Transverse myelitis is a neurological disorder caused by inflammation (swelling) across both sides of one level or segment of the spinal cord. Inflammation can damage or destroy myelin, the fatty protective substance that covers nerve cell fibers. This damage causes scars that interrupt the communication between the nerves in the spinal cord and the rest of the body. Most people affected by transverse myelitis will have only one attack; a small percentage may have more than one attack.
The exact reason for transverse myelitis is not known. Sometimes there is no known cause. There are a number of conditions that appear to cause the disorder, including:
Viral and other infections of the respiratory tract or the gastrointestinal tract may cause transverse myelitis. In most cases, the inflammatory disorder appears after recovery from the infection.
Viruses that can infect the spinal cord directly are herpes viruses, including the one that causes shingles and chickenpox (zoster), enteroviruses, and West Nile virus. Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.
Rarely, parasites may infect the spinal cord, and certain bacteria such as Lyme disease can cause a painful inflammation of nerve roots of the spinal cord.
Multiple sclerosis is a disorder in which the immune system destroys myelin surrounding nerves in your spinal cord and brain. Transverse myelitis can be the first sign of multiple sclerosis or represent a relapse. Transverse myelitis as a sign of multiple sclerosis usually causes symptoms on only one side of your body.
Neuromyelitis optica (Devic’s disease) is a condition that causes inflammation and myelin loss around the spinal cord and the nerve in your eye that transmits information to your brain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body.
In addition to transverse myelitis, you may experience symptoms of damage to myelin of the optic nerve, including pain in the eye with movement and temporary vision loss. This can happen with or separately from transverse myelitis symptoms. However, some people with neuromyelitis optica don’t experience eye-related problems and might have only recurrent episodes of transverse myelitis.
Autoimmune disorders probably contribute to transverse myelitis in some people. These disorders include lupus, which can affect multiple body systems, and Sjogren’s syndrome, which causes severe dryness of the mouth and eyes.
Transverse myelitis associated with an autoimmune disorder may be a warning sign of neuromyelitis optica. Neuromyelitis optica occurs more frequently in people with other autoimmune diseases.
- Vaccinations for infectious diseases — including hepatitis B, measles-mumps-rubella and diphtheria-tetanus
- Vaccines — have occasionally been associated as a possible trigger. However, at this time the association is not strong enough to warrant limiting any vaccine.
Who gets transverse myelitis, and when?
Transverse myelitis occurs in adults and children, in males and females and in all races.
- Females have a higher risk of transverse myelitis than males.
- No genetic pattern is known. Transverse myelitis is not related to family history.
- The highest number of new cases in a given year occur between age 10 and 19 and between age 30 and 39 years.
- The symptoms of transverse myelitis can appear suddenly, developing over hours to several days or more gradually developing over a period of 1 to 4 weeks.
It is estimated that about 1,400 new cases of transverse myelitis are diagnosed each year in the United States. It is estimated that about 33,000 Americans have some type of disability resulting from transverse myelitis.