Transverse myelitis: symptoms and causes
Transverse myelitis is inflammation of the spinal cord. It can cause weakness, numbness, pain, and bladder or bowel changes that build over hours to days. New weakness with numbness, or trouble passing urine, needs urgent care.
Quick facts
- Symptoms usually affect the body at and below the inflamed part of the cord.
- Many people feel a band of odd feeling around the trunk.
- In the US, about 1 to 8 new cases are found per million people each year.
- Causes include immune diseases, infections, and other inflammation. Often no cause is found.
- Most people have at least partial recovery, mostly in the first three months.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis; Transverse Myelitis Consortium Working Group, Neurology 2002.
What is transverse myelitis?
The spinal cord carries messages between the brain and the body. In transverse myelitis, inflammation harms a section of the cord. It often damages myelin, the coating that covers nerve fibers. Messages then slow down or stop at that point.
The word "transverse" describes the pattern. The problem runs across the cord at one level. So symptoms often start at a line on the body and affect the parts below it. The upper back is the most common site.
Doctors also sort cases by speed. Acute myelitis builds over minutes to several days. Subacute myelitis builds over one to four weeks. In the formal criteria, the worst point comes between 4 hours and 21 days after symptoms begin.
Some episodes affect the whole width of the cord and cause weakness and numbness on both sides. Others affect only part of it and cause uneven changes. Doctors call these complete and partial myelitis, and they note which pattern a person has.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis; Transverse Myelitis Consortium Working Group, Neurology 2002.
Transverse myelitis symptoms
Symptoms often come on fast. Back pain is often first. Weakness, odd feelings, and bladder trouble may follow over hours to days.
| Area | What a person may notice | Detail worth telling the team |
|---|---|---|
| Strength | Legs feel weak or heavy; arms too if the neck is involved | Which tasks got harder, and how fast |
| Feeling | Numbness, burning, tingling, or a tight band around the trunk | Where the change starts and how far it spreads |
| Pain | Low back pain, or sharp pain down the legs, arms, or around the torso | When it began and whether it is getting worse |
| Bladder and bowel | Urgency, leaking, trouble passing urine, constipation | Whether this is new for you |
| Other | Muscle spasms, sexual problems, a general unwell feeling | Anything that changed at the same time |
Weakness in the legs can get worse quickly. Some people lose the use of their legs. In rare cases, breathing is affected. That is an emergency.
Bladder changes are very common in this condition. Even if you can still walk, a new problem passing urine is worth reporting at once.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis.
When to get urgent care
Get urgent care right away if you have new weakness in your legs or arms, numbness that is spreading, or you cannot pass urine. Call 911 if breathing is hard.
Speed matters for a reason. Other problems can look just like myelitis at first. Something may be pressing on the cord. A tumor or a blood vessel problem in the cord can also look the same. These need a different kind of care, so doctors check for them first, before they settle on inflammation.
A short timeline helps the team. Note when each change began and what you can no longer do. Mention any recent infection, injury, or past nerve symptoms. A clear timeline helps more than a guess about the cause.
Sources: Transverse Myelitis Consortium Working Group, Neurology 2002; NINDS: transverse myelitis.
What causes transverse myelitis?
Transverse myelitis is usually set off by another condition. The main groups are below. In many people, no cause is found even after a full workup. Doctors call this idiopathic, which means the cause is unknown.
| Cause group | Examples | What it means |
|---|---|---|
| Immune diseases of the nervous system | MS, NMOSD, MOGAD | Myelitis can be the first sign of one of these |
| Immune reaction after an infection or, rarely, a vaccine | The immune system attacks the cord by mistake | It may follow a recent illness |
| Infection | Herpes viruses, West Nile virus, enteroviruses, some bacteria and fungi | It is not always clear if the germ or the immune response does the harm |
| Body-wide inflammatory disease | Lupus, Sjogren's syndrome, sarcoidosis | The cord can be one of several organs involved |
| Immune reaction to a cancer | Rare | Doctors may look for a hidden tumor |
Transverse myelitis can affect people of any age, sex, or race. It does not seem to run in families. It is most common in people aged 10 to 19 and in people in their thirties.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis.
How doctors diagnose it
Doctors start with your history and a full nerve exam. The exam shows roughly where in the cord the problem sits. Tests then confirm the inflammation and look for a cause.
| Test | Main question it answers |
|---|---|
| Spine MRI | Is there a lesion in the cord, and is anything pressing on it? |
| Brain MRI | Are there signs that point to MS or a related disease? |
| Spinal tap (lumbar puncture) | Are there signs of infection or inflammation in the spinal fluid? |
| Blood tests | Could an infection, low vitamin B12, or another illness explain it? |
| AQP4 and MOG antibody tests | Do NMOSD or MOGAD fit the picture? |
MRI almost always shows the damaged area in the cord. Still, the scan alone does not predict how well someone will recover. Results make the most sense when the team reads them with the exam and the timeline.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis; NINDS: neuromyelitis optica spectrum disorder.
Transverse myelitis vs MS
Transverse myelitis names an event: inflammation in the spinal cord. MS is a long-term disease that can cause that event. It can also cause damage in the brain and optic nerves. So one does not equal the other.
| Question | Transverse myelitis | Multiple sclerosis |
|---|---|---|
| What is it? | An attack of spinal cord inflammation | A chronic immune disease of the brain and spinal cord |
| How often does it happen? | Most cases are a single event | Most people have repeat attacks with breaks between them |
| Pattern in the cord | Often central and even across the cord | Smaller patches toward the edge of the cord |
| Role of a brain MRI | Helps look for a wider cause | Brain lesions are a key clue |
Myelitis is more likely to come back when an underlying disease such as MS or NMOSD caused it. That is one reason doctors may follow people over time. To learn how MS is confirmed, read how MS is diagnosed. The related conditions MOGAD and NMOSD also cause myelitis.
Sources: NINDS: transverse myelitis; NINDS: multiple sclerosis; AAPM&R KnowledgeNow: transverse myelitis.
Treatment and recovery
Treatment depends on the cause, and a specialist decides what fits. Early on, doctors may consider IV steroids to calm the inflammation. If those do not help enough, plasma exchange or IV immunoglobulin (IVIG) may be options. If an infection is the cause, doctors treat the infection. Other medicines may help with pain, spasms, and bladder problems.
Most people have at least partial recovery. For cases with no known cause, NIH figures are often split into rough thirds. About one third recover fully, one third keep some problems, and one third have major lasting deficits. Most recovery happens in the first three months. Strength can keep improving for a year or longer, and sometimes for years.
Rehab is a big part of care. A team may include rehab doctors, physical and occupational therapists, and mental health care. Recovery is more than walking. Changes in feeling, pain, tiredness, and bladder or sexual problems can stay even when walking improves. Ask the team how to report a new problem, so it is not written off as part of recovery.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis.
Who this page is for
If you have just heard the words transverse myelitis, this page is meant for you and for the family sitting with you. It may also help clinicians who want a plain summary to share. If you are reading this from a hospital bed, you are not expected to have the answers yet. Start with one question for your team: what is the next test, and what will it tell us?
Questions people ask
Is transverse myelitis the same as MS?
No. Transverse myelitis is an attack of spinal cord inflammation. MS is a long-term disease that can cause such attacks, but so can NMOSD, MOGAD, infections, and other conditions. A brain MRI and spinal fluid tests help doctors judge whether MS is likely. Most cases of transverse myelitis are a single event, and the name alone does not prove any long-term diagnosis.
What are the first signs of transverse myelitis?
Back pain is often the first sign. It can be low back pain, or sharp pain that shoots down the legs or arms or around the trunk. Over hours to days, weakness, numbness or tingling, and bladder changes may follow. Many people notice a band of odd feeling around the chest or belly. If weakness or bladder trouble is new and getting worse, get urgent care.
Is transverse myelitis curable?
There is no single cure, but most people get at least some function back. Early treatment aims to calm the inflammation and treat any cause that is found. Rehab helps people regain strength and daily skills. Some people recover with few or no lasting problems. Others keep weakness, pain, or bladder issues. A specialist can explain what is likely in your case.
How long does recovery from transverse myelitis take?
Most recovery happens in the first three months after symptoms begin. Healing can go on for many months, and strength can keep improving for a year or more. Some people see gains years later with rehab. The pace differs from person to person, so ask your team which signs of progress they will track and when.
What are the long-term effects of transverse myelitis?
Some people have no lasting problems. Others live with weakness, stiffness, nerve pain, tiredness, or bladder, bowel, or sexual problems. Some use a cane, braces, or a wheelchair. Mood can be affected too, and counseling is part of care for many people. These effects deserve attention even when walking looks fine.
What is pediatric transverse myelitis?
It is transverse myelitis in a child. It causes the same kinds of symptoms: weakness, numbness, and bowel or bladder changes. Doctors look at the same causes, plus acute flaccid myelitis, a related illness. Cases are less common in children than in adults. Data suggest 30 to 50 percent of children make a full recovery. Our pediatric neuroimmunology page covers care for children.
Sources: NINDS: transverse myelitis; AAPM&R KnowledgeNow: transverse myelitis; Wang and Greenberg, Children 2019.
Sources
- NINDS: transverse myelitis
- NINDS: neuromyelitis optica spectrum disorder
- NINDS: multiple sclerosis
- AAPM&R KnowledgeNow: transverse myelitis
- Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002
- Wang C, Greenberg B. Clinical approach to pediatric transverse myelitis, NMOSD and acute flaccid myelitis. Children 2019