Editing Transverse myelitis (section)

==Signs and symptoms==
Symptoms include weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional [[Urethral sphincters|urethral]] and anal sphincter activities, and dysfunction of the [[autonomic nervous system]] that can lead to episodes of [[hypertension|high blood pressure]].<ref name="West2013" /> Symptoms typically develop for hours to a few weeks.<ref name="West2013">{{Cite journal |vauthors=West TW |date=October 2013 |title=Transverse myelitis--a review of the presentation, diagnosis, and initial management |url=http://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/ |url-status=live |journal=Discovery Medicine |volume=16 |issue=88 |pages=167–177 |pmid=24099672 |archive-url=https://web.archive.org/web/20191210202032/http://www.discoverymedicine.com/Timothy-W-West/2013/09/29/transverse-myelitis-a-review-of-the-presentation-diagnosis-and-initial-management/ |archive-date=2019-12-10 |access-date=2014-10-18}}</ref><ref name=":0">{{Cite journal |vauthors=Awad A, Stüve O |date=September 2011 |title=Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices |journal=Current Neuropharmacology |volume=9 |issue=3 |pages=417–428 |doi=10.2174/157015911796557948 |pmc=3151596 |pmid=22379456}}</ref> Sensory symptoms of TM may include a sensation of [[paresthesia|pins and needles]] traveling up from the feet.<ref name="West2013" />  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 [[dorsal root ganglion|spinal ganglion]] 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]] and mainly affects the muscles that [[Flexor muscles|flex the legs]] and [[Extensor muscles|extend the arms]].<ref name="West2013" />

Disturbances in [[sensory nerve]]s and [[motor nerve]]s and dysfunction of the [[autonomic nervous system]] at the level of the lesion or below, are noted. Therefore, the signs and symptoms depend on the area of the spine involved.<ref name="Dale2010" /> Back pain can occur at the level of any inflamed segment of the spinal cord.<ref name="West2013" />

If the upper [[Spinal cord#Spinal cord segments|cervical segment]] of the spinal cord is involved, all four limbs may be affected and there is the risk of [[respiratory failure]] – the [[phrenic nerve]] which is formed by the cervical spinal nerves [[C3 nerve|C3]], [[C4 nerve|C4]], and [[Cervical spinal nerve 5|C5]] innervates the main [[muscles of respiration|muscle of respiration]], the [[thoracic diaphragm|diaphragm]].<ref>{{Cite book |url=https://books.google.com/books?id=JNvuDwAAQBAJ&dq=Transverse+myelitis+upper+cervical+segment+of+the+spinal+cord+is+involved%2C+all+four+limbs+may+be+affected+and+there+is+risk+of+respiratory+failure&pg=PA122 |title=Diagnosis & Management of Neurological Disorders |vauthors=Misra UK, Kalita J |date=2011-01-01 |publisher=Wolters kluwer india Pvt Ltd |isbn=978-81-8473-191-0 |language=en}}</ref>

Lesions of the lower cervical region (C5–T1) will cause a combination of [[upper motor neuron|upper]] and [[lower motor neuron]] signs in the upper limbs, and exclusively upper motor neuron signs in the lower limbs. Cervical lesions account for about 20% of cases.<ref name="Dale2010" />

A lesion of the [[Spinal cord#Spinal cord segments|thoracic segment]] ([[Thoracic vertebrae|T1–12]]) will produce [[upper motor neuron]] signs in the lower limbs, presenting as a [[spasticity|spastic]] [[paraparesis]]. This is the most common location of the lesion,<!-- <ref name="Alexander2015">{{ --> and therefore most individuals will have weakness in the lower limbs.<ref name="Alexander2015">{{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}}</ref>

A lesion of the [[Spinal cord#Spinal cord segments|lumbar segment]], the lower part of the spinal cord ([[Lumbar vertebrae|L1]]–[[Vertebra#Sacral vertebrae|S5]]) often produces a combination of upper and lower motor neuron signs in the lower limbs. Lumbar lesions account for about 10% of cases.<ref name="Dale2010" />