What happens in the spinal cord
The spinal cord transmits commands from the brain to the muscles and returns sensory information. In transverse myelitis, inflammation and swelling damage the myelin sheath and the nerve fibers themselves in a certain area. Below the level of the lesion, the conduction of signals is disrupted, so weakness and loss of sensitivity have a clear boundary on the torso, and the functions of the pelvic organs suffer. The thoracic region is most commonly affected, so weakness in the legs and levels of numbness in the chest or abdomen are typical. When the cervical spine is affected, the arms are also involved, and in severe cases, breathing suffers.
- Inflammation extends across the spinal cord
- The thoracic region is most often affected
- Disruption of signal conduction below the level of the lesion
- Possible defeat on several levels
- The severity depends on the level and extent
Reasons
In about a third of cases, transverse myelitis is the first manifestation of a demyelinating disease - multiple sclerosis or neuromyelitis optica spectrum disorders, which also affect the optic nerves. Another common group is post-infectious myelitis, which develops one to three weeks after a viral or bacterial infection when the immune system mistakenly attacks its own tissue. Direct infection, systemic lupus erythematosus and other autoimmune diseases, as well as vascular causes are possible. In some cases, the cause cannot be determined.
- Debut of multiple sclerosis
- Neuromyelitis optica spectrum diseases
- Post-infectious autoimmune reactions
- Direct damage from viruses and bacteria
- Systemic lupus erythematosus and vasculitis
- Vascular disorders of the spinal cord
- Idiopathic forms
Symptoms
The disease often develops acutely or subacutely—over hours, less often over several days. Often the first thing to appear is back pain or a feeling of a tight band around the body. Then weakness and heaviness in the legs increase, the gait changes, numbness, tingling or burning appears, starting from the feet and rising up to a certain level. The functions of the pelvic organs are almost always impaired: urinary retention occurs, less often incontinence, and constipation appears. It is the combination of weakness, level of sensitivity and pelvic disturbances that distinguishes myelitis from sciatica.
- Weakness in the legs and sometimes in the arms
- Numbness and burning with a clear boundary
- Back pain and shingles
- Urinary retention or incontinence
- Constipation
- Increased muscle tone and revitalized reflexes after a few days
Survey
The main study is magnetic resonance imaging of the spinal cord with contrast: it shows the focus of inflammation and, equally important, excludes compression by a tumor, hernia or hematoma, which requires urgent surgery. An MRI of the brain is required to identify other lesions and assess the risk of multiple sclerosis. A lumbar puncture with examination of the cerebrospinal fluid helps confirm inflammation and find specific markers. The blood is tested for infections, autoantibodies, vitamin B12, and indicators of systemic disease.
- MRI of the spinal cord with contrast
- MRI of the brain
- Cerebrospinal fluid examination
- Tests for specific autoantibodies
- Screening for infections
- Vitamin B12 and markers of systemic diseases
- Bladder function assessment
Treatment and recovery
Treatment begins in the hospital as early as possible. The standard is a course of high-dose intravenous glucocorticoids, which reduces inflammation and swelling. If the response is insufficient, plasmapheresis is used, and if the autoimmune disease is confirmed, specific therapy is added to prevent new exacerbations. If the cause is an infection, appropriate medications are prescribed. From the first days, bladder care and prevention of bedsores and thrombosis are important. Then long-term rehabilitation begins, the quality of which largely determines the final result.
- Urgent hospitalization
- Glucocorticoids intravenously
- Plasmapheresis with insufficient effect
- Specific therapy for multiple sclerosis and neuromyelitis optica
- Catheterization and urination regimen
- Prevention of bedsores and thrombosis
- Long-term rehabilitation with physical therapy
- Observation by a neurologist to exclude new exacerbations