Transverse Myelitis

Transverse myelitis is a disorder of the spinal cord. Inflammation in the spinal cord can hurt the fatty substance (myelin) that covers the nerve fibers. This would be similar to losing the insulation around electrical wires. This damage causes problems with the nerve cells (neurons) in the spinal cord that carry signals from the brain to the rest of the body.

The part of the spinal cord affected determines which parts of the body are affected. An injury to the spinal cord at the level of the chest can cause problems with leg movement and bowel and bladder control. An injury to the spinal cord at the level of the neck can cause problems with sensation and motor function of the arms, legs, and bowel and bladder control. If an injury is high enough in the neck, it may even affect breathing.

Some patients recover from this disorder with minor or no lasting problems. Others may have lasting problems that make daily living difficult. Most patients will have only 1 episode of transverse myelitis. A small percentage may have problems return.

CAUSES

The exact cause is not known. Some of the things thought to cause this problem include:

  • Viral infections, such as herpes, chickenpox (varicella zoster), cytomegalovirus, and Epstein-Barr virus.

  • Abnormal immune reactions.

  • Poor blood flow to the spinal cord.

This disorder may also occur as a complication of:

  • Syphilis.

  • Measles.

  • Lyme disease.

  • Chickenpox, if severe.

  • Some vaccinations, including those for chickenpox and rabies.

SYMPTOMS

Symptoms can come on over several hours to weeks. Transverse myelitis may cause a loss of spinal cord function over several hours to several weeks. Some symptoms are:

  • Headaches.

  • Fever.

  • Loss of appetite.

  • A sudden onset of lower back pain.

  • Abnormal sensations in the toes and feet.

  • Weakness in the arms and legs.

  • Bowel and urinary problems.

DIAGNOSIS

  • Medical history and neurological exam.

  • Magnetic resonance imaging (MRI). This procedure provides a picture of the brain and spinal cord.

  • Myelography. This procedure involves injecting a dye and taking X-rays.

  • Blood tests may be performed.

  • A spinal tap may be done to examine the spinal fluid.

TREATMENT

No cure exists for this illness. Treatments are designed to help decrease the symptoms.

  • Corticosteroid treatment is often used during the first few weeks of illness. This decreases inflammation.

  • Pain medicines are prescribed as needed.

  • Sometimes, respirators are needed if there is severe difficulty breathing.

  • Physical therapy may be used to keep muscles flexible and strong.

  • Movement decreases the chances of pressure sores developing.

  • Later, if patients begin to recover limb control, physical therapy helps begin to improve muscle strength, coordination, and range of motion.

HOME CARE INSTRUCTIONS

Much can be done for people with permanent disabilities.

  • Treatment programs and other resources are likely available in your community. Medical social workers can help you locate this information.

  • Rehabilitative therapy will teach you how to care for yourself. Rehabilitation cannot reverse the physical damage resulting from this illness. However, it can help people, even those with severe paralysis, become as independent as possible. This helps you attain the best possible quality of life.

  • Medicines can be prescribed by your caregiver. These medicines can help with depression and adapting to a changed way of life. A wide variety of drugs now exist that can help with the pain from spinal cord injuries.

  • Increasing your strength and endurance is possible. Treatment improves coordination and reduces muscle spasms (spasticity) and muscle wasting in paralyzed limbs. Physical therapists can help you regain greater control over bladder and bowel function through various exercises. They can also teach paralyzed patients techniques for using assistive devices (wheelchairs, canes, braces) as effectively as possible.

  • Learning new ways of performing everyday tasks is important. These tasks include bathing, dressing, preparing a meal, house cleaning, engaging in arts and crafts, or gardening. Occupational therapists can help you with this.

FOR MORE INFORMATION

National Institute of Neurological Disorders and Stroke: www.ninds.nih.gov

Transverse Myelitis Association: www.myelitis.org

American Chronic Pain Association: www.theacpa.org

Miami Project to Cure Paralysis: www.themiamiproject.org

National Rehabilitation Information Center: www.naric.com