Transverse myelitis: Symptoms, causes, diagnosis, treatments

2021-09-07 03:43 PM

The disrupted nerve transmission of transverse myelitis can cause pain or other sensory problems, muscle weakness or paralysis, or bowel and bladder dysfunction.

Transverse myelitis: Symptoms, causes, diagnosis, treatments 

Transverse myelitis: Symptoms, causes, diagnosis, treatments 

Define

Transverse myelitis is inflammation of the spinal cord, the target of which is usually the covering of nerve fibers (myelin). Transverse myelitis can cause injury to the spine, causing decreased or absent sensation after the injury.

The disrupted nerve transmission of transverse myelitis can cause pain or other sensory problems, muscle weakness or paralysis, or bowel and bladder dysfunction.

Several factors can cause transverse myelitis, including infections that don't directly affect the spine and immune system disorders that attack the body's own tissues. It can also occur as myelin disorders, such as multiple sclerosis.

Treatment of transverse myelitis includes anti-inflammatory drugs, medications to manage symptoms, and rehabilitation therapy. Most people with transverse myelitis recover at least partially.

Symptoms

Signs and symptoms of transverse myelitis usually develop rapidly over a few hours and worsen over a few days. Less commonly, signs and symptoms develop gradually over days to weeks. Usually, but not always, both sides of the body are affected.

Typical signs and symptoms include:

Pain. Pain associated with transverse myelitis often begins suddenly in the neck or back, depending on which part of the spine is affected. The stinging and burning sensation may also spread down the legs or arms or around the abdomen.

Unusual feeling. Some people with transverse myelitis experience numbness, cold, itching, or burning sensations. Some are particularly sensitive to the light touch of clothing or to extreme heat or cold. You may feel that the skin of your chest, abdomen, or legs is tightly wrapped around something.

Weakness in arms or legs. Some people with mild weakness say they tripped, dragged on one leg, or felt heavy when moving. Others may develop severe numbness.

Bladder and bowel problems. These problems can include increased frequency of bowel movements, urinary incontinence, difficulty urinating, and constipation.

Call your doctor or get emergency medical care if you are experiencing signs and symptoms of transverse myelitis. Some neurological disorders can cause sensory problems, weakness, or bowel and bladder dysfunction. It is important to get a timely diagnosis and appropriate treatment.

Causes

Inflammation is a normal response of the immune system to disease or injury. But sometimes the immune system attacks the body's own tissues - an event known as an autoimmune phenomenon. The exact reason for immune system dysfunction in transverse myelitis is not known. However, there are a number of problems that appear to trigger or contribute to the disorder. These issues include:

Respiratory or gastrointestinal viral infections are associated with transverse myelitis. In most cases, inflammatory disorders appear after a person has recovered from a viral infection.

Mycoplasma pneumonia, a relatively mild form of bacterial pneumonia, may act as a trigger for the immune system mechanism that causes transverse myelitis.

Multiple sclerosis is an autoimmune disorder in which the immune system destroys myelin around nerves in the brain and spinal nerves. Transverse myelitis may be the first sign of multiple sclerosis or represent a recurrence of symptoms. Transverse myelitis that occurs as a sign of multiple sclerosis usually presents on only one side of the body.

Neuromyelitis Optica (Devi's disease) causes inflammation and loss of myelin around the spinal and optic nerves, the nerves in the eye that transmit information to the brain. The signs and symptoms of transverse myelitis associated with Devic's disease usually affect both sides of the body. Damage to the myelin of the optic nerve and subsequent symptoms, including pain in the eye and temporary loss of vision, can occur at the same time as transverse myelitis symptoms. However, some people with Devic's disease may not experience related eye problems and may only have recurrent bouts of transverse myelitis.

Autoimmune disorders affecting other organ systems are likely to contribute to factors in some people with transverse myelitis. These disorders include lupus, which can affect many body systems, and Sjogren's syndrome, which causes severe dry mouth and eyes, as well as other symptoms. Transverse myelitis associated with an autoimmune disorder may indicate coexisting Devic disease, occurring more often in people with other autoimmune diseases than in other people who do not have an autoimmune disease.

Immunization for infectious diseases - including hepatitis B, measles-mumps-rubella, diphtheria, tetanus, and vaccines - has rarely been identified as a trigger.

Complications

People with transverse myelitis usually experience only one acute attack. However, complications are often long-lasting and include:

Pain. Pain is one of the long-term complications of the most common debilitating disorder.

Muscle stiffness. Stiffness or spasms in the muscles, especially in the legs and buttocks, affect most people who have residual effects of transverse myelitis.

Arm numbness. Partial or complete numbness of the arms, legs, or both may persist after the onset of initial symptoms.

Sexual dysfunction. It is a common complication arising from transverse myelitis. Men may have difficulty achieving an erection or reaching orgasm. It can be difficult for women to orgasm.

Osteoporosis. Limit physical activity for long periods because transverse myelitis can lead to osteoporosis, spongy or weak bones. People with osteoporosis are at increased risk of fractures.

Depression. Depression or anxiety is common in people with long-term complications because of significant lifestyle changes, the stress of chronic pain or disability, and the impact of sexual dysfunction on relationships. .

Tests and diagnostics

Diagnosis of transverse myelitis is based on answers to questions about signs and symptoms, medical history, clinical assessment of neurological function, and laboratory findings. These tests can show inflammation of the spinal cord and rule out other disorders, including:

Magnetic Resonance (MRI). An MRI uses a magnetic field and radio waves to create horizontal or 3D images of soft tissue. An MRI can show inflammation of the spinal cord, and it can identify other potential causes of symptoms, including abnormal spinal compression and vascular malformations.

Lumbar puncture. The use of a needle to draw a small amount of cerebrospinal fluid (CSF) from the spine, the protective fluid that surrounds the spinal cord and brain. In some people with transverse myelitis, CSF may have abnormalities in large numbers of white blood cells or immune proteins that indicate inflammation. Cerebrospinal fluid may also be tested for viral infections or cancer.

Blood tests. May include testing for antibodies linked to Devic's disease, a problem in which inflammation occurs in both the spinal nerves and the nerves in the eye. People with a positive antibody test have an increased risk of multiple episodes of transverse myelitis and need treatment to prevent future infections. Other blood tests can identify infection that may be a contributing factor in transverse myelitis or rule out other symptomatic causes.

Treatments and drugs

Several targeted treatments for the signs and symptoms of acute transverse myelitis:

Intravenous corticosteroid injection. Once diagnosed, intravenous steroids will be used for several days. Steroids help reduce inflammation.

Plasma. Those who do not respond to intravenous corticosteroids may undergo plasma exchange therapy. This therapy involves the removal of straw-yellow fluids in which blood cells, plasma, and plasma are replaced with a special fluid. It is not a cure for people with transverse myelitis, but it can clear the plasma exchange antibodies involved in inflammation.

Analgesic. Chronic pain is a common complication of transverse myelitis. Medicines that can relieve pain associated with spinal cord injury include common pain relievers, including acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others), and naproxen (Aleve, Naprosyn). , others); antidepressants such as sertraline (Zoloft); and anticonvulsants such as gabapentin (Neurontin) or pregabalin (Lyrica).

Medicines to treat other complications. Your doctor may prescribe other medications as needed to treat problems such as muscle spasticity, urinary tract dysfunction, depression, or other complications associated with transverse myelitis.

Non-drug treatment

Other treatments focus on long-term recovery and care:

Physical therapy. Physical therapy helps to increase strength and improve coordination. Physical therapy will likely teach the use of assistive devices, such as wheelchairs, canes, or braces, if necessary.

Occupational therapy. This type of treatment helps people with transverse myelitis learn new ways of doing everyday activities, such as bathing or preparing a meal.

Psychotherapy. Psychologists can use talk therapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioral problems that may be related to dealing with transverse myelitis. .

Prognosis

Although most people with transverse myelitis recover at least partially, the process can take a year or more. Aggressive recovery depends on the cause of transverse myelitis. People with Devic disease have a worse prognosis, although even in this situation, most recover with treatment. About one-third of people with transverse myelitis fall into each of the following three categories after developing transverse myelitis:

Absence or slight disability. These people have only minimal symptoms left.

Moderate disability. People who are mobile, but may have difficulty walking, numbness or tingling, bladder and bowel problems.

Severe disability. Some people may have frequent wheelchair needs and require assistance and care with daily activities.

It is difficult to predict transverse myelitis. In general, people who experience a rapid onset of signs and symptoms have a worse prognosis than those with a relatively slow onset.

Lifestyle and remedies

Some lifestyle strategies that can help manage complications of transverse myelitis include:

Prevents bowel problems. If you have intestinal problems caused by transverse myelitis, eat a diet rich in fiber and drink plenty of water to help prevent constipation.

Maintain strong bones. People with transverse myelitis are at increased risk for osteoporosis because of limited activity. Talk to your doctor about calcium and vitamin D supplements to improve bone health. Weight-bearing exercises, if possible, will also strengthen bones.

Keep up the exercise routine. Spasticity or contracture is a common complication of transverse myelitis and can limit ease of movement. Increase flexibility by following a stretching routine suggested by physical therapists. Design a strengthening therapy program that can target muscle weakness to help improve mobility.