What are the causes of Transverse Myelitis (inflammation of the spinal cord)?

From the Guidelines

Transverse myelitis is primarily caused by inflammation of the spinal cord, which can result from various factors including autoimmune disorders, infections, post-infectious or post-vaccination immune responses, vascular disorders, and certain medications or treatments. According to the American College of Radiology Appropriateness Criteria 1, myelopathy, which includes transverse myelitis, can be the result of primary intrinsic disorders of the spinal cord or from secondary conditions that result in extrinsic compression of the spinal cord. The causes of myelopathy, and by extension transverse myelitis, may be multiple, but the acuity of presentation and symptom onset frame a practical approach to the differential diagnosis. Some of the key causes of transverse myelitis include:

• Autoimmune disorders like multiple sclerosis, neuromyelitis optica, or systemic lupus erythematosus
• Infections such as viral infections (herpes viruses, enteroviruses, HIV), bacterial infections (tuberculosis, syphilis), fungal infections, and parasitic infections
• Post-infectious or post-vaccination immune responses
• Vascular disorders that disrupt blood flow to the spinal cord
• Certain medications or treatments like some antibiotics or chemotherapy agents It's worth noting that in many cases (15-30%), no specific cause can be identified, and these are classified as idiopathic transverse myelitis 1. The inflammation disrupts normal nerve signaling across the spinal cord, leading to symptoms like weakness, sensory changes, and bowel/bladder dysfunction. Imaging, particularly MRI, plays a crucial role in the evaluation of myelopathy, including transverse myelitis, as it is the preferred modality for assessing the spinal cord 1.

From the Research

Causes of Transverse Myelitis

• Transverse myelitis (TM) is an inflammatory process involving restricted areas of the spinal cord 2
• The condition can be caused by various factors, including autoimmune diseases such as systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS) 2
• The presence of antiphospholipid antibodies might play a role in the etiology of TM 2
• Other causes of TM include immune-mediated processes, infections, and compressive etiologies 3, 4
• The condition can also be associated with multiple sclerosis, aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and spinal cord sarcoidosis 4

Autoimmune Causes

• Autoimmune diseases are a common cause of TM, with SLE and SS being the most commonly associated conditions 2
• Other autoimmune conditions, such as multiple sclerosis and AQP4+NMOSD, can also cause TM 4
• The identification of autoantibodies directed against specific central nervous system targets has led to major improvements in our understanding of the mechanisms underlying inflammation in myelitis 5

Infectious Causes

• Infectious causes of TM include viral and bacterial infections 3, 4
• The condition can also be caused by other infectious agents, such as parasites and fungi 4

Other Causes

• Compressive etiologies, such as spinal cord compression, can also cause TM 3
• Other causes of TM include vascular disorders, such as spinal cord infarction, and traumatic injuries 4