From the Guidelines
Transverse myelitis manifests as inflammation across a segment of the spinal cord, causing a range of neurological symptoms that develop over hours to days, and is often associated with infections such as HIV, cytomegalovirus, Epstein–Barr virus, varicella zoster virus, syphilis, tuberculosis, or diphtheria infection, as reported in a study published in Nature Reviews Neurology in 2021 1.
Clinical Presentation
The clinical presentation of transverse myelitis varies depending on which spinal cord segment is affected, with symptoms including:
- Weakness or paralysis in the legs and sometimes arms
- Sensory disturbances such as numbness, tingling, or burning sensations below the level of spinal cord involvement
- Autonomic dysfunction including bladder and bowel problems
- Pain, often described as a band-like sensation around the trunk
- Back pain at the level of inflammation
Diagnosis and Prognosis
Diagnosis requires MRI showing spinal cord inflammation, cerebrospinal fluid analysis revealing inflammatory markers, and exclusion of compressive causes, as recommended in the ACR Appropriateness Criteria® Myelopathy: 2021 update 1. The severity of initial symptoms and the rapidity of onset often correlate with prognosis, with approximately one-third of patients recovering well, one-third having moderate disability, and one-third experiencing severe permanent disabilities.
Imaging and Evaluation
MRI is useful for evaluation of the spinal cord when investigating the etiology of acute myelopathy, with superior soft-tissue resolution and multiplanar capability, making it ideal for evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures 1. Diffusion-weighted imaging can show signal alteration in the spinal cord earlier after patient symptom onset compared with T2-weighted images, and should be included anytime there is concern for spinal cord ischemia 1.
From the Research
Manifestation of Transverse Myelitis
The manifestation of transverse myelitis (TM) can vary, but it is generally characterized by:
- Weakness
- Sensory alterations
- Autonomic dysfunction 2
- Bowel and bladder problems
- Temperature dysregulation
- Hypertension 3
Clinical Presentation
Patients with TM can present with a range of symptoms, including:
- Sensory alteration
- Weakness
- Autonomic dysfunction 3
- The symptoms typically develop over hours or days and then worsen over a matter of days to weeks 3
Diagnosis and Management
The diagnosis and management of TM depend on the underlying etiology, which can include:
- Immune-mediated processes
- Infectious causes
- Autoimmune disorders such as multiple sclerosis, aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) 4
- The management of TM may involve acute treatment, preventive treatment, and supportive management, depending on the specific etiology 4
Treatment Options
Treatment options for TM may include: