Acute Transverse Myelitis

Overview

Acute transverse myelitis is inflammation of the spinal cord that affects a segment, or band, across its width. The term "transverse" refers to this band-like pattern of inflammation, which interrupts the nerve signals traveling up and down the spinal cord. As a result, the parts of the body below the affected level can lose strength, sensation, and normal control.

Symptoms usually develop quickly, over hours to a few days, and can range from mild to severe. Acute transverse myelitis is a medical emergency because early treatment can limit nerve damage and improve recovery. With prompt care, some people recover fully or partly, while others have lasting symptoms, so quick evaluation is essential.

Symptoms

Symptoms depend on which part of the spinal cord is inflamed but typically affect both sides of the body below that level. They often begin suddenly and worsen over hours to days:

• Weakness in the legs, and sometimes the arms
• Abnormal sensations such as numbness, tingling, burning, or a tight band-like feeling around the trunk
• Pain in the back, neck, or limbs
• Bladder and bowel problems, such as urgency, retention, or incontinence

Seek emergency care immediately for new weakness, numbness spreading up the body, or loss of bladder or bowel control, as rapid treatment can make a major difference.

Causes

Acute transverse myelitis results from inflammation of the spinal cord, often triggered by an immune response. Possible causes and associations include:

• Infections: Some viral, bacterial, and other infections can trigger spinal cord inflammation, sometimes after the infection itself has passed.
• Immune and inflammatory diseases: Conditions in which the immune system attacks the nervous system, including some that also affect the brain or optic nerves.
• Post-infectious or post-vaccination immune reactions: In some cases inflammation follows an immune trigger.

In many people, no specific cause is found (idiopathic transverse myelitis). Identifying any underlying condition is important because it may guide treatment and follow-up.

Risk Factors

• A recent infection or illness
• An underlying autoimmune or inflammatory disorder
• Conditions affecting the central nervous system, such as those that can cause optic nerve inflammation
• Transverse myelitis can affect people of any age, including children

Diagnosis

Because symptoms can resemble other spinal cord problems, prompt testing is needed:

• MRI of the spine and brain: Imaging shows inflammation in the spinal cord and helps rule out compression and other causes.
• Lumbar puncture (spinal tap): Examining the fluid around the spinal cord can reveal signs of inflammation or infection.
• Blood tests: Look for infections and autoimmune conditions that may be responsible.

Treatment

Treatment aims to reduce inflammation, treat any underlying cause, and support recovery:

• Corticosteroids: High-dose anti-inflammatory steroids, often given by vein, are commonly used early to calm the inflammation.
• Other immune treatments: Procedures or medications that remove or modify harmful immune activity may be used if steroids are not enough.
• Treating the underlying cause: For example, treating an infection or managing an autoimmune disease.
• Rehabilitation: Physical and occupational therapy, bladder care, and pain management help recovery and daily function.

Recovery varies; some people improve substantially over weeks to months, while others have lasting symptoms.

Prevention

• There is no sure way to prevent acute transverse myelitis
• Managing an underlying autoimmune condition with your doctor may lower the risk of recurrence
• Seeking care promptly for new neurological symptoms supports the best possible outcome
• Attending follow-up to monitor for any related conditions

When to See a Doctor

Seek emergency care immediately if you develop:

• Sudden weakness or numbness in the legs or arms
• Numbness or a tight band-like sensation spreading up the body
• Loss of bladder or bowel control, or being unable to urinate
• Difficulty walking that comes on over hours to days

These symptoms require urgent evaluation, because early treatment of spinal cord inflammation can limit damage and improve recovery.

Related Topics

Frequently Asked Questions

References

1. National Institute of Neurological Disorders and Stroke (NINDS). Transverse Myelitis.
2. Mayo Clinic. Transverse myelitis — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Transverse myelitis.
4. National Multiple Sclerosis Society.