Transverse myelitis may be either acute (developing over hours to several days) or subacute (usually developing over one to four weeks).
Four classic features of transverse myelitis are:
- Weakness of the legs and arms. People with transverse myelitis may have weakness in the legs that progresses rapidly. If the myelitis affects the upper spinal cord it affects the arms as well. Individuals may develop paraparesis (partial paralysis of the legs) that may progress to paraplegia (complete paralysis of the legs), requiring the person to use a wheelchair.
- Pain. Initial symptoms usually include lower back pain or sharp, shooting sensations that radiate down the legs or arms or around the torso.
- Sensory alterations. Transverse myelitis can cause paresthesias (abnormal sensations such as burning, tickling, pricking, numbness, coldness, or tingling) in the legs, and sensory loss. Abnormal sensations in the torso and genital region are common. Sometimes the shooting sensations occur when the neck is bent forward and resolve when the neck is brought back to normal position (a condition called Lhermitte’s phenomenon).
- Bowel and bladder dysfunction. Common symptoms include an increased frequency or urge to use the toilet, incontinence, difficulty voiding, and constipation.
Many individuals also report experiencing muscle spasms, a general feeling of discomfort, headache, fever, and loss of appetite, while some people experience respiratory problems. Other symptoms may include sexual dysfunction and depression and anxiety caused by lifestyle changes, stress, and chronic pain.
The segment of the spinal cord at which the damage occurs determines which parts of the body are affected. Damage at one segment will affect function at that level and below. In individuals with transverse myelitis, myelin damage most often occurs in nerves in the upper back, causing problems with leg movement and bowel and bladder control, which require signals from the lower segments of the spinal cord.
Symptoms may show up in a few hours or days (your doctor will call this an acute attack). Or you might notice them gradually over a few weeks (this is called subacute). While the condition isn’t chronic, it can come back if you have a history of autoimmune disease.
The first symptoms are usually:
- Pain in your lower back
- Sharp pain that moves down your legs and arms or around your chest and belly
- Weakness or paralysis in your legs or arms
- Sensitivity to touch, to the point where slight fingertip pressure causes pain
- Numbness or a pins-and-needles feeling in your toes, feet, or legs
- Muscle spasms
- Loss of appetite
- Bladder and bowel control issues
Once they start, symptoms can get worse within hours. Most of the time, they peak within 10 days. At that point, about half the people who get transverse myelitis lose control of their legs. Most have some numbness, tingling, or a burning sensation in their back, belly, arms, or legs. Almost all lose some bladder control.
How much of your body is affected depends on which part of your spinal cord has the problem. The higher it is, the more problems you’ll have.