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Transverse myelitis is a condition resulting from inflammation of your spinal cord. The word "myelitis" refers to inflammation of the insulating material that covers nerve cell fibers (myelin), and "transverse" means the inflammation occurs across the width of your spinal cord. If myelin is damaged, communications relayed between your spine and the rest of your body may be disrupted.

Transverse myelitis often develops following a viral infection or occurs along with a disorder in which your immune system attacks your own tissues. Sometimes, transverse myelitis is an indication of a relapsing illness.

Most people with transverse myelitis experience at least partial recovery. Although long-term complications are common, medication combined with rehabilitative therapy can help you achieve the best quality of life possible.

Signs and symptoms of transverse myelitis usually develop rapidly over a period of hours. Less commonly, signs and symptoms progress over several days or even weeks. Typical signs and symptoms include:

• Pain. Pain associated with transverse myelitis often begins suddenly in your neck or back, depending on the part of your spinal cord that is affected. Sharp, shooting sensations may also radiate down your legs or arms or around your abdomen.
• Abnormal sensations. Some people with transverse myelitis report sensations of numbness, tingling, coldness or burning below the affected area of the spinal cord. You might notice that you're especially sensitive to the light touch of clothing or to extreme heat or cold. You may feel as though the skin of your chest, abdomen or legs is being wrapped by something tight.
• Weakness in your arms or legs. Some people with mild weakness notice that they're stumbling, dragging one foot or that their legs feel heavy as they move. Others may develop severe paralysis.
• Bladder and bowel problems. These problems include an increased urinary urge, difficulty urinating and constipation.

Other signs and symptoms may include:

• Muscle spasms, especially in your legs
• Headache
• Fever
• Loss of appetite

When to see a doctor
Call your health care provider if you experience any signs or symptoms such as weakness in your arms or legs, pain, changes in sensation, or problems with bowel or bladder function. Disorders of the spinal cord can be serious, so be sure to have your condition checked out promptly.

Having transverse myelitis can significantly impact your ability to perform activities you enjoy or even daily tasks, which may cause you to become depressed. If you have been experiencing symptoms of depression, such as a feeling of hopelessness and a lack of interest in things that you normally enjoy, ask your doctor to refer you to a mental health professional. Depression is treatable.

Researchers believe that transverse myelitis often occurs when your body's immune system mistakenly attacks its own tissues, resulting in inflammation and injury to the fatty insulating material that covers nerve cell fibers (myelin) within your spinal cord. Diseases of the central nervous system frequently cause transverse myelitis. These include:

• Multiple sclerosis. Multiple sclerosis occurs when your immune system mistakenly attacks the myelin sheath surrounding nerves in your spinal cord and brain, resulting in areas of scarring (scleroses). Mild attacks of transverse myelitis may be the first sign or represent a relapse of multiple sclerosis. Transverse myelitis occurring as a sign or symptom of multiple sclerosis usually manifests on one side of your body only.
• Neuromyelitis optica. This refers to a condition that causes injury and inflammation of the spinal cord (myelitis) and of the optic nerve (optic neuritis), the nerve in your eye that transmits information to your brain. Transverse myelitis occurring as a symptom of neuromyelitis optica usually affects both sides of your body. Optic neuritis may cause pain and temporary vision loss. However, some people with neuromyelitis optica may not experience optic neuritis and may only have recurrent episodes of transverse myelitis.

In instances of transverse myelitis following an infection, the inflammation within the spinal cord may arise as a result of your body's immune reaction to the virus or bacteria. Or, some viruses may directly invade the spinal cord and produce symptoms of transverse myelitis. Such viruses include:

• Varicella zoster. This virus causes chickenpox and shingles, a reactivation of the virus years after chickenpox.
• Herpes simplex. Herpes viruses are associated with cold sores that develop on your face (herpes simplex virus type 1) as well as genital lesions (herpes simplex virus type 2).

Transverse myelitis occasionally develops in people who have other autoimmune diseases. These include:

• Lupus. Lupus is an inflammatory disease that may cause swollen, painful joints, a skin rash and other symptoms.
• Sjogren's syndrome. This autoimmune disease often causes dry eyes and a dry mouth.

Rarely, transverse myelitis may develop following certain vaccinations, including those for chickenpox and rabies. It's unclear how transverse myelitis and vaccinations are related.

Other conditions that alter normal patterns of blood flow in your spine may cause signs and symptoms similar to those of transverse myelitis. These include:

• Blood vessel abnormalities
• Hardening of the arteries (atherosclerosis)
• Tumors that develop in your spinal cord or radiation therapy used to treat such tumors

Doctors rule out such disorders before arriving at a diagnosis of transverse myelitis.

Usually, people with transverse myelitis experience only one acute episode. However, complications often linger. Chronic pain is one of the most debilitating long-term complications. Others may include:

• Spasticity. This refers to stiffness, tightness or painful spasms in your muscles, especially in your buttocks and legs. The majority of people with lingering effects of transverse myelitis experience some degree of spasticity.
• Partial or total paralysis. The weakness associated with transverse myelitis may result in partial or total paralysis of your arms, legs or both. In severe cases, use of a wheelchair may be necessary.
• Osteoporosis. People with transverse myelitis are at an increased risk of developing thinning of the bones, because they might not be able to engage in weight-bearing activities or because they're taking steroid medications for an extended period of time.
• Sexual dysfunction. Sexual dysfunction is a common complication arising from transverse myelitis. Men may experience difficulty achieving an erection or reaching an orgasm. Women also may have difficulty reaching an orgasm.
• Depression. The complications associated with transverse myelitis change your lifestyle, which can make you feel depressed. Depression may also hinder recovery because people who are depressed don't always feel up to participating in a physical therapy regimen.

If your symptoms are severe and make it difficult for you to walk, urinate or feel your legs, call 911 or emergency medical help or have a friend or family member take you to the emergency room.

Rarely, symptoms may develop slowly enough that you would first make an appointment with your family doctor or a general practitioner. However, when you call to set up an appointment, your doctor may recommend that you seek immediate medical care.

If you have time before your appointment to prepare, the following information can help you get ready and learn what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Be as specific and detailed as possible in describing your symptoms, including what part of your body is affected and what adjectives you'd use to describe your discomfort.
• Write down key personal information, including any recent stresses or major life changes.
• Make a list of your key medical information. Your doctor will want to know about any recent infectious illnesses you've had, as well as any other health conditions with which you've been diagnosed or treated. Also write down any recent vaccinations or medical procedures you've had, as well as the names of all prescription and over-the-counter medications or supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.

For transverse myelitis, important questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there any other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• What treatments do you recommend now?
• Do I need to be hospitalized? For how long?
• How fully do you expect I will recover with treatment?
• Am I at risk of lasting complications? If yes, what are they?
• Will I need long-term therapy?
• Will I be able to return to work?
• Will I be able to live independently?
• I have these other health conditions. How can I best manage them together?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• When did you first begin experiencing symptoms?
• How would you describe your symptoms?
• Have your symptoms changed or gotten worse over time?
• Where is your pain, weakness or uncomfortable sensations located?
• Have you noticed problems with movement and coordination?
• Has your appetite changed?
• Have you noticed a change in your bowel or bladder control?
• Are you having any difficulty breathing?
• Have you recently had any infections?
• Have you recently had any vaccinations?
• Have you traveled abroad lately? Where?
• Have you had any medical procedures in recent history?
• Have you been diagnosed or treated for any other medical conditions?

Your doctor may suspect transverse myelitis if you report weakness in your arms or legs, pain, changes in sensation, and problems with bowel or bladder function. Your doctor will ask about your medical history, including any recent illnesses or vaccinations. Reaching a diagnosis of transverse myelitis also requires evidence of inflammation within your spinal cord. Your doctor may determine this with several tests:

• Magnetic resonance imaging (MRI). An MRI scan is a test that uses a magnetic field and pulses of radio wave energy to make pictures of your body. If you have transverse myelitis, an MRI of your brain and spinal cord may show inflammation.
• Lumbar puncture. This test, also called a spinal tap, is used to collect a small amount of the fluid that surrounds your spinal cord and brain. During this test, your doctor injects a numbing medicine into your lower spine and then inserts a needle into your spinal canal to measure the fluid pressure and collect a sample. Some people with transverse myelitis may have abnormally high numbers of white blood cells or protein in the fluid, suggesting an infection or an inflammation. Spinal fluid can also be tested for viruses, the possibility of multiple sclerosis or the presence of certain cancers.
• Blood test. A blood test called an NMO-IgG test checks for antibodies for neuromyelitis optica, a condition in which inflammation occurs both in your spinal cord and in the nerve in your eye. People with a positive test for NMO-IgG are at an increased risk of experiencing multiple attacks of transverse myelitis.

In addition, your doctor may order blood tests to rule out other disorders that cause similar signs and symptoms.

Depending on the results of your MRI scan, other radiology tests may be necessary. For example, your doctor may request a myelogram or angiogram of your spinal cord to search for abnormal blood vessels. Rarely, you may need a biopsy of your spinal cord.

Several therapies target the acute signs and symptoms of transverse myelitis:

• Intravenous steroids. After your diagnosis, you'll likely receive steroids through a vein in your arm over the course of several days. Steroids help reduce the inflammation in your spinal column.
• Plasma exchange therapy. People who don't respond to intravenous steroids may undergo plasma exchange therapy. This therapy involves removing the straw-colored fluid in which blood cells are suspended (plasma) and replacing the plasma loss with special fluids. It's not certain how this therapy helps people with transverse myelitis, but it may be that plasma exchange removes antibodies that are involved in inflammation.
• Pain medication. Chronic pain is a common complication of transverse myelitis. Nonsteroidal anti-inflammatory drugs — such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others) — can help reduce inflammation and relieve pain.

Other therapies focus on long-term recovery and care:

• Physical therapy. Physical therapy helps you increase strength and improve coordination. Your physical therapist will likely teach you how to use assistive devices, such as a wheelchair, canes or braces, if needed.
• Occupational therapy. This type of therapy helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
• Other medications. Your doctor may make suggestions for long-term treatment depending on any complications that you may be experiencing. For example, if you're plagued by painful muscle spasms, your doctor may recommend anti-spasticity drugs. Or if you think you may be depressed, taking antidepressant medication may help. Treatment can be tailored to fit your needs.

Prognosis
Although most people with transverse myelitis have at least partial recovery, the process may take up to two years. About one-third of people with transverse myelitis fall into each of three categories after an episode of transverse myelitis:

• No or slight disability. These people experience only minimal residual symptoms.
• Moderate disability. These people are mobile, but may have difficulty walking, numbness or tingling, and bladder and bowel problems.
• Severe disability. Some people may remain wheelchair-bound and dependent on others for help with daily tasks.

It's difficult to predict the course of transverse myelitis. Generally, people who experience a rapid onset of signs and symptoms have a worse prognosis than those with relatively slower onset.

Whether your symptoms of transverse myelitis have subsided or you're experiencing chronic complications, it's likely that you'll choose to make several changes to improve your quality of life. Here are a few suggestions:

• Prevent bowel problems. If you have bowel problems caused by transverse myelitis, make sure you pack enough fiber in your diet by eating fiber-rich foods or taking a supplement. Drinking plenty of fluids, especially water, will help you feel more comfortable.
• Maintain strong bones. People with transverse myelitis are at an increased risk of developing osteoporosis because of limited activity, so help build your bones by taking calcium and vitamin D supplements and engaging in weight-bearing exercise, if possible.
• Stretch and strengthen. Stiff or tight muscles, also referred to as spasticity, are a common complication of transverse myelitis and may limit your ability to get around easily. Try to increase your flexibility by sticking to a stretching routine suggested by your physical therapist. A strengthening program targeting your weaker muscles will also help you maintain good muscle balance.