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Transverse Myelitis Associated Diseases
Several diseases may lead to transverse myelitis, and should be investigated at the time TM presents itself.
Infectious Diseases
Lupus
Multiple Sclerosis
Vascular Disease
Infectious Diseases
TM can occur as a result of a recent infection. This is called parainfectious TM. Although it can be the result of a direct infection of the neurons and supporting cells within the spinal cord, usually TM develops after the infection has been cleared by the immune system. Thirty to 60 percent of patients report a preceding infection, usually involving the upper respiratory tract. A few of these diseases include:
- Hepatitis viruses, including A, B and C. Evaluation of the spinal fluid and blood is the best way to detect existing viral illnesses or markers from previous infections.
- Syphilis remains a rare cause of TM, but related diseases, such as Lyme disease, are increasingly common causes. TM related to the Lyme disease can occur at the onset of infection or many years after. These patients usually have multiple painful joints, fatigue, changes in personality or thinking and cranial nerve deficits.
- Mycoplasma pneumonia is a rare but important cause of transverse myelitis. Antibiotic treatment can lead to improved outcomes for these patients. This diagnosis is commonly missed because many patients don’t experience respiratory symptoms. It is very important to use new molecular technologies—such as the PCR-based strategies used at Johns Hopkins—for diagnosis because older methods of detecting mycoplasma don’t allow the organisms to be found in time for effective treatment.
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Lupus
Systemic lupus erythematosus (SLE), often called lupus, is an autoimmune disorder that can involve the nervous system. Some of the most common symptoms are a facial rash, inflammation of the linings of the heart and lungs and kidney disease. About one to three percent of those with lupus develop TM. Intravenous steroids and other immunosuppressant treatments have been shown to improve the outcome in patients who develop lupus after they are diagnosed with TM. This relationship can be complex to find, however, because some classic features of lupus are absent in those with transverse myelitis. For example, the usual MRI and spinal tap studies can come back normal when in fact blood clots within the artery supplying the spinal cord have killed cells, causing the TM.
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Multiple Sclerosis
TM is sometimes a feature of relapsing-remitting multiple sclerosis (MS). This type of TM tends to be partial (rather than complete loss of function below the level of injury) and involves one side of the body more than the other. Treatment strategies may be very different for patients with MS compared to those without, so screening is important. An MRI to detect if lesions are present in other areas of the central nervous system, as well as a spinal tap to determine if antibodies are being synthesized within the central nervous system, may be part of this screening process.
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Vascular Disease
Many cases of TM are due to vascular disease, which can cause ischemia or bleeding into the spinal cord. This can be viewed as a stroke involving the spinal cord. Just like the brain, blood vessels are required to bring oxygen and nutrients, and to remove metabolic products from the cells of the spinal cord. When one of these vessels becomes blocked—either by a clot that has traveled to an artery supplying the spinal cord, or by progressive narrowing of the vessels—that area of the spinal cord may become ischemic. Patients who get TM as a result of vascular disease tend to be older, have cardiac disease or have recently undergone a chest or abdominal operation. Other patients develop the disease due to an abnormal collection of blood vessels on the surface of the spinal cord that either impair blood return away from the spinal cord or cause bleeding into the spinal cord. This diagnosis may be difficult, and is often missed. A physician may choose to use a spinal angiogram or myelogram for diagnosis. Several procedures exist to halt the symptoms of transverse myelitis due to vascular disease.
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