Editing Transverse myelitis (section)

==Causes==
[[File:Borrelia burgdorferi-cropped.jpg|thumb|200 px|''[[Borrelia burgdorferi]]'' [[spirochetes]] cause [[Lyme disease]] and are one of many infections associated with transverse myelitis.]]
[[File:Cytomegalovirus 01.jpg|thumb|left|Cytomegalovirus]]
TM is a [[heterogeneous condition]], that is, there are several identified causes. Sometimes the term ''Transverse myelitis spectrum disorder'' is used.<ref>{{Cite journal |vauthors=Pandit L |date=Mar–Apr 2009 |title=Transverse myelitis spectrum disorders |journal=Neurology India |volume=57 |issue=2 |pages=126–133 |doi=10.4103/0028-3886.51278 |pmid=19439840 |doi-access=free |hdl-access=free |hdl=1807/56285}}</ref> In 60% of patients the cause is [[idiopathic]].<ref>{{Cite news |title=What is Transverse Myelitis (TM)? {{!}} Johns Hopkins Transverse Myelitis Center |url=https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/transverse_myelitis/about-tm/what-is-transverse-myelitis.html |url-status=live |archive-url=https://web.archive.org/web/20180722141553/https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/transverse_myelitis/about-tm/what-is-transverse-myelitis.html |archive-date=2018-07-22 |access-date=2018-07-22 |language=en}}</ref> In rare cases, it may be associated with [[meningococcal meningitis]]<ref name="khare90">{{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}}</ref>

When it appears as a [[comorbidity|comorbid]] condition with [[neuromyelitis optica]] (NMO), it is considered to be caused by NMO-[[Immunoglobulin G|IgG]] autoimmunity, and when it appears in [[multiple sclerosis]] (MS) cases, it's misdiagnosed as multiple sclerosis (MS) or seen as a type of <abbr>MS</abbr>. But <abbr>NMO</abbr> is a different condition.<ref>{{Cite web |title=Neuromyelitis optica |url=https://www.mayoclinic.org/diseases-conditions/neuromyelitis-optica/symptoms-causes/syc-20375652 |url-status=live |archive-url=https://web.archive.org/web/20200714020222/https://www.mayoclinic.org/diseases-conditions/neuromyelitis-optica/symptoms-causes/syc-20375652 |archive-date=July 14, 2020 |access-date=April 4, 2024 |website=Mayo Clinic}}</ref>

Other causes of TM include infections, immune system disorders, and [[demyelinating disease]]s.<ref name="NIH_2015">{{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)}}</ref>  [[Viral disease|Viral]] infections known to be associated with TM include [[HIV]], [[herpes simplex]], [[herpes zoster]], [[cytomegalovirus]], and [[Epstein-Barr virus|Epstein-Barr]].<ref name="Levin2018">{{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}}</ref> [[Flavivirus]] infections such as [[Zika virus]] and [[West Nile virus]] have also been associated. Viral association of  transverse myelitis could result from the infection itself or from the response to it.<ref name="NIH_2015" /> Bacterial causes associated with TM include ''[[Mycoplasma pneumoniae]]'',  ''[[Bartonella henselae]]'', and the types of ''[[Borrelia]]'' that cause [[Lyme disease]]. Lyme disease gives rise to [[neuroborreliosis]]  which is seen in a small percentage (4 to 5  per cent) of acute transverse myelitis cases.<ref>{{Cite journal |display-authors=6 |vauthors=Blanc F, Froelich S, Vuillemet F, Carré S, Baldauf E, de Martino S, Jaulhac B, Maitrot D, Tranchant C, de Seze J |date=November 2007 |title=[Acute myelitis and Lyme disease] |journal=Revue Neurologique |volume=163 |issue=11 |pages=1039–1047 |doi=10.1016/S0035-3787(07)74176-0 |pmid=18033042}}</ref> The diarrhea-causing bacteria ''[[Campylobacter jejuni]]'' is also a reported cause of transverse myelitis.<ref name="Ross2013">{{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}}</ref>

Other associated causes include the [[helminthiasis|helminth]] infection [[schistosomiasis]], spinal cord injuries, vascular disorders that impede the blood flow through vessels of the spinal cord, and [[paraneoplastic syndrome]].<ref name="NIH_2015" /> Another exceptionally rare cause is heroin associated transverse myelitis.<ref>{{Cite journal |vauthors=Hussain M, Shafer D, Taylor J, Sivanandham R, Vasquez H |date=2023-07-02 |title=Heroin-Induced Transverse Myelitis in a Chronic Heroin User: A Case Report |journal=Cureus |language=en |volume=15 |issue=7 |pages=e41286 |doi=10.7759/cureus.41286 |issn=2168-8184 |pmc=10315196 |pmid=37405127 |doi-access=free}}</ref><ref>{{Cite journal |vauthors=Sidhu MK, Mekala AP, Ronen JA, Hamdan A, Mungara SS |date=June 2021 |title=Heroin Relapse "Strikes a Nerve": A Rare Case of Drug-Induced Acute Myelopathy |journal=Cureus |volume=13 |issue=6 |pages=e15865 |doi=10.7759/cureus.15865 |pmc=8301723 |pmid=34327090 |doi-access=free}}</ref>