Section 6. Brain, Spinal Cord, and Nerve Disorders

Chapter 93. Spinal Cord Disorders

Topics: Introduction | Accident-Related Injuries | Spinal Cord Compression | Cervical Spondylosis | Spinal Hematoma | Syrinx | Hereditary Spastic Paraparesis | Acute Transverse Myelitis | Blockage of the Blood Supply | Subacute Combined Degeneration of the Spinal Cord

Acute Transverse Myelitis

Acute transverse myelitis is a localized inflammation of the spinal cord that blocks transmission of nerve impulses up and down the spinal cord.

The cause of acute transverse myelitis is unknown, but it may result from an autoimmune reaction (in which the immune system misinterprets the body's tissues as foreign and attacks them). About 30 to 40% of people with this disorder develop it after an otherwise minor viral infection. People who have multiple sclerosis or certain bacterial infections (such as Lyme disease, syphilis, or tuberculosis) and those who inject heroin or amphetamine intravenously are at increased risk of developing acute transverse myelitis.

Symptoms

Acute transverse myelitis usually begins with sudden back pain, followed by numbness and muscle weakness that start in the feet and move upward. Commonly, a beltlike tightness is felt around the chest or stomach at the level affected by the myelitis. People may have difficulty urinating. These effects may worsen over several hours or several days and may become severe, resulting in paralysis, loss of sensation, and loss of bladder and bowel control. The degree of disability depends on the location (level) of the inflammation in the spinal cord and the severity of the inflammation.

Diagnosis and Treatment

Acute transverse myelitis must be distinguished from other disorders that cause similar symptoms, such as Guillain-Barré syndrome, spinal cord compression, or blockage of the blood supply to the spinal cord. To exclude other possible diagnoses, doctors may perform a spinal tap (lumbar puncture (see Section 6, Chapter 77)). In people with acute transverse myelitis, the number of certain types of white blood cells and the protein level in the spinal fluid are usually increased, but these findings are not conclusive. Magnetic resonance imaging (MRI) can detect swelling of the spinal cord. Blood tests are rarely helpful.

High doses of corticosteroids such as prednisone are often given to suppress the immune system, which is thought to be involved in acute transverse myelitis. However, the benefit of these drugs has been shown only in people who also have multiple sclerosis.

Most people with acute transverse myelitis recover at least partially, and many recover completely. However, many others continue to have weakness and numbness. Generally, the more quickly symptoms develop, the better the chance of recovery.