U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

Public Health Service

National Institutes of Health

Transverse 

Myelitis

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Transverse Myelitis

What is transverse myelitis?

Transverse myelitis is a neurological disorder caused by inflammation across both sides 

of one level, or segment, of the spinal cord. The 

term myelitis refers to inflammation of the 

spinal cord; transverse describes the position 

of the inflammation—across the width of the 

spinal cord. Attacks of inflammation can 

damage or destroy myelin, the fatty insulating 

substance that covers nerve cell fibers. This 

damage causes nervous system scars that 

interrupt communications between the nerves 

in the spinal cord and the rest of the body. 

Symptoms of transverse myelitis include 

a loss of spinal cord function over several 

hours to several weeks. What usually begins 

as a sudden onset of lower back pain, muscle 

weakness, or abnormal sensations in the toes 

and feet can rapidly progress to more severe 

symptoms, including paralysis, urinary retention, and loss of bowel control. Although some 

individuals recover from transverse myelitis 

with minor or no residual problems, others 

suffer permanent impairments that affect 

their ability to perform ordinary tasks of 

daily living. Most individuals will have only 

one episode of transverse myelitis; a small 

percentage may have a recurrence.
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The segment of the spinal cord at which the 

damage occurs determines which parts of the 

body are affected. Nerves in the cervical

(neck) region control signals to the neck, 

arms, hands, and the muscles that control 

breathing (the diaphragm). Nerves in the 

thoracic (upper back) region relay signals to 

the torso and some parts of the arms. Nerves 

at the lumbar (mid-back) level control signals 

to the hips and legs. Finally, sacral nerves, 

located within the lowest segment of the 

spinal cord, relay signals to the groin, toes, 

and some parts of the legs. Damage at one 

segment will affect function at that segment 

and segments below it. In individuals with 

transverse myelitis, demyelination usually 

occurs at the thoracic level, causing problems 

with leg movement and bowel and bladder 

control, which require signals from the lower 

segments of the spinal cord. 

Who gets transverse myelitis?

Transverse myelitis occurs in adults and children, in both genders, and in all races. 

A peak in incidence rates (the number of new 

cases per year) appears to occur between 

ages 10 and 19 years and 30 and 39 years. 

Although only a few studies have examined 

incidence rates, it is estimated that about 

1,400 new cases of transverse myelitis are 

diagnosed each year in the United States, and 

approximately 33,000 Americans have some 

type of disability resulting from the disorder. 
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What causes transverse myelitis?

Researchers are uncertain of the exact causes of transverse myelitis. The 

inflammation that causes such extensive 

damage to nerve fibers of the spinal cord 

may result from viral infections or abnormal 

immune reactions. Transverse myelitis also 

may occur as a complication of syphilis, 

measles, Lyme disease, and some vaccinations, including those for chickenpox, 

pertussis, and rabies. Cases in which a cause 

cannot be identified are called idiopathic. 

Transverse myelitis often develops following 

viral infections. Infectious agents suspected 

of causing transverse myelitis include varicella zoster (the virus that causes chickenpox 

and shingles), herpes simplex, cytomegalovirus, Epstein-Barr, influenza, echovirus, 

human immunodeficiency virus (HIV), 

hepatitis A, and rubella. Bacterial skin 

infections, middle-ear infections (otitis 

media), and bacterial pneumonia also 

have been associated with the condition. 

In post-infectious cases of transverse myelitis, 

immune system mechanisms, rather than 

active viral or bacterial infections, appear to 

play an important role in causing damage to 

spinal nerves. Although researchers have not 

yet identified the precise mechanisms of 

spinal cord injury in these cases, stimulation 

of the immune system in response to infection 

indicates that an autoimmune reaction may be 

responsible. This theory is further reinforced 

by the observation that some individuals 

who experience transverse myelitis also 
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have such autoimmune diseases as systemic 

lupus erythematosus, Sjogren’s syndrome, 

and sarcoidosis. In autoimmune diseases, the 

immune system—which normally protects 

the body from foreign organisms—mistakenly 

attacks the body’s own tissue. This can cause 

inflammation and, in some cases, damage to 

myelin within the spinal cord.

In addition, some cancers may trigger an 

abnormal immune response that may lead 

to transverse myelitis. 

In some people, transverse myelitis represents the first symptom of an underlying 

demyelinating disease of the central nervous 

system such as multiple sclerosis (MS) or 

neuromyelitis optica (NMO). A form of transverse myelitis known as “partial” myelitis, 

because it affects only a portion of the crosssectional area of the spinal cord, is more 

characteristic of MS. Neuromyelitis optica 

typically causes both transverse myelitis 

and optic neuritis (inflammation of the optic 

nerve that results in visual loss), but not 

necessarily at the same time. All individuals 

with transverse myelitis should be evaluated for MS or NMO because people with 

these diagnoses may require different forms 

of treatment, including therapies to prevent 

future attacks.
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What are the symptoms of 

transverse myelitis?

Transverse myelitis may be either acute(developing over hours to several days) 

or subacute (usually developing over 1 to 4 

weeks). Initial symptoms usually include 

localized lower back pain, sudden paresthesias

(abnormal sensations such as burning, tickling, pricking, or tingling) in the legs, sensory 

loss, and paraparesis (partial paralysis of the 

legs). Paraparesis may progress to paraplegia 

(paralysis of the legs and lower part of the 

trunk). Bladder and bowel dysfunction is 

common. Many people also report experiencing muscle spasms, a general feeling 

of discomfort, headache, fever, and loss of 

appetite. Depending on which segment of the 

spinal cord is involved, some individuals may 

experience respiratory problems as well. 

From this wide array of symptoms, four 

classic features of transverse myelitis emerge: 

1) weakness of the legs and arms, 2) pain, 

3) a change in sensation, and 4) bowel and 

bladder dysfunction. Most people will experience weakness of varying degrees in their 

legs; some also experience it in their arms. 

Initially, people with transverse myelitis may 

notice that they are stumbling or dragging 

one foot or that their legs seem heavier than 

normal. Coordination of hand and arm movements, as well as arm and hand strength, 

may also be compromised. Progression of the 

disease may lead to full paralysis of the legs, 

requiring the individual to use a wheelchair.
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Pain is the primary symptom of transverse 

myelitis in approximately one-third to onehalf of all individuals. The pain may be 

localized in the lower back or may consist of 

sharp, shooting sensations that radiate down 

the legs or arms or around the torso.

People with transverse myelitis who experience sensory disturbances often use terms 

such as numbness, tingling, coldness, or burning

to describe their symptoms. Up to 80 percent 

of those with transverse myelitis report areas 

of heightened sensitivity to touch, such that 

clothing or a light touch with a finger causes 

significant discomfort or pain (a condition 

called allodynia). Many also experience 

heightened sensitivity to changes in 

temperature or to extreme heat or cold.

Bladder and bowel problems may involve 

increased frequency of the urge to urinate 

or have bowel movements, incontinence, 

difficulty voiding, the sensation of incomplete 

evacuation, and constipation. Over the course 

of the disease, the majority of people with 

transverse myelitis will experience one or 

several of these symptoms.

How is transverse myelitis diagnosed?

Physicians diagnose transverse myelitis by taking a medical history and performing a 

thorough neurological examination. Because 

it is often difficult to distinguish between 

someone with an idiopathic form of transverse myelitis and one who has an underlying 

condition, physicians must first eliminate 

potentially treatable causes of the condition. 
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When a spinal cord problem is suspected, 

physicians seek first to rule out structural 

lesions (damaged or abnormally functioning 

areas) that could cause spinal cord compression or otherwise affect its function. Such 

potential lesions include tumors, herniated 

or slipped discs, stenosis (narrowing of the 

canal that holds the spinal cord), abscesses, 

and abnormal collections of blood vessels. 

Diagnostic imaging of the brain and spine, 

using magnetic resonance imaging (MRI), can 

rule out such lesions and check for inflammation. MRI uses computer-generated radio 

waves and a powerful magnetic field to 

produce detailed images of body structures, 

including tissues, organs, bones, and nerves.

MRI will almost always confirm the presence 

of a lesion within the spinal cord whereas 

the brain MRI may provide clues to other 

underlying causes, especially MS. If an MRI 

is not possible (for example, if the individual 

has a pacemaker), physicians may consider 

other diagnostic tests such as computed tomography (CT, which uses x-rays and a computer 

scanner to provide cross-sectional images 

of bones, tissues, and organs) of the spine. 

Myelography involves injecting a dye into 

the spinal canal to enhance x-ray imaging of 

the spine. Myelograms are used to diagnose 

spinal nerve injury, herniated discs, and 

spinal tumors. 
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Blood tests may be performed to rule out 

various systemic lupus erythematosus, HIV 

infection, vitamin B12 deficiency, and various 

other disorders. A blood test for NMO, called 

NMO-IgG, is also necessary. In some individuals with transverse myelitis, the cerebrospinal fluid that bathes the spinal cord and 

brain contains more protein than usual and 

an increased number of leukocytes (white 

blood cells). A spinal tap may be performed 

to obtain fluid to study these factors, exclude 

infections, and to look for markers of such 

diseases as MS. 

If none of these tests suggests a specific 

cause, the person is presumed to have 

idiopathic transverse myelitis. 

How is transverse myelitis treated?

As with many disorders of the spinal cord, no effective cure currently exists 

for people with transverse myelitis. Treatments 

are designed to reduce spinal cord inflammation and alleviate or manage symptoms. 

Physicians often prescribe anti-inflammatory 

corticosteroid therapy as soon as the diagnosis 

is made in order to decrease inflammation 

and improve the chances and speed of neurological recovery. Although no clinical trials 

have investigated whether corticosteroids 

alter the course of transverse myelitis, these 

drugs often are prescribed to reduce immune 

system activity because of the suspected 

autoimmune mechanisms involved in the 

disorder. Corticosteroid medications that 
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might be prescribed may include intravenous 

methylprednisone or dexamethasone (usually 

for about 5 days); in some cases, oral prednisone is used for a period of time afterwards. 

In severe cases that do not appear to respond 

to corticosteroid treatment, other therapies 

such as plasma exchange or drug therapies 

may be used to try to salvage neurological 

function. General painkillers may be prescribed for any pain the individual may have. 

Other symptoms such as muscle spasms may 

require additional drug therapies. Bladder 

dysfunction may require the placement of a 

urinary catheter to drain the bladder. 

Following initial therapy, the most critical 

part of the treatment for this disorder consists 

of keeping the individual’s body functioning 

in anticipation of either complete or partial 

spontaneous recovery of the nervous system. 

This may require placing the person on a 

respirator in the uncommon scenario where 

breathing is significantly affected. People are 

most often treated in a hospital or in a rehabilitation facility where a specialized medical 

team can prevent or treat problems that 

afflict paralyzed patients. Often, even before 

recovery begins, caregivers may be instructed 

to move an individual’s limbs manually to 

help keep the muscles flexible and strong, 

and to reduce the likelihood of pressure sores 

developing in immobilized areas. Later, if 

the person begins to recover limb control, 

physical therapy can help improve muscle 

strength, coordination, and range of motion. 
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What therapies are available to 

help people who have permanent 

physical disabilities?

Many forms of long-term rehabilitative therapy are available for people who 

have permanent disabilities resulting from 

transverse myelitis. Medical social workers, 

often affiliated with local hospitals or 

outpatient clinics, are the best sources for 

information about treatment programs and 

other resources that exist in a community. 

Rehabilitative therapy teaches people strategies for carrying out activities in new ways in 

order to overcome, circumvent, or compensate 

for permanent disabilities. Rehabilitation 

cannot reverse the physical damage resulting 

from transverse myelitis or other forms of 

spinal cord injury, but it can help people, 

even those with severe paralysis, become 

as functionally independent as possible and 

thereby attain the best possible quality of life.

Common permanent neurological deficits 

resulting from transverse myelitis include 

severe weakness, spasticity (painful muscle 

stiffness or contractions), or paralysis; incontinence, and chronic pain. Such deficits can 

substantially interfere with a person’s ability to 

carry out such everyday activities as bathing, 

dressing, and performing household tasks.

People living with permanent disability may 

feel a range of emotions, from fear and sadness 

to frustration and anger. Such feelings are 

natural responses, but they can sometimes 

jeopardize health and potential for functional 

recovery. Those with permanent disabilities 

frequently experience clinical depression. 
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Fortunately, depression is treatable, due to the 

development of a wide range of medications that 

can be used with psychotherapeutic treatment. 

Today, most rehabilitation programs attempt 

to address the emotional dimensions along 

with the physical problems resulting from 

permanent disability. Individuals typically 

consult with a range of rehabilitation specialists, who may include physiatrists (physicians 

specializing in physical medicine and rehabilitation), physical therapists, occupational 

therapists, vocational therapists, and mental 

health care professionals.

Physical Therapy: Physiatrists and physical 

therapists treat disabilities that result from 

motor and sensory impairments. Their aim 

is to help individuals increase their strength 

and endurance, improve coordination, reduce 

spasticity and muscle wasting in paralyzed 

limbs, and regain greater control over 

bladder and bowel function through various 

exercises. Physiatrists and physical therapists 

teach paralyzed individuals techniques for 

using assistive devices such as wheelchairs, 

canes, or braces as effectively as possible. 

Paralyzed patients also learn ways to avoid 

developing painful pressure sores on immobilized parts of the body, which may lead 

to increased pain or systemic infection. In 

addition, physiatrists and physical therapists 

are involved in pain management. A wide 

variety of medications can alleviate the 

pain that results from spinal cord injuries 

such as those caused by transverse myelitis. 

Some examples include nonsteroidal antiinflammatory drugs such as ibuprofen or 
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naproxen; antidepressant drugs such as 

amitryptyline (tricyclic) and sertraline 

(a selective serotonin reuptake inhibitor); 

muscle relaxants such as baclofen or tizanidine; and anticonvulsant drugs such as 

gabapentin, pregabalin, and carbamazepine.

Occupational Therapy: Occupational therapists 

help people learn new ways of performing 

meaningful, self-directed, goal-oriented, 

everyday tasks such as bathing, dressing, 

preparing a meal, house cleaning, engaging 

in arts and crafts, or gardening. They teach 

people how to develop compensatory strategies, how to make changes in their homes to 

improve safety (such as installing grab bars 

in bathrooms), how to change obstacles in 

their environment that interfere with normal 

activity, and how to use assistive devices.

Vocational Therapy: In addition to acquainting 

people with their rights as defined under the 

Americans with Disabilities Act of 1990 and 

helping people develop and promote work skills, 

vocational therapists identify potential employers, assist in job searches, and act as mediators 

between employees and employers to secure 

reasonable workplace accommodations. 

What is the prognosis?

Recovery from transverse myelitis usually begins within 2 to 12 weeks of the onset of 

symptoms and may continue for up to 2 years. 

However, if there is no improvement within 

the first 3 to 6 months, significant recovery is 

unlikely. About one-third of people affected 
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with transverse myelitis experience good or 

full recovery from their symptoms, regaining 

the ability to walk normally and experience 

minimal urinary or bowel effects and paresthesias. Another one-third show only fair 

recovery and are left with significant deficits 

such as spastic gait, sensory dysfunction, and 

prominent urinary urgency or incontinence. 

The remaining one-third show no recovery at 

all, remaining wheelchair-bound or bedridden 

with marked dependence on others for basic 

functions of daily living. Unfortunately, 

making predictions about individual cases 

is difficult. However, research has shown 

that a rapid onset of symptoms generally 

results in poorer recovery.

The majority of people with this disorder 

experience only one episode although in 

rare cases recurrent or relapsing transverse 

myelitis does occur. Some individuals recover 

completely, and then experience a relapse. 

Others begin to recover, and then suffer worsening of symptoms before recovery continues. 

In cases of relapse, physicians will re-evaluate possible underlying causes such as MS, 

NMO, or systemic lupus erythematosus since 

most people who experience relapse have an 

identifiable underlying disorder. People with 

a recurrent/relapsing disorder will usually 

require some type of ongoing therapy that 

modulates or suppresses the immune system. 

The purpose of such therapies is to reduce the 

chance of future relapses.
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What research is being done?

Within the Federal government, the National Institute of Neurological 

Disorders and Stroke (NINDS), a component 

of the National Institutes of Health (NIH), has 

primary responsibility for conducting and 

supporting research on spinal cord disorders 

and demyelinating diseases such as transverse 

myelitis. The NINDS conducts research in 

its laboratories at the NIH and also supports 

studies through grants to major medical 

research institutions across the country.

Some NINDS researchers are seeking to 

clarify the role of the immune system in 

the development of demyelination in autoimmune diseases or disorders. Other work 

focuses on strategies to repair demyelinated 

spinal cords including approaches using 

cell transplantation. The knowledge gained 

from such research should lead to a greater 

knowledge of the mechanisms responsible 

for demyelination in transverse myelitis 

and may ultimately provide a means to 

prevent and treat this disorder.

NINDS also funds researchers who are using 

animal models of spinal cord injury to study 

strategies for replacement or regeneration of 

spinal cord nerve cells. The ultimate goals 

of these studies are to encourage the same 

regeneration in humans and to restore function to paralyzed individuals. Scientists are 

also developing neural prostheses to help 

people with spinal cord damage compensate 

for lost function. These sophisticated electrical and mechanical devices connect with 

the nervous system to supplement or replace 

lost motor and sensory function.
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Where can I find more information?

For more information on neurological disorders or research programs funded 

by the NINDS, contact the Institute’s Brain 

Resources and Information Network 

(BRAIN) at:

BRAIN

P.O. Box 5801

Bethesda, MD 20824

301-496-5751

800-352-9424

www.ninds.nih.gov

Information also is available from the 

following organizations:

Cody Unser First Step Foundation

P.O. Box 56696

Albuquerque, NM 87187

505-792-9551

www.cufsf.org

Christopher and Dana Reeve 

Foundation and Resource Center

636 Morris Turnpike

Suite 3A

Short Hills, NJ 07078

800-225-0292

www.christopherreeve.org

Miami Project to Cure Paralysis

1095 NW 14th Terrace

Lois Pope LIFE Center

Miami, Florida 33136

305-243-6001

800-782-6387

www.themiamiproject.org
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National Multiple Sclerosis Society

733 Third Avenue

3rd Floor

New York, NY 10017-3288

800-344-4867

www.nationalmssociety.org

Transverse Myelitis Association

1787 Sutter Parkway

Powell, OH 43065-8806

614-766-1806

www.myelitis.org

NIH . . . Turning Discovery into Health

Prepared by:

Office of Communications and Public Liaison

National Institute of Neurological 

Disorders and Stroke

National Institutes of Health

Department of Health and Human Services

Bethesda, Maryland 20892-2540

NIH Publication No. 12-4841 July 2012