Symptoms and Diagnosis of Transverse Myelitis

Pain is often (up to 50 percent of the time) the first symptom of transverse myelitis, generally beginning as a lower back pain. The segment (location) of the spinal cord where the damage occurs determines which parts of the body are affected; damage at one segment will affect function at that segment and the segments below it.

Other early symptoms can include:

• Sensitivity to touch (allodynia) — experienced by as many as 80 percent of people; a sensitivity in which clothing or a light touch with a finger causes significant discomfort or pain
• Weakness in the arms or legs (paraparesis)
• Sensory symptoms (paresthesias) such as numbness, tingling, burning, tickling, or prickling in the legs, feet or toes
• Bowel and bladder problems — may include an increased frequency of the urge to urinate or have bowel movements, loss of bowel or bladder control (incontinence), difficulty urinating, constipation or the feeling of incomplete bowel evacuation
• Heightened sensitivity to changes in temperature or to extreme heat or cold
• Fatigue

The symptoms of transverse myelitis can develop over hours to several days, or more gradually over a period of one to four weeks.

The process of diagnosis includes:

• A complete medical history, including any history of recent viral or bacterial infections
• A thorough neurological examination
• Magnetic resonance imaging (MRI)
• Blood tests to identify other possible causes of the symptoms such as systemic lupus erythematosus (lupus), HIV infection, vitamin B12 deficiency, and to assess for antibodies associated with transverse myelitis, including anti-AQP4 and anti-MOG antibodies
• Lumbar puncture (spinal tap) to examine the fluid that surrounds the brain and spinal cord for white blood cells (indicating a possible infection), and to look for indications of diseases such as MS
• Spinal angiography, which involves injecting dye through a catheter to assess the blood vessels of the spinal cord to identify vascular causes of the symptoms.  

Reviewed by Elias Sotirchos, MD November 2019