What are the symptoms of transverse myelitis (TM)?
Symptoms of transverse myelitis may develop within a few hours or days (have sudden onset), or they may develop over one to four weeks. Symptoms of TM can quickly become severe.
Symptoms of TM tend to happen at or below the damaged area of your spinal cord. For example, if the damaged area of your spinal cord is in your middle back below your arms, then your legs and bladder/bowel control will likely be affected, but your arms won’t.
TM often affects both sides of your body, but it sometimes only affects one side (this is more common in people with multiple sclerosis).
At its worst point, 50% of people with TM have lost all movements of their legs, 80% to 94% of people experience numbness or abnormal sensation (tingling or pricking), and almost all people have some degree of bladder dysfunction.
For some people, these symptoms improve or go away completely with treatment, whereas others experience permanent complications.
There are several different groups of symptoms for TM, including:
- Abnormal sensations.
- Pain.
- Bowel and bladder issues.
- Muscle and movement issues.
- Sexual dysfunction.
- Other symptoms.
Abnormal sensations caused by transverse myelitis
TM may cause the following abnormal sensations (paresthesia) in certain areas of your body, depending on where the damage is on your spine:
- Numbness.
- Pricking.
- Burning.
- Sensitivity to touch or temperature.
- Diminished temperature sensitivity.
Pain caused by transverse myelitis
TM may cause pain in certain areas of your body. The pain may feel sharp or blunt. It may shoot (radiate) down your arms and/or legs or wrap around your chest and abdomen.
Bowel and bladder symptoms caused by transverse myelitis
TM can cause the following bladder and bowel symptoms:
- Constipation.
- Urinary retention (not fully emptying your bladder when you pee).
- Bladder control issues, such as a frequent urge to pee (urge incontinence).
- Urinary incontinence (urine leakage).
Muscle and movement issues caused by transverse myelitis
People with TM may have weakness in their legs that progresses rapidly. If the inflammation affects your upper spinal cord, it affects your arms as well.
Signs of muscle and movement issues include:
- Loss of balance.
- Difficulty walking (stumbling or dragging your feet).
- Muscle spasms.
- Partial loss of muscle function, which may develop into paralysis.
Sexual dysfunction caused by transverse myelitis
People with TM may experience difficulty having an org*sm, and people with a penis may experience erectile dysfunction.
Other symptoms of transverse myelitis
TM can also have the following symptoms:
- Loss of appetite.
- Headache.
- Fever.
- Respiratory (breathing) problems.
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What causes transverse myelitis (TM)?
In general, transverse myelitis (TM) is caused by inflammation of your spinal cord.
When your body encounters an offending agent (like viruses, bacteria or toxic chemicals) or suffers an injury, it activates your immune system.
Your immune system sends out its first responders: inflammatory cells and cytokines (substances that stimulate more inflammatory cells).
These cells begin an inflammatory response to trap bacteria and other offending agents or start healing injured tissue. While this inflammatory response is necessary in a lot of cases, sometimes, your immune system can send out its first responders for no known reason and attack healthy tissue. Or the inflammatory response to an offending agent can be excessive and damage tissues in your body in the process.
In the case of TM, the covering around the nerve cells in your spinal cord is damaged due to inflammation.
There are several possible causes of inflammation that lead to transverse myelitis (TM). The causes can be grouped into the following categories:
- Idiopathic (no known cause).
- Inflammation from an infection.
- Systemic inflammatory autoimmune diseases.
- Central nervous system diseases.
Idiopathic transverse myelitis
Idiopathic TM means there’s no known cause of the condition. This represents the majority of TM cases.
Scientists think idiopathic TM results from an abnormal and excessive immune response against your spinal cord that results in inflammation and tissue damage. But they can’t figure out the exact cause or trigger.
Infections that can cause transverse myelitis
Bacterial, viral, parasitic and fungal infections that can cause TM include, but aren’t limited to:
- Enteroviruses (a very common type of virus, most of which cause only mild illness).
- West Nile virus.
- Herpes viruses, such as genital herpes.
- HIV.
- Varicella-zoster (the virus that causes chickenpox and shingles).
- Human T-cell leukemia virus type 1 (HTLV-1).
- Zika virus.
- Neuroborreliosis (Lyme disease).
- Syphilis.
- Tuberculosis.
- Bacterial skin infections.
- Mycoplasma bacterial pneumonia.
It’s often difficult for healthcare providers to determine whether direct viral infection or a post-infectious response from your immune system causes TM.
Systemic inflammatory autoimmune conditions that can cause transverse myelitis
Systemic inflammatory autoimmune conditions that have an association with TM include:
- Ankylosing spondylitis.
- Antiphospholipid syndrome.
- Behçet’s disease.
- Mixed connective tissue disease.
- Rheumatoid arthritis.
- Sarcoidosis.
- Scleroderma.
- Sjogren’s syndrome.
- Systemic lupus erythematosus (SLE).
Central nervous system diseases that can cause transverse myelitis
Central nervous system autoimmune conditions that can cause TM include:
- Multiple sclerosis (MS).
- Neuromyelitis optica spectrum disorder (NMOSD) — also called Devic’s disease.
- Myelin oligodendrocyte glycoprotein antibody disorders (MOGAD).
- Acute disseminated encephalomyelitis.
In some people, transverse myelitis represents the first symptom of a central nervous system autoimmune or immune-mediated condition, such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD).
“Partial” myelitis, which means only one side of your body is affected, is more common in MS.
NMSOD is much more likely as an underlying condition when the myelitis is “complete,” meaning it causes severe paralysis and numbness on both sides of your body. Myelitis attacks that happen to people with NMOSD tend to be more severe and are associated with less recovery than attacks in people with MS.
Can the COVID-19 vaccine cause transverse myelitis (TM)?
Post-vaccination transverse myelitis cases have been reported from two days to three months after vaccination against hepatitis B virus, measles–mumps–rubella, diphtheria–tetanus–pertussis and others. Recently, some cases of TM from one to 14 days after COVID-19 vaccination have also been reported.
Although scientists haven’t found the exact cause of this reaction, one theory suggests that the vaccination may have excited an autoimmune process. It’s very important to know that extensive research has proven that vaccinations are safe, and the potential link to TM may only be coincidental or, at worst, a very rare complication.
