|
Transverse Myelitis
Overview
Transverse myelitis (TM) is a neurological condition produced by abnormal
inflammation in the spinal cord, resulting in block of the nerve impulses and
neurologic symptoms. TM is a rare disease, with a frequency estimated to be five
new cases for every one million people. TM can affect anybody, regardless of
age, gender, or race.
Symptoms
Typical symptoms of TM include:
- Back or neck pain
- Weakness in the arms or legs
- Muscle spasms
- Numbness or tingling
- Loss of bladder or bowel control
The distribution of symptoms depends on the location of the inflammation.
Inflammation in the neck produces symptoms from the neck down. Inflammation in
the mid-spine produces symptoms from the waist down. The severity of TM depends
upon the severity and extent of the inflammation.
Symptoms usually develop over a period of several hours up to several weeks.
Over this time, the symptoms become more severe, they may spread, and new
symptoms may accumulate. Symptoms typically persist for weeks to months then
improve over months. Recovery can range from minimal to complete. TM can be
monophasic (occurring only once) or recurrent (with repeated episodes).
Cause
There are many potential causes of TM, including:
- Idiopathic. Much of the time, a specific cause of TM is not identified
- Multiple sclerosis: TM can develop as one type of MS attack (relapse),
including the first MS attack. In general, TM in MS tends to be a less
severe form.
- Devic’s Neuromyelitis Optica, is a disorder related to MS that
produces severe recurrent TM and optic neuritis (inflammation in the optic
nerve that connects the eye to the brain).
- Systemic inflammatory diseases. Diseases such as Systemic Lupus
Erythematosus, Sjogren’s syndrome, or sarcoidosis can cause TM.
- Infections. TM can develop in association with a variety of infections,
both viruses (for example, herpes simplex, Epstein-Barr, influenza, and
HIV) and bacteria (for example tuberculosis, syphilis, and Lyme).
Diagnosis
The first step to making the diagnosis of TM is for a physician to review
the medical history and perform a physical examination. If this review suggests
a spinal cord problem, making the diagnosis of TM involves 1) eliminating the
possibility that a process other than inflammation is affecting the spinal cord,
for example a tumor, a herniated disc, or abscess compressing the spinal cord,
2) confirming the presence of abnormal inflammation within the spinal cord, and
3) trying to identify the cause for the abnormal inflammation.
The initial test usually is an MRI scan of the spine to confirm the presence
of inflammation in the cord and rule out some other cause of a spinal cord
problem. If the MRI scan shows lesions (spots) in the spinal cord with the
appearance of TM, a lumbar puncture often is performed to confirm inflammation
and to help determine its cause, for example looking for MS or infection. An MRI
scan of the brain may be performed looking for other lesions suggestive of MS.
Finally, blood tests can also help identify the cause.
Treatment
Treatment of TM is aimed at relieving the abnormal inflammation with the
goal of accelerating recovery, limiting tissue damage, and improving recovery.
TM is treated most often with high-dose corticosteroids. Corticosteroids work by
reducing inflammation and by reducing the activity of the immune system. If
corticosteroids are ineffective, plasma exchange, intravenous gamma globulin, or
other immune suppressing drugs sometimes are used. Management of the symptoms of
TM, for example, pain, spasms, bladder or bowel problems also is an important
aspect of management.
Recovery from TM is highly variable among individuals. Approximately
one-third of people with TM experience good to complete recovery, another third
experience fair recovery, and the remaining third have poor recovery. Most
improvement occurs within the first three to six months, although some gradual
improvement can continue for up to several years. For patients experiencing
sequelae of TM, some daily activities can become challenging. Physical therapy,
occupational therapy, and other rehabilitation approaches can help improve
function.
For further information
Like most disorders, knowledge is an important tool to help manage TM and
its complications. The following organizations can provide more information
about TM:
The Transverse Myelitis Association
1787 Sutter Parkway
Powell, OH 43065-8806
(614) 766-1806
www.myelitis.org
National MS Society
733 Third Avenue
New York, NY 10017-3288
www.nationalmssociety.org
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: (800) 352-9424
www.ninds.nih.gov
©Copyright 1995-2013 Cleveland Clinic. All rights reserved.
index#8980 |
