From the Guidelines
Transverse myelitis is primarily caused by inflammation of the spinal cord due to infections, autoimmune disorders, or vascular disorders, as evidenced by recent studies 1. The main causes of transverse myelitis include:
- Infections such as HIV, cytomegalovirus, Epstein–Barr virus, varicella zoster virus, syphilis, tuberculosis, or diphtheria infection 1
- Autoimmune disorders like multiple sclerosis, neuromyelitis optica, and systemic lupus erythematosus
- Vascular disorders that disrupt blood flow to the spinal cord
- Post-infectious or post-vaccination immune reactions The inflammation disrupts normal nerve signaling across the spinal cord, leading to symptoms like weakness, sensory changes, pain, and bowel/bladder dysfunction. Key diagnostic evaluations include contrast-enhanced imaging, particularly MRI, to assess the spinal cord and identify potential causes such as metabolic disorders, chronic infections, or vascular malformations 1. In some cases, the condition may be idiopathic, meaning no specific cause can be identified. Early diagnosis and treatment with anti-inflammatory medications, particularly corticosteroids, are crucial to minimize permanent neurological damage. Recent recommendations also highlight the importance of testing for myelin oligodendrocyte glycoprotein (MOG) antibodies in patients presenting with acute CNS demyelination, especially those with longitudinally extensive transverse myelitis or optic neuritis 1.
From the Research
Causes of Transversus Myelitis
- Transversus myelitis is a rare neurological disorder of the spinal cord caused by inflammation, which can have devastating neurologic effects 2
- The condition can be caused by various etiologies, including autoimmune, inflammatory, and infectious factors 2
- Herpes simplex virus (HSV) infection, particularly HSV type 1, has been identified as a potential cause of transverse myelitis 3, 4
- Other potential causes of transverse myelitis include multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) 5, 6
- Cardiovascular conditions, such as hypertension, may also be associated with transverse myelitis, particularly in patients with MS 6
Infectious Causes
- HSV-1 infection has been linked to the development of transverse myelitis, with positive PCR testing on cerebrospinal fluid (CSF) indicating the presence of the virus 3
- The seroprevalence of IgG against HSV-1 has been shown to be increased in pediatric patients with MS/CIS, suggesting a potential link between prior HSV-1 infection and the onset of pediatric MS/CIS 4
Autoimmune Causes
- Multiple sclerosis (MS) is a demyelinating disease that can present with symptoms similar to transverse myelitis, including motor and sensory dysfunction 5
- The clinical and laboratory features of MS can be distinguished from those of transverse myelitis, with MS patients often exhibiting asymmetric motor and sensory symptoms 5