of the spinal cord to check for inflammation or abnormalities...

[7] Context 7: by CG Simone · 2022 · Cited by 27 — Neuro-ophthalmologic evaluation · Paraneoplastic evaluation · Infectious serologic and CSF studies · Nasopharyngeal swab for enteroviral PCR · Serum...

[8] Context 8: by J Sellner · 2009 · Cited by 51 — Cerebrospinal fluid diagnostics are the mainstay for ruling out infectious causes, and may support the diagnosis of transverse myelitis by...

Treatment Options for Transverse Myelitis

Transverse myelitis (TM) is a rare condition that affects the spinal cord, causing inflammation and damage to the nerve fibers. The primary goal of treatment is to reduce inflammation, manage symptoms, and prevent further damage.

Medications Used in Treatment

Several medications are used to treat transverse myelitis, including:

• Intravenous steroids: These are usually the first-line treatment for TM, as they can help reduce inflammation and swelling in the spinal cord. [1][2]
• Antiviral medication: In some cases, antiviral medication may be prescribed to treat viral infections that may have triggered the condition. [1]
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as naproxen, can help reduce pain and inflammation. [4]
• Plasma exchange therapy: If steroids do not relieve symptoms, plasma exchange therapy (plasmapheresis) may be tried to remove antibodies that are attacking the spinal cord. [6]

Other Treatment Options

In some cases, other treatment options may be considered, such as:

• Muscle relaxants: These medications can help manage muscle weakness and spasms associated with TM.
• Pain management: Medications like lidocaine (xylocaine) or mexiletine may be used to treat neuropathic pain. [5]

Standard of Care

The standard of care for treating transverse myelitis is intravenous glucocorticoids, which have been shown to be effective in reducing inflammation and improving symptoms. [8]

It's essential to note that treatment plans are tailored to individual patients and may involve a combination of medications and other therapies.

References:

[1] Context 1 [2] Context 2 [4] Context 4 [5] Context 5 [6] Context 6 [8] Context 8

Differential Diagnosis of Transverse Myelitis

Transverse myelitis (TM) is a rare and acquired neuroimmune spinal cord disorder that can present with the rapid onset of weakness, sensory loss, and autonomic dysfunction. The differential diagnosis for TM includes various conditions that cause myelopathy or segmental deficits in the spinal cord.

Conditions to Consider:

• Compressive Myelopathy: This refers to any disease causing compression on the spinal cord, which can lead to similar symptoms as TM (1).
• Guillain-Barré Syndrome: A rare autoimmune disorder that can cause ascending paralysis and is often distinguished from TM by its rapid progression and distinctive electrophysiological features (5).
• Multiple Sclerosis (MS): Although MS is a demyelinating disease, it can sometimes present with longitudinally extensive transverse myelitis (LETM), which may be confused with TM (8).
• Neuromyelitis Optica Spectrum Disorders (NMOSD): This includes conditions such as NMO and recurrent LETM, which are often associated with TM in the differential diagnosis (8, 9).

Other Conditions to Consider:

• Infectious Diseases: Certain infections like viral or bacterial meningitis can cause inflammation of the spinal cord, leading to symptoms similar to TM (7).
• Spinal Cord Tumors: Rarely, tumors within the spinal cord can compress adjacent neural tissue and lead to segmental deficits, which may be mistaken for TM (3).

Key Points:

• The differential diagnosis for TM is broad and includes various conditions that cause myelopathy or segmental deficits in the spinal cord.
• Guillain-Barré syndrome, MS, NMOSD, infectious diseases, and spinal cord tumors are some of the key conditions to consider when differentiating TM from other causes.

References:

(1) CG Simone (2022) (5) [Not provided] (7) Nov 18, 2024 (8) [Not provided] (9) by S Apostolos-Pereira · 2013