Transverse myelitis is a rare neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. This inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. When this occurs, the nervous system’s ability to send and receive messages is disrupted, leading to a variety of symptoms that can develop over hours to several weeks.
Understanding the symptoms of transverse myelitis is crucial for early detection and timely medical intervention. This condition can affect people of any age, gender, or race, though it most commonly appears in individuals between the ages of 10 and 19 years and 30 and 39 years. Recognizing these warning signs can help patients seek appropriate medical care quickly, which is essential for the best possible outcome.
1. Sudden Onset of Back Pain
One of the earliest and most common symptoms of transverse myelitis is sudden, sharp pain in the lower back. This pain often appears without any obvious cause or injury and can be quite severe.
The pain typically:
- Begins at a specific point along the spine
- May radiate around the torso to the chest or abdomen
- Can feel like a tight band wrapping around the body
- Often intensifies over a period of hours or days
This distinctive back pain is caused by inflammation affecting the spinal cord at a particular level. The pain may be accompanied by tenderness when touching the affected area of the spine. Some patients describe it as a burning or stabbing sensation that differs from typical back pain caused by muscle strain or injury.
2. Weakness in Arms or Legs
Muscle weakness is a hallmark symptom of transverse myelitis and can range from mild to severe. This weakness typically affects the legs more commonly than the arms, though the specific pattern depends on which section of the spinal cord is inflamed.
Characteristics of this weakness include:
- Progressive worsening over hours to days
- May start in one limb and spread to others
- Can range from slight heaviness to complete paralysis
- Often affects both sides of the body symmetrically
- May cause difficulty walking, climbing stairs, or lifting objects
In severe cases, patients may find themselves unable to move their legs at all or may experience complete paralysis below the level of the spinal cord inflammation. This weakness occurs because the inflamed spinal cord cannot properly transmit signals from the brain to the muscles. Early recognition of progressive weakness is critical, as it indicates active inflammation that requires immediate medical attention.
3. Abnormal Sensations and Numbness
Sensory disturbances are extremely common in transverse myelitis, affecting up to 80% of patients. These abnormal sensations can manifest in various ways and may be one of the first noticeable symptoms.
Common sensory symptoms include:
- Numbness or decreased sensation in the feet, legs, or other body parts
- Tingling or “pins and needles” sensations
- Burning or prickling feelings on the skin
- Heightened sensitivity to touch, heat, or cold
- Feeling as though the limbs are wrapped in tight clothing or bandages
These sensations typically begin in the feet and gradually move upward, though the pattern can vary. Some patients report feeling as if insects are crawling on their skin, while others experience extreme sensitivity where even light touch causes discomfort. The sensory level—the point on the body below which sensation is altered—helps doctors determine which part of the spinal cord is affected by inflammation.
4. Bladder and Bowel Dysfunction
Transverse myelitis frequently affects the autonomic nervous system’s control over bladder and bowel function. These symptoms can be particularly distressing for patients and significantly impact quality of life.
Bladder and bowel problems may include:
- Urinary urgency or increased frequency
- Difficulty initiating urination or complete urinary retention
- Loss of bladder control or incontinence
- Constipation or inability to control bowel movements
- Feeling of incomplete bladder emptying
These symptoms occur because the spinal cord inflammation disrupts the nerve signals that coordinate bladder and bowel function. Some patients initially notice that they need to urinate more frequently or urgently, while others may find they cannot urinate at all. Bowel problems may begin with constipation and progress to loss of bowel control. These symptoms require medical management to prevent complications such as urinary tract infections or kidney damage.
5. Muscle Spasms and Stiffness
Many individuals with transverse myelitis experience involuntary muscle contractions, spasms, and increased muscle tone, a condition known as spasticity. These symptoms can develop during the acute phase of the illness or may emerge later as a chronic issue.
Muscle-related symptoms include:
- Sudden, involuntary jerking or twitching of muscles
- Persistent muscle tightness or rigidity
- Painful cramping, especially in the legs
- Difficulty relaxing muscles voluntarily
- Increased muscle tone that makes movement difficult
Spasticity occurs when the inflammation damages the nerve pathways that normally regulate muscle tone. Without proper nerve signals, muscles may contract involuntarily or remain in a state of tension. These spasms can be painful and may interfere with sleep, mobility, and daily activities. The spasms may be triggered by changes in position, temperature, or even emotions. While spasticity can be challenging to manage, various therapies and management strategies can help reduce its impact.
6. Breathing Difficulties
When transverse myelitis affects the upper portions of the spinal cord, particularly the cervical (neck) region, it can interfere with the nerves that control breathing muscles. This is a serious symptom that requires immediate medical attention.
Respiratory symptoms may include:
- Shortness of breath or feeling unable to take a deep breath
- Rapid, shallow breathing
- Difficulty coughing effectively
- Feeling of chest tightness or heaviness
- Fatigue from the effort of breathing
The diaphragm and intercostal muscles (between the ribs) are essential for breathing, and these muscles are controlled by nerves from the upper spinal cord. When inflammation affects these nerve pathways, the muscles may not function properly, making it difficult to breathe normally. In severe cases, patients may require mechanical ventilation to support breathing until the inflammation subsides. Any breathing difficulties in someone with suspected transverse myelitis should be treated as a medical emergency.
7. Extreme Fatigue and General Malaise
Overwhelming fatigue is a frequently overlooked but significant symptom of transverse myelitis. This exhaustion goes beyond normal tiredness and can be debilitating, affecting every aspect of daily life.
Characteristics of this fatigue include:
- Profound tiredness that doesn’t improve with rest
- Feeling of physical and mental exhaustion
- Decreased energy for even simple activities
- Need for frequent rest periods throughout the day
- General feeling of being unwell or “flu-like” symptoms
This fatigue may be accompanied by other general symptoms such as fever, headache, or a general feeling of illness. Some patients report experiencing flu-like symptoms in the days or weeks before other more specific neurological symptoms appear. The extreme tiredness results from multiple factors: the body’s immune response to inflammation, the physical effort required to compensate for muscle weakness, and the overall stress that the condition places on the body. This fatigue can persist even after other symptoms begin to improve and may require long-term management strategies.
What Causes Transverse Myelitis?
The exact cause of transverse myelitis is not always identified, but several factors are known to trigger the condition. Understanding these potential causes can help with diagnosis and management.
Viral and Bacterial Infections: Many cases of transverse myelitis develop following an infection. Common infectious triggers include:
- Herpes viruses (including those causing chickenpox and shingles)
- Enteroviruses
- West Nile virus
- Cytomegalovirus
- Epstein-Barr virus
- Influenza virus
- Bacterial infections such as Lyme disease, syphilis, or tuberculosis
Immune System Disorders: Transverse myelitis can be associated with autoimmune conditions where the body’s immune system mistakenly attacks its own tissues:
- Multiple sclerosis
- Neuromyelitis optica spectrum disorder
- Systemic lupus erythematosus
- Sjögren’s syndrome
- Sarcoidosis
Post-Vaccination Reactions: Rarely, transverse myelitis may develop following certain vaccinations, though this is extremely uncommon and the benefits of vaccination far outweigh this small risk.
Inflammatory Disorders: Conditions causing widespread inflammation in the body may trigger transverse myelitis as a complication.
Idiopathic Cases: In many instances, despite thorough investigation, no specific cause is identified. These cases are termed “idiopathic transverse myelitis.”
Frequently Asked Questions
How quickly do transverse myelitis symptoms develop?
Symptoms typically develop over several hours to several days, though some patients experience a more gradual onset over a few weeks. The most rapid progression usually occurs within the first 24 to 48 hours after symptoms begin.
Is transverse myelitis contagious?
No, transverse myelitis itself is not contagious. However, if it is triggered by an infection, that underlying infection might be contagious. The inflammatory condition itself cannot be spread from person to person.
Can transverse myelitis symptoms come and go?
Typically, transverse myelitis is a monophasic illness, meaning it occurs once and does not recur. However, if it is part of another condition like multiple sclerosis, symptoms may appear, improve, and then return over time.
Who is most at risk for developing transverse myelitis?
Transverse myelitis can affect anyone, but it appears most commonly in two age groups: children and adolescents (10-19 years) and adults (30-39 years). There is no significant gender or racial predisposition.
How is transverse myelitis diagnosed?
Diagnosis involves a combination of neurological examination, medical history, MRI imaging of the spine, lumbar puncture (spinal tap) to analyze cerebrospinal fluid, and blood tests to rule out other conditions or identify underlying causes.
What is the prognosis for someone with transverse myelitis?
Recovery varies significantly among individuals. About one-third of patients recover with little or no residual symptoms, one-third experience moderate disability, and one-third have significant permanent disability. Early treatment generally improves outcomes.
Can stress trigger transverse myelitis?
There is no evidence that stress directly causes transverse myelitis. However, the condition may develop following physical stressors such as infections or immune system activation.
Should I see a doctor immediately if I suspect transverse myelitis?
Yes, absolutely. Transverse myelitis is a medical emergency. If you experience sudden back pain accompanied by weakness, numbness, or bladder/bowel problems, seek immediate medical attention. Early diagnosis and treatment can significantly impact recovery and outcomes.
References:
- Mayo Clinic – Transverse Myelitis
- National Institute of Neurological Disorders and Stroke – Transverse Myelitis
- National Organization for Rare Disorders – Transverse Myelitis
- Johns Hopkins Medicine – Transverse Myelitis
- NHS – Transverse Myelitis
The information on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions related to your health.
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