Transverse myelitis (TM) is a rare

neurological Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the s ...

condition wherein the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

inflamed Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', ''d ...

. The adjective ''

transverse Transverse may refer to: *Transverse engine, an engine in which the crankshaft is oriented side-to-side relative to the wheels of the vehicle *Transverse flute, a flute that is held horizontally * Transverse force (or ''Euler force''), the tangen ...

'' implies that the spinal inflammation (

myelitis Myelitis is inflammation of the spinal cord which can disrupt the normal responses from the brain to the rest of the body, and from the rest of the body to the brain. Inflammation in the spinal cord can cause the myelin and axon to be damaged re ...

) extends horizontally throughout the cross section of the spinal cord; the terms ''partial transverse myelitis'' and ''partial myelitis'' are sometimes used to specify inflammation that affects only part of the width of the spinal cord. TM is characterized by weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional urethral and anal sphincter activities, and dysfunction of the

autonomic nervous system The autonomic nervous system (ANS), sometimes called the visceral nervous system and formerly the vegetative nervous system, is a division of the nervous system that operates viscera, internal organs, smooth muscle and glands. The autonomic nervo ...

that can lead to episodes of

high blood pressure Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major ri ...

. Signs and symptoms vary according to the affected level of the spinal cord. The underlying cause of TM is unknown. The spinal cord inflammation seen in TM has been associated with various infections, immune system disorders, or damage to

nerve fibers A nerve is an enclosed, cable-like bundle of nerve fibers (called axons). Nerves have historically been considered the basic units of the peripheral nervous system. A nerve provides a common pathway for the electrochemical nerve impulses called ...

, by loss of myelin. As opposed to leukomyelitis which affects only the

white matter White matter refers to areas of the central nervous system that are mainly made up of myelinated axons, also called Nerve tract, tracts. Long thought to be passive tissue, white matter affects learning and brain functions, modulating the distr ...

, it affects the entire cross-section of the spinal cord. Decreased

electrical conductivity Electrical resistivity (also called volume resistivity or specific electrical resistance) is a fundamental specific property of a material that measures its electrical resistance or how strongly it resists electric current. A low resistivity in ...

in the nervous system can result.

Signs and symptoms

Symptoms include weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional

urethral The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which placental mammals urinate and ejaculate. The external urethral sphincter is a striated muscle that allows voluntary control ...

and anal sphincter activities, and dysfunction of the

that can lead to episodes of

. Symptoms typically develop for hours to a few weeks. Sensory symptoms of TM may include a sensation of

pins and needles Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or chronic and has many possible underlying causes. Paresthesia is usually painless and can oc ...

traveling up from the feet. The degree and type of sensory loss will depend upon the extent of the involvement of the various sensory tracts, but there is often a "sensory level" at the

spinal ganglion A dorsal root ganglion (or spinal ganglion; also known as a posterior root ganglion) is a cluster of neurons (a ganglion) in a dorsal root of a spinal nerve. The cell bodies of sensory neurons known as first-order neurons are located in the dorsal ...

of the segmental spinal nerve, below which sensation of pain or light touch is impaired. Motor weakness occurs due to the involvement of the

pyramidal tracts The pyramidal tracts include both the corticobulbar tract and the corticospinal tract. These are aggregations of efferent nerve fibers from the upper motor neurons that travel from the cerebral cortex and terminate either in the brainstem (''cort ...

and mainly affects the muscles that flex the legs and extend the arms. Disturbances in

sensory nerve A sensory nerve, or afferent nerve, is a nerve that contains exclusively afferent nerve fibers. Nerves containing also motor fibers are called mixed nerve, mixed. Afferent nerve fibers in a sensory nerve carry sensory system, sensory information ...

s and

motor nerve A motor nerve, or efferent nerve, is a nerve that contains exclusively efferent nerve fibers and transmits motor signals from the central nervous system (CNS) to the effector organs (muscles and glands), as opposed to sensory nerves, which transf ...

s and dysfunction of the

at the level of the lesion or below, are noted. Therefore, the signs and symptoms depend on the area of the spine involved. Back pain can occur at the level of any inflamed segment of the spinal cord. If the upper

cervical segment The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

of the spinal cord is involved, all four limbs may be affected and there is the risk of

respiratory failure Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a r ...

– the

phrenic nerve The phrenic nerve is a mixed nerve that originates from the C3–C5 spinal nerves in the neck. The nerve is important for breathing because it provides exclusive motor control of the diaphragm, the primary muscle of respiration. In humans, t ...

which is formed by the cervical spinal nerves C3, C4, and C5 innervates the main muscle of respiration, the diaphragm. Lesions of the lower cervical region (C5–T1) will cause a combination of upper and

lower motor neuron Lower motor neurons (LMNs) are motor neurons located in either the anterior grey column, anterior nerve roots (spinal lower motor neurons) or the cranial nerve nuclei of the brainstem and cranial nerves with motor function (cranial nerve lower ...

signs in the upper limbs, and exclusively upper motor neuron signs in the lower limbs. Cervical lesions account for about 20% of cases. A lesion of the thoracic segment ( T1–12) will produce

upper motor neuron Upper motor neurons (UMNs) is a term introduced by William Gowers in 1886. They are found in the cerebral cortex and brainstem and carry information down to activate interneurons and lower motor neurons, which in turn directly signal muscles ...

signs in the lower limbs, presenting as a spastic paraparesis. This is the most common location of the lesion, and therefore most individuals will have weakness in the lower limbs.{{Cite book , url=https://books.google.com/books?id=Gp4sCQAAQBAJ&pg=PA523 , title=Pediatric Rehabilitation, Fifth Edition: Principles and Practice , vauthors=Alexander MA, Matthews DJ, Murphy KP , publisher=Demos Medical Publishing , year=2015 , isbn=978-1-62070-061-7 , pages=523, 524 , access-date=2016-10-20 , archive-url=https://web.archive.org/web/20230111162540/https://books.google.com/books?id=Gp4sCQAAQBAJ&pg=PA523 , archive-date=2023-01-11 , url-status=live A lesion of the lumbar segment, the lower part of the spinal cord ( L1– S5) often produces a combination of upper and lower motor neuron signs in the lower limbs. Lumbar lesions account for about 10% of cases.

Causes

TM is a heterogeneous condition, that is, there are several identified causes. Sometimes the term ''Transverse myelitis spectrum disorder'' is used. In 60% of patients the cause is

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...

. In rare cases, it may be associated with meningococcal meningitis{{Cite journal , vauthors=Khare KC, Masand U, Vishnar A , date=February 1990 , title=Transverse myelitis--a rare complication of meningococcal meningitis , journal=The Journal of the Association of Physicians of India , volume=38 , issue=2 , pages=188 , pmid=2380146 When it appears as a

comorbid In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sicknes ...

condition with

neuromyelitis optica Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord ( myelitis).Banerjee S, Butcher R. Rituximab for the Treatment o ...

(NMO), it is considered to be caused by NMO- IgG autoimmunity, and when it appears in

multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

(MS) cases, it's misdiagnosed as multiple sclerosis (MS) or seen as a type of MS. But NMO is a different condition. Other causes of TM include infections, immune system disorders, and

demyelinating disease A demyelinating disease refers to any disease affecting the nervous system where the myelin sheath surrounding neurons is damaged. This damage disrupts the transmission of signals through the affected nerves, resulting in a decrease in their con ...

s.{{Cite web , title=Transverse Myelitis Fact Sheet , url=http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm , url-status=dead , archive-url=https://web.archive.org/web/20161123085435/http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm , archive-date=2016-11-23 , access-date=2015-08-06 , website=National Institute of Neurological Disorders and Stroke (NINDS) Viral infections known to be associated with TM include

HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the im ...

herpes simplex Herpes simplex, often known simply as herpes, is a viral disease, viral infection caused by the herpes simplex virus. Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are Cold sore, ora ...

herpes zoster Shingles, also known as herpes zoster or zona, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. T ...

cytomegalovirus ''Cytomegalovirus'' (CMV) (from ''cyto-'' 'cell' via Greek - 'container' + 'big, megalo-' + -''virus'' via Latin 'poison') is a genus of viruses in the order '' Herpesvirales'', in the family '' Herpesviridae'', in the subfamily '' Betaherp ...

, and Epstein-Barr.{{Cite journal , vauthors=Levin SN, Lyons JL , date=January 2018 , title=Infections of the Nervous System , journal=The American Journal of Medicine , type=Review , volume=131 , issue=1 , pages=25–32 , doi=10.1016/j.amjmed.2017.08.020 , pmid=28889928 Flavivirus infections such as

Zika virus Zika virus (ZIKV; pronounced or ) is a member of the virus family ''Flaviviridae''. It is spread by daytime-active ''Aedes'' mosquitoes, such as '' A. aegypti'' and '' A. albopictus''. Its name comes from the Ziika Forest of Uganda, where ...

and

West Nile virus West Nile virus (WNV) is a single-stranded RNA virus that causes West Nile fever. It is a member of the family ''Flaviviridae'', from the genus ''Flavivirus'', which also contains the Zika virus, dengue virus, and yellow fever virus. The virus ...

have also been associated. Viral association of transverse myelitis could result from the infection itself or from the response to it. Bacterial causes associated with TM include '' Mycoplasma pneumoniae'', '' Bartonella henselae'', and the types of ''

Borrelia ''Borrelia'' is a genus of bacteria of the spirochete phylum. Several species cause Lyme disease, also called Lyme borreliosis, a zoonotic, vector-borne disease transmitted by ticks. Other species of ''Borrelia'' cause relapsing fever, and are ...

'' that cause

Lyme disease Lyme disease, also known as Lyme borreliosis, is a tick-borne disease caused by species of ''Borrelia'' bacteria, Disease vector, transmitted by blood-feeding ticks in the genus ''Ixodes''. It is the most common disease spread by ticks in th ...

. Lyme disease gives rise to neuroborreliosis which is seen in a small percentage (4 to 5 per cent) of acute transverse myelitis cases. The diarrhea-causing bacteria ''

Campylobacter jejuni ''Campylobacter jejuni'' is a species of pathogenic bacteria that is commonly associated with poultry, and is also often found in animal feces. This species of microbe is one of the most common causes of food poisoning in Europe and in the US, w ...

'' is also a reported cause of transverse myelitis.{{Cite journal , vauthors=Ross AG, Olds GR, Cripps AW, Farrar JJ, McManus DP , date=May 2013 , title=Enteropathogens and chronic illness in returning travelers , journal=The New England Journal of Medicine , type=Review , volume=368 , issue=19 , pages=1817–1825 , doi=10.1056/NEJMra1207777 , pmid=23656647 , s2cid=13789364 , hdl-access=free , hdl=10072/54169 Other associated causes include the

helminth Parasitic worms, also known as helminths, are a polyphyletic group of large macroparasites; adults can generally be seen with the naked eye. Many are intestinal worms that are soil-transmitted and infect the gastrointestinal tract. Other par ...

infection

schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever is a neglected tropical helminthiasis, disease caused by parasitism, parasitic Schistosoma, flatworms called schistosomes. It affects both humans and animals. It affects ...

, spinal cord injuries, vascular disorders that impede the blood flow through vessels of the spinal cord, and paraneoplastic syndrome. Another exceptionally rare cause is heroin associated transverse myelitis.

Pathophysiology

This progressive loss of the fatty myelin sheath surrounding the nerves in the affected spinal cord occurs for unclear reasons following

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

s or due to

. Infections may cause TM through direct tissue damage or by immune-mediated infection-triggered tissue damage. The lesions present are usually inflammatory. Spinal cord involvement is usually central, uniform, and symmetric in comparison to

which typically affects the cord in a patchy way. The lesions in acute TM are mostly limited to the spinal cord with no involvement of other structures in the

central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...

Longitudinally extensive transverse myelitis

A proposed special clinical presentation is the "longitudinally extensive transverse myelitis" (LETM), which is defined as a TM with a spinal cord lesion that extends over three or more vertebral segments. The causes of LETM are also heterogeneous{{Cite journal , display-authors=6 , vauthors=Pekcevik Y, Mitchell CH, Mealy MA, Orman G, Lee IH, Newsome SD, Thompson CB, Pardo CA, Calabresi PA, Levy M, Izbudak I , date=March 2016 , title=Differentiating neuromyelitis optica from other causes of longitudinally extensive transverse myelitis on spinal magnetic resonance imaging , journal=Multiple Sclerosis , volume=22 , issue=3 , pages=302–311 , doi=10.1177/1352458515591069 , pmc=4797654 , pmid=26209588 and the presence of MOG auto-antibodies has been proposed as a diagnostic biomarker.{{Cite journal , display-authors=6 , vauthors=Cobo-Calvo Á, Sepúlveda M, Bernard-Valnet R, Ruiz A, Brassat D, Martínez-Yélamos S, Saiz A, Marignier R , date=March 2016 , title=Antibodies to myelin oligodendrocyte glycoprotein in aquaporin 4 antibody seronegative longitudinally extensive transverse myelitis: Clinical and prognostic implications , journal=Multiple Sclerosis , volume=22 , issue=3 , pages=312–319 , doi=10.1177/1352458515591071 , pmid=26209592 , s2cid=8356201

Diagnosis

Diagnostic criteria

In 2002, the Transverse Myelitis Consortium Working Group proposed the following diagnostic criteria for idiopathic acute transverse myelitis:{{Cite journal , vauthors=((Transverse Myelitis Consortium Working Group)) , date=August 2002 , title=Proposed diagnostic criteria and nosology of acute transverse myelitis , journal=Neurology , volume=59 , issue=4 , pages=499–505 , doi=10.1212/WNL.59.4.499 , pmid=12236201 {{columns-list, colwidth=30em, * Inclusion criteria ** Motor, sensory or autonomic dysfunction attributable to spinal cord ** Signs and symptoms on both sides of the body (not necessarily symmetrical) ** Clearly defined sensory level ** Signs of inflammation ( pleocytosis of the

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, transcellular body fluid found within the meninges, meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricular system, ven ...

, or elevated

immunoglobulin G Immunoglobulin G (IgG) is a type of antibody. Representing approximately 75% of serum antibodies in humans, IgG is the most common type of antibody found in blood circulation. IgG molecules are created and released by plasma B cells. Each IgG ...

, or evidence of inflammation on

gadolinium Gadolinium is a chemical element; it has Symbol (chemistry), symbol Gd and atomic number 64. It is a silvery-white metal when oxidation is removed. Gadolinium is a malleable and ductile rare-earth element. It reacts with atmospheric oxygen or moi ...

-enhanced (MRI) Magnetic resonance imaging) ** Peak of this condition can occur anytime between 4 hours to 21 days after onset * Exclusion criteria ** Irradiation of the spine (e.g.,

radiotherapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a treatment using ionizing radiation, generally provided as part of cancer therapy to either kill or control the growth of malignant cells. It is normally delivered by a linear particle ...

) in the last 10 years ** Evidence of thrombosis of the anterior spinal artery ** Evidence of extra-axial compression on neuroimaging ** Evidence of

arteriovenous malformation An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. Usually congenital, this vascular anomaly is widely known because of its occurrence in the central nervous system (usually ...

(abnormal flow voids on surface of spine) ** Evidence of

connective tissue disease Connective tissue diseases (also termed connective tissue disorders, or collagen vascular diseases), are medical conditions that affect connective tissue. Connective tissues protect, support, and provide structure for the body's other tissues a ...

, e.g.

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

, Behçet's disease, Sjögren's syndrome,

systemic lupus erythematosus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...

mixed connective tissue disease Mixed connective tissue disease (MCTD) is a systemic autoimmune disease that shares characteristics with at least two other systemic autoimmune diseases, including Systemic scleroderma, systemic sclerosis (Ssc), systemic lupus erythematosus (SLE),� ...

** Evidence of

optic neuritis Optic neuritis (ON) is a debilitating condition that is defined as inflammation of cranial nerve II which results in disruption of the neurologic pathways that allow visual sensory information received by the retina to be able to be transmitted to ...

(diagnostic of

(NMO)) ** Evidence of infection (

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...

Human immunodeficiency virus The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause AIDS, acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of th ...

, Human T-lymphotropic virus 1,

mycoplasma ''Mycoplasma'' is a genus of bacteria that, like the other members of the class ''Mollicutes'', lack a cell wall, and its peptidoglycan, around their cell membrane. The absence of peptidoglycan makes them naturally resistant to antibiotics ...

Herpes simplex virus Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) are two members of the Herpesviridae#Human herpesvirus types, human ''Herpesviridae'' family, a set of viruses that produce Viral disease, viral infections in the majority of humans. Both HSV-1 a ...

, Varicella-zoster virus, Epstein-Barr virus,

Human herpesvirus 6 Human herpesvirus 6 (HHV-6) is the common collective name for human herpesvirus 6A (HHV-6A) and human herpesvirus 6B (HHV-6B). These closely related viruses are two of the nine known herpesviruses that have humans as their primary host. HHV-6 ...

enterovirus ''Enterovirus'' is a genus of positive-sense single-stranded RNA viruses associated with several human and mammalian diseases. Enteroviruses are named by their transmission-route through the intestine ('enteric' meaning intestinal). Serologic ...

es) ** Evidence of

(abnormalities detected on MRI and presence of oligoclonal antibodies in

(CSF))

Investigations

Individuals who develop TM are typically transferred to a

neurologist Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the ...

who can urgently investigate the patient in a hospital. If

breathing Breathing (spiration or ventilation) is the rhythmical process of moving air into ( inhalation) and out of ( exhalation) the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxy ...

is affected, particularly in upper spinal cord lesions, methods of

artificial ventilation Artificial ventilation or respiration is when a machine assists in a metabolic process to exchange gases in the body by pulmonary ventilation, external respiration, and internal respiration. A machine called a ventilator provides the person air ...

must be on hand before and during the transfer procedure. The patient should also be

catheter In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...

ized to test for and, if necessary, drain an over-distended

bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distens ...

. A lumbar puncture can be performed after the MRI or at the time of CT myelography.

Corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s are often given in high doses when symptoms begin with the hope that the degree of inflammation and swelling of the spinal cord will be lessened, but whether this is truly effective is still debated.

Differential diagnosis

The

differential diagnosis In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...

of acute TM includes demyelinating disorders, such as

and

, infections, such as herpes zoster and herpes simplex virus, and other types of inflammatory disorders, such as

and neurosarcoidosis. It is important to also rule out an acute cause of compression on the spinal cord.

Treatment

If treated early, some people experience a complete or near complete recovery. Treatment options also vary according to the underlying cause. One treatment option includes

plasmapheresis Plasmapheresis (from the Greek language, Greek πλάσμα, ''plasma'', something molded, and ἀφαίρεσις ''aphairesis'', taking away) is the removal, treatment, and return or exchange of blood plasma or components thereof from and to the ...

. Recovery from TM is variable between individuals and also depends on the underlying cause. Some patients begin to recover between weeks 2 and 12 following onset and may continue to improve for up to two years. Other patients may never show signs of recovery.

Prognosis

The prognosis for TM depends on whether there is improvement in 3 to 6 months. Complete recovery is unlikely if no improvement occurs within this time. Incomplete recovery can still occur; however, aggressive physical therapy and rehabilitation will be very important. One-third of people with TM experience full recovery, one-third experience fair recovery but have significant neurological deficits, such as spastic gait. The final third experience no recovery at all.

Epidemiology

The incidence of TM is 4.6 per 1 million per year, affecting men and women equally. TM can occur at any age, but there are peaks around age 10, age 20, and after age 40.

History

The earliest reports describing the signs and symptoms of transverse myelitis were published in 1882 and 1910 by the English neurologist Henry Bastian.{{Cite book , url=https://books.google.com/books?id=jwlt4t3GKj4C&pg=PA96 , title=Inflammatory and Autoimmune Disorders of the Nervous System in Children , vauthors=Dale RC, Vincent A , publisher=John Wiley & Sons , year=2010 , isbn=978-1-898683-66-7 , pages=96–106 , access-date=2016-10-20 , archive-url=https://web.archive.org/web/20230111162547/https://books.google.com/books?id=jwlt4t3GKj4C&pg=PA96 , archive-date=2023-01-11 , url-status=live In 1928, Frank Ford noted that in

mumps MUMPS ("Massachusetts General Hospital Utility Multi-Programming System"), or M, is an imperative, high-level programming language with an integrated transaction processing key–value database. It was originally developed at Massachusetts Gen ...

patients who developed acute myelitis, symptoms only emerged after the mumps infection and associated symptoms began to recede. In an article in

The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...

, Ford suggested that acute myelitis could be a post-infection syndrome in most cases (i.e. a result of the body's immune response attacking and damaging the spinal cord) rather than an infectious disease where a virus or some other infectious agent caused paralysis. His suggestion was consistent with reports in 1922 and 1923 of rare instances in which patients developed "post-vaccinal encephalomyelitis" subsequent to receiving the

rabies Rabies is a viral disease that causes encephalitis in humans and other mammals. It was historically referred to as hydrophobia ("fear of water") because its victims panic when offered liquids to drink. Early symptoms can include fever and abn ...

vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifi ...

which then was made from brain tissue carrying the virus. The pathological examination of those who had died from the disease revealed inflammatory cells and demyelination as opposed to the vascular lesions predicted by Bastian. Ford's theory of an

allergic response An allergic response is a hypersensitive immune reaction to a substance that normally is harmless or would not cause an immune response in everyone. An allergic response may cause harmful symptoms such as itching or inflammation or tissue inju ...

being at the root of the disease was later shown to be only partially correct, as some infectious agents such as mycoplasma,

measles Measles (probably from Middle Dutch or Middle High German ''masel(e)'', meaning "blemish, blood blister") is a highly contagious, Vaccine-preventable diseases, vaccine-preventable infectious disease caused by Measles morbillivirus, measles v ...

and

rubella Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...

were isolated from the spinal fluid of some infected patients, suggesting that direct infection could contribute to the manifestation of acute myelitis in certain cases. In 1948, Dr. Suchett-Kaye described a patient with rapidly progressing impairment of lower extremity motor function that developed as a complication of pneumonia. In his description, he coined the term transverse myelitis to reflect the band-like thoracic area of altered sensation that patients reported. The term 'acute transverse myelopathy' has since emerged as an acceptable synonym for 'transverse myelitis', and the two terms are currently used interchangeably in the literature.{{Cite journal , vauthors=Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA , date=May 2004 , title=Transverse Myelitis: pathogenesis, diagnosis and treatment , journal=Frontiers in Bioscience , volume=9 , issue=1–3 , pages=1483–1499 , doi=10.2741/1351 , pmid=14977560 The definition of transverse myelitis has also evolved over time. Bastian's initial description included few conclusive diagnostic criteria; by the 1980s, basic diagnostic criteria were established, including acutely developing paraparesis combined with bilateral spinal cord dysfunction for <4 weeks and a well-defined upper sensory level, no evidence of spinal cord compression, and a stable, non-progressive course. Later definitions, were written to exclude patients with underlying systemic or neurological illnesses and to include only those who progressed to maximum deficit in fewer than 4 weeks.{{Cite journal , vauthors=Christensen PB, Wermuth L, Hinge HH, Bømers K , date=May 1990 , title=Clinical course and long-term prognosis of acute transverse myelopathy , journal=Acta Neurologica Scandinavica , volume=81 , issue=5 , pages=431–435 , doi=10.1111/j.1600-0404.1990.tb00990.x , pmid=2375246 , s2cid=44660348 , doi-access=free

Society and culture

In 2016, former Slipknot drummer

Joey Jordison Nathan Jonas "Joey" Jordison (April 26, 1975 – July 26, 2021) was an American musician. He was the original drummer of the nu metal band Slipknot (band), Slipknot, in which he was designated #1, and the guitarist for the horror punk Supergroup ...

revealed that he had been hospitalised by the disease in 2013 and that this was the reason for his controversial firing. As the first celebrity to publicly speak about having transverse myelitis, this helped to raise public awareness of the disease. Jordison died in his sleep on July 26, 2021,{{Cite web , title=Ex-Slipknot Drummer Joey Jordison Dies at 46 , url=https://www.billboard.com/articles/news/obituary/9606945/joey-jordison-dead-slipknot-drummer , access-date=July 28, 2021 , website=Billboard.com , vauthors=Atkinson K however it is not known whether the disease had any connection to his death.

Etymology

The word is from Latin: ''myelitis transversa'' and the disorder's name is derived from Greek {{transliteration, el, ''myelós'' referring to the "

", and the suffix ''

-itis Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

'', which denotes

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

.{{Cite book , url=https://archive.org/details/isbn_9780787691516 , title=The Gale Encyclopedia of Neurological Disorders , publisher=Thomson Gale , year=2005 , isbn=978-0-7876-9150-9 , veditors=Chamberlin SL, Narins B , location=Detroit , pages=1859–70 , url-access=registration

References

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