Transverse Myelitis - The Causes, Symptoms, Diagnosis, and Medical Management

What Is Transverse Myelitis?

Transverse myelitis is a rare neurological condition characterized by inflammation of a section of the spinal cord. This can cause damage to myelin and the insulating sheath covering the nerve cell fibers (including those in the brain and the spinal cord). Myelin fits around the nerve cells, just like the insulation that covers an electric wire, and allows for quick and efficient transmission of electrical impulses along with them. When myelin is damaged, the nerves also get damaged, making it harder for them to send signals to other body parts. In transverse myelitis, the nerves of both sides of the spinal cord are affected, interrupting the messages the spinal cord sends throughout the body. In severe cases, the condition can lead to major disabilities.

What Are the Causes of Transverse Myelitis?

The underlying cause of transverse myelitis is unknown to the majority of patients. The inflammation of the nerves may be associated with the following conditions:

• Viral infections, such as human immunodeficiency virus (HIV), herpes simplex, Epstein-Barr, cytomegalovirus, herpes zoster, Zika virus, West Nile virus, etc.

• Bacterial infections such as tuberculosis, syphilis, and Lyme disease.

• Immune system disorders such as lupus and Sjogren's syndrome.

• Inflammatory disorders such as sarcoidosis and scleroderma.

• Multiple sclerosis (a condition that destroys the myelin of nerves in the spinal cord and brain).

• Neuromyelitis optica is a condition that causes inflammation and myelin loss in nerves in the spinal cord and optic nerve.

• Spinal cord injuries.

• Vascular disorders disrupt the blood flow through the vessels of the spinal cord, such as disk embolism and arteriovenous malformation.

What Are the Signs and Symptoms of Transverse Myelitis?

One may develop symptoms within a few hours of nerve damage or a few days. The progress of the disease is very quick, and symptoms turn severe in a short period. One experiences the discomforts associated with this condition below the area of nerve damage in the spinal cord. In the majority of cases, both sides of the body are affected. Symptoms include:

• Pain in the Lower Back - It may be a sharp or blunt pain that shoots down the legs or arms or around the chest and abdomen.

• Weakness or paralysis in the legs or arms. One may experience difficulty walking, tend to drag the feet or stumble while walking due to loss of balance.

• Muscle Spasms - Where occasionally, muscles go painfully stiff and tight.

• Troubles with bowel and bladder control, including urinary incontinence, difficulty urinating, a need to urinate more frequently, and constipation.

• Abnormal sensations include pins and needles in the feet, toes, or legs. There may be tingling, coldness, numbness, and a burning feeling over the affected area. One tends to get over-sensitive to changes in temperature and touch.

• Sexual dysfunction involves a lack of orgasms. Men may suffer erectile dysfunction as well.

• The long-term pain and illness may cause depression and anxiety in the majority of the affected individuals.

• Some suffer a loss of appetite, respiratory issues, and fever.

When to See a Doctor in Case of Transverse Myelitis?

It is important to see a doctor if the person experiences symptoms suggestive of transverse myelitis or if they have a known history of conditions associated with transverse myelitis, such as autoimmune disorders, such as neuromyelitis optica or viral infections. Individuals with transverse myelitis need to receive comprehensive medical care and support to address their specific needs and challenges.

How to Diagnose Transverse Myelitis?

The doctor will make the diagnosis based on symptoms, medical history review, assessment of nerve function, and test results. The diagnostic tests that may indicate inflammation of the spinal cord and rule out other disorders include:

• A comprehensive neurological examination is needed to evaluate the muscle tone and reflexes and identify the level of weakness and loss of muscle function in the affected area. One is tested for the level of pain and abnormal sensations as well.

• A magnetic resonance imaging (MRI) scan of the spinal cord helps identify inflammation and other abnormalities. It also rules out other disease conditions with similar symptoms.

• A lumbar puncture or spinal tap procedure is where a needle is used to draw small amounts of cerebrospinal fluid (CSF) that surrounds the spinal cords and the brain. This fluid is tested for signs of inflammation and other abnormalities.

• Blood tests to identify infections and antibodies associated with neuromyelitis optica (damage to the optic nerve and spinal cord) and to rule out other conditions.

What Are the Treatments for Transverse Myelitis?

Since transverse myelitis is an inflammatory condition, the treatment aims to suppress the inflammation and control further demyelination of nerves and subsequent nerve damage. If there is an underlying infection, one needs to eliminate that as well. Reducing the symptoms is also a priority. The doctor may prescribe:

• Intravenous steroids to reduce inflammation in the spinal column.

• Plasma exchange therapy for people who do not respond to intravenous steroids. Here, the liquid part of the blood taken from a healthy person is used to replace the plasma of the affected individual.

• Antibiotic, antiviral, and antifungal medications for people with an infection in the spinal cord.

• Pain medication to lessen the chronic pain and muscle spasm. Over-the-counter pain medications, such as Acetaminophen, and non-steroidal anti-inflammatory drugs, such as Naproxen or Ibuprofen, can help relieve muscle pain. One may also apply heat or cold in the painful areas for relief.

• Medications to treat other complications such as urinary or bowel dysfunction, anxiety, and depression.

• Medications to prevent a recurrent attack.

One may advise on additional treatment modalities to focus on long-term recovery and care. These may include:

• Physical therapy to help improve strength and coordination. One may adopt devices like canes, braces, or wheelchairs for mobility assistance.

• Occupational therapy to learn new ways to perform day-to-day activities such as bathing, cleaning the house.

• Psychotherapy may help with anxiety, depression, sexual dysfunction, and other behavioral issues. One may seek professional counseling to cope with the stress and emotional agony resulting from transverse myelitis.

What Are the Complications of Transverse Myelitis?

The complications of transverse myelitis are as follows:

• Loss of sensation in the limbs and trunk.

• Partial or complete paralysis of the affected area of the spinal cord.

• Bladder and bowel issues, such as urinary retention, difficulty in emptying the bladder and bowel, and urinary or fecal incontinence.

• Chronic nerve pain.

• Weakness and paralysis.

• Difficulty in walking.

• Muscle tightness, muscle spasms, and affecting movement.

• Respiratory problems, such as difficulty breathing and respiratory failure.

• Neurological problems, such as balance problems and coordination difficulties.

• Psychological problems and emotional distress.

Conclusion:

Transverse myelitis affects men and women equally, regardless of the age or race in which they are born. Most people recover within three months from the start of symptoms. Recovery may be complete or with continuing moderate disabilities. A few individuals may suffer permanent disability with transverse myelitis. One should contact the doctor if there are symptoms like sudden sharp pain in the lower back with numbness and weakness in the arms and legs.