Transverse myelitis is a rare inflammatory demyelinating disease caused by inflammation of the spinal cord. The underlying etiology may be infectious (e.g. Mycoplasma pneumoniae, Epstein-Barr virus [EBV; infectious mononucleosis] or cytomegalovirus [CMV]) or autoimmune (e.g. lupus, multiple sclerosis [MS], neuromyelitis optica spectrum disorder [NMOSD; read more here]).
The symptoms of transverse myelitis appear suddenly, over a period of a few hours to a few days, and can worsen rapidly. It may present with the clinical manifestations of:
Diagnosis is based on clinical examination of the symptoms and their sudden onset, together with brain and spinal cord magnetic resonance imaging (MRI). A lumbar puncture may help determine the diagnosis, and further tests (notably blood tests) are needed to determine the cause of the myelitis. These tests will also help to determine if this first episode will remain isolated (as is the case of infectious myelitis, which is most common) or if it is the first attack of a neurological condition, like neuromyelitis optica spectrum disorder (NMOSD).
Treatment must be initiated rapidly in order to limit the risk of sequelae.
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