Editing Transverse myelitis

{{short description|Inflammation of the entire cross-section of the spinal cord}}
{{Infobox medical condition (new)
| name            = Transverse myelitis
| image           = Transverse_myelitis_MRI.jpg
| caption         = An [[Magnetic resonance imaging|MRI]] showing a transverse myelitis lesion, which is lighter, oval shape at center-right. The patient recovered 3 months later.
| field           = [[Neurology]]
| symptoms        = Weakness of the limbs<ref name="West2013" />
| complications   =
| onset           =
| duration        =
| types           =
| causes          = Uncertain<ref name="gar">{{Cite web |title=Transverse myelitis |url=https://rarediseases.info.nih.gov/diseases/7796/transverse-myelitis |url-status=live |archive-url=https://web.archive.org/web/20180104013833/https://rarediseases.info.nih.gov/diseases/7796/transverse-myelitis |archive-date=4 January 2018 |access-date=3 January 2018 |website=Genetic and Rare Diseases Information Center (GARD) – an NCATS Program}}</ref>
| risks           =
| diagnosis       = Neurological exam<ref name=gar/>
| differential    =
| prevention      =
| treatment       = [[Corticosteroids]]<ref name=gar/>
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}

<!-- Definition and symptoms -->
'''Transverse myelitis''' ('''TM''') is a rare [[neurological]] condition wherein the [[spinal cord]] is [[Inflammation|inflamed]]. The adjective ''[[wikt:transverse#Adjective|transverse]]'' implies that the spinal inflammation ([[myelitis]]) extends horizontally throughout the [[cross section (geometry)|cross section]] of the spinal cord;<ref name="West2013" /> 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.<ref name="West2013" /> 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]] that can lead to episodes of [[high blood pressure]]. 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 [[axon|nerve fibers]], by [[demyelination|loss of myelin]].<ref name="West2013" /> As opposed to [[leukomyelitis]] which affects only the [[white matter]], it affects the entire cross-section of the spinal cord.<ref name="servant99">{{Cite book |title=Klinische Neurologie |vauthors=Servant S |year=1999 |isbn=978-3-662-08119-8 |veditors=Knecht S |pages=485–96 |chapter=Entzündliche Rückenmarkerkrankungen |doi=10.1007/978-3-662-08118-1_21}}</ref> Decreased [[Nerve conduction velocity|electrical conductivity]] in the nervous system can result.{{citation needed|date=July 2018}}
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==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" />

==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>

==Pathophysiology==
This [[demyelination|progressive loss of the fatty myelin sheath]] surrounding the nerves in the affected spinal cord occurs [[idiopathic|for unclear reasons]] following [[infection]]s or due to [[multiple sclerosis]]. Infections may cause TM through direct tissue damage or by immune-mediated infection-triggered tissue damage.<ref name=":0" /> The lesions present are usually inflammatory. Spinal cord involvement is usually central, uniform, and symmetric in comparison to [[multiple sclerosis]] 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]].<ref name=":0" />

===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.<ref>{{Cite journal |vauthors=Cuello JP, Romero J, de Ory F, de Andrés C |date=September 2013 |title=Longitudinally extensive varicella-zoster virus myelitis in a patient with multiple sclerosis |journal=Spine |volume=38 |issue=20 |pages=E1282–E1284 |doi=10.1097/BRS.0b013e31829ecb98 |pmid=23759816 |s2cid=205519782}}</ref> The causes of LETM are also heterogeneous<ref name="pmid26209588">{{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}}</ref> and the presence of [[myelin oligodendrocyte glycoprotein|MOG]] auto-antibodies has been proposed as a diagnostic biomarker.<ref name="pmid26209592">{{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}}</ref>

==Diagnosis==
[[File:Transverse Myelitis.PNG|thumb|Axial [[Magnetic resonance imaging#T1 and T2|T2 MRI]] of cervical spine demonstrating normal cord signal (green circle) and increased T2 signal in the central cord (red circle).]]

===Diagnostic criteria===
In 2002, the Transverse Myelitis Consortium Working Group proposed the following diagnostic criteria for idiopathic acute transverse myelitis:<ref name="WorkingGroup2002">{{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}}</ref>
{{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]], or elevated [[immunoglobulin G]], or evidence of inflammation on [[gadolinium]]-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]]) in the last 10 years
** Evidence of thrombosis of the [[anterior spinal artery]]
** Evidence of extra-axial compression on neuroimaging
** Evidence of [[arteriovenous malformation]] (abnormal flow voids on surface of spine)
** Evidence of [[connective tissue disease]], e.g. [[sarcoidosis]], [[Behçet's disease]], [[Sjögren's syndrome]], [[systemic lupus erythematosus]] or [[mixed connective tissue disease]]
** Evidence of [[optic neuritis]] (diagnostic of [[neuromyelitis optica]] (NMO))
** Evidence of infection ([[syphilis]], [[Lyme disease]], [[Human immunodeficiency virus]], [[Human T-lymphotropic virus 1]], [[mycoplasma]], [[Herpes simplex virus]], [[Varicella-zoster virus]], [[Epstein-Barr virus]], [[cytomegalovirus]], [[Human herpesvirus 6]] or [[enterovirus]]es)
** Evidence of [[multiple sclerosis]] (abnormalities detected on MRI and presence of oligoclonal antibodies in [[cerebrospinal fluid]] (CSF))
}}

===Investigations===
Individuals who develop TM are typically transferred to a [[neurologist]] who can urgently investigate the patient in a hospital. If [[breathing]] is affected, particularly in upper spinal cord lesions, methods of [[Mechanical ventilation|artificial ventilation]] must be on hand before and during the transfer procedure. The patient should also be [[catheter]]ized to test for and, if necessary, drain an over-distended [[urinary bladder|bladder]]. A [[lumbar puncture]] can be performed after the MRI or at the time of  [[Computed tomography|CT]] [[myelography]]. [[Corticosteroid]]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.<ref name="gar" />

===Differential diagnosis===
The [[differential diagnosis]] of acute TM includes [[demyelination|demyelinating]] disorders, such as [[multiple sclerosis]] and [[neuromyelitis optica]], infections, such as herpes zoster and herpes simplex virus, and other types of [[inflammation|inflammatory]] disorders, such as [[systemic lupus erythematosus]] and [[neurosarcoidosis]]. It is important to also rule out an acute cause of compression on the spinal cord.<ref>{{Cite journal |vauthors=Jacob A, Weinshenker BG |date=February 2008 |title=An approach to the diagnosis of acute transverse myelitis |journal=Seminars in Neurology |volume=28 |issue=1 |pages=105–120 |doi=10.1055/s-2007-1019132 |pmid=18256991 |doi-access=free}}</ref>

==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]].<ref>{{Cite book |url=https://books.google.com/books?id=LxQkUu2tfXcC |title=Multiple Sclerosis Therapeutics |vauthors=Cohen JA, Rudick RA |publisher=Cambridge University Press |year=2011 |isbn=978-1-139-50237-5 |page=625 |access-date=2015-10-30 |archive-url=https://web.archive.org/web/20230111162541/https://books.google.com/books?id=LxQkUu2tfXcC |archive-date=2023-01-11 |url-status=live}}</ref> 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.<ref>{{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=2007-09-16 |publisher=National Institute of Neurological Disorders and Stroke (NINDS) |quote=About one-third of patients do not recover at all: These patients are often wheelchair-bound or bedridden, with marked dependence on others for basic functions of daily living.}}</ref>

==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.<ref name="NIH_2015" />

==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.<ref>{{Cite book |url=https://books.google.com/books?id=T5UMm9iSekwC&q=transverse+myelitis+epidemiology&pg=PA417 |title=Neurology |vauthors=Mumenthaler M, Mattle H |publisher=Thieme |year=2011 |isbn=978-1-60406-135-2}}</ref>

==History==
[[File:PSM V08 D008 Henry Charlton Bastian.jpg|150 px|thumb| Henry Charlton Bastian]]
The earliest reports describing the signs and symptoms of transverse myelitis were published in 1882 and 1910 by the English neurologist [[Henry Charlton Bastian|Henry Bastian]].<ref name="Dale2010">{{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}}</ref><ref>{{Cite book |url=https://books.google.com/books?id=hi0AAAAAQAAJ&pg=PA998 |title=A Dictionary of Medicine: Including General Pathology, General Therapeutics, Hygiene, and the Diseases Peculiar to Women and Children |publisher=Longmans, Green, and Company |year=1882 |veditors=Quain R |volume=2 |pages=1479–83}}</ref>

In 1928, Frank Ford noted that in [[mumps]] patients who developed acute myelitis, symptoms only emerged after the mumps infection and associated symptoms began to recede. In an article in [[The Lancet]], 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]] [[vaccine]] 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.<ref>{{Cite news |title=The History of TM: The Origins of the Name and the Identification of the Disease |url=https://myelitis.org/resources/the-history-of-tm-the-origins-of-the-name-and-the-identification-of-the-disease/ |url-status=live |archive-url=https://web.archive.org/web/20180722130041/https://myelitis.org/resources/the-history-of-tm-the-origins-of-the-name-and-the-identification-of-the-disease/ |archive-date=2018-07-22 |access-date=2018-07-22 |work=The Transverse Myelitis Association |language=en-US |vauthors=Kerr D}}</ref>

Ford's theory of an [[Allergy|allergic response]] being at the root of the disease was later shown to be only partially correct, as some infectious agents such as mycoplasma, [[measles]] and [[rubella]]<ref>{{Cite journal |vauthors=Morris MH, Robbins A |date=1943-09-01 |title=Acute infectious myelitis following rubella |url=http://www.jpeds.com/article/S0022-3476(43)80017-2/fulltext |url-status=live |journal=The Journal of Pediatrics |volume=23 |issue=3 |pages=365–67 |doi=10.1016/S0022-3476(43)80017-2 |archive-url=https://web.archive.org/web/20210829093227/https://www.jpeds.com/article/S0022-3476%2843%2980017-2/fulltext |archive-date=2021-08-29 |access-date=2018-01-29}}</ref> 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.<ref>{{Cite web |last=Douglas |first=Kerr, MD, PhD |date=Sep 1, 1998 |title=The History of TM: The Origins of the Name and the Identification of the Disease, Disorders: Spinal Stroke or AVM, Transverse Myelitis |url=https://wearesrna.org/resources/the-history-of-tm-the-origins-of-the-name-and-the-identification-of-the-disease/}}</ref>

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.<ref name="Dale2010" /> 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.<ref name="pmid14977560">{{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}}</ref>

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.<ref>{{Cite journal |vauthors=Berman M, Feldman S, Alter M, Zilber N, Kahana E |date=August 1981 |title=Acute transverse myelitis: incidence and etiologic considerations |journal=Neurology |volume=31 |issue=8 |pages=966–971 |doi=10.1212/WNL.31.8.966 |pmid=7196523 |s2cid=42676273}}</ref><ref>{{Cite journal |vauthors=Ropper AH, Poskanzer DC |date=July 1978 |title=The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms |journal=Annals of Neurology |volume=4 |issue=1 |pages=51–59 |doi=10.1002/ana.410040110 |pmid=697326 |s2cid=38183956}}</ref> 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.<ref name="pmid2375246">{{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}}</ref>

==Society and culture==
In 2016, former [[Slipknot (band)|Slipknot]] drummer [[Joey Jordison]] revealed that he had been hospitalised by the disease in 2013 and that this was the reason for his controversial firing.<ref>{{Cite web |title=Ex-Slipknot Drummer Reveals Struggle With Rare Disease: 'I Lost My Legs' |url=https://www.billboard.com/articles/columns/rock/7407899/slipknot-joey-jordison-disease-split-golden-gods |url-status=live |archive-url=https://web.archive.org/web/20210710023506/https://www.billboard.com/articles/columns/rock/7407899/slipknot-joey-jordison-disease-split-golden-gods |archive-date=July 10, 2021 |access-date=July 3, 2021 |website=Billboard.com}}</ref> 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,<ref>{{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}}</ref> 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 "[[spinal cord]]", and the suffix ''[[wikt:-itis|-itis]]'', which denotes [[inflammation]].<ref name="Chamberlin_2005">{{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}}</ref>

== See also ==
* [[Acute disseminated encephalomyelitis]]

== References ==
{{reflist|32em}}

== Further reading ==
{{refbegin}}
* {{Cite book |url=https://books.google.com/books?id=FiMoQ-OtbB0C&q=transverse+myelitis+nih&pg=PA911 |title=Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation |vauthors=Frontera WR, Silver JK, Rizzo TD |date=2008 |publisher=Elsevier Health Sciences |isbn=978-1-4160-4007-1}}
* {{Cite book |url=https://books.google.com/books?id=zKgMHabsTwMC |title=The Encyclopedia of Autoimmune Diseases |vauthors=Cassell DK, Rose NR |date=2003 |publisher=Infobase Publishing |isbn=978-1-4381-2094-2 |access-date=2015-10-30 |archive-url=https://web.archive.org/web/20230111162542/https://books.google.com/books?id=zKgMHabsTwMC |archive-date=2023-01-11 |url-status=live}}
{{refend}}

{{Medical resources
|  DiseasesDB     = 13265
| ICD11           = {{ICD11|8A41.0}}
|  ICD10          = {{ICD10|G|37|3|g|35}}
|  ICD9           = {{ICD9|323.82}}, {{ICD9|341.2}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    =
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D009188
}}
{{Commons}}

{{Scholia|topic}}

{{Spinal cord lesions}}
{{Diseases of the nervous system}}
{{Paraneoplastic syndromes}}
{{Authority control}}

[[Category:Autoimmune diseases]]
[[Category:Syndromes]]
[[Category:Central nervous system disorders]]
[[Category:Multiple sclerosis]]
[[Category:Rare diseases]]
[[Category:Myelin disorders]]