Transverse myelitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Julinka Auta Fernandes
History and Symptoms
Transverse myelitis is an acute or subacute inflammatory spinal cord syndrome characterized by varying combinations of motor, sensory, and autonomic symptoms.[1] Under the Transverse Myelitis Consortium Working Group proposed criteria for idiopathic acute transverse myelitis, signs or symptoms are bilateral, although not necessarily symmetric, and a clearly defined sensory level is present.[1]
A focused history should assess sensory, motor, respiratory, bladder, bowel, sexual, and pain-related symptoms.[2]
Time course
- Under the Transverse Myelitis Consortium Working Group proposed criteria for idiopathic acute transverse myelitis, progression from symptom onset to the clinical nadir occurs between 4 hours and 21 days.[1]
- The history should document the exact time of onset, pattern of progression, and time to maximal neurological impairment.
Important points in the history
The history should document:[1][2]
- The onset and progression of weakness, sensory symptoms, pain, and autonomic dysfunction.
- Whether symptoms affect both sides of the body, whether their severity is asymmetric, and whether they ascend or spread to additional limbs.
- Difficulty standing or walking, falls, stumbling, dragging a foot, or a sensation of limb heaviness.
- The presence and location of back pain, neck pain, radiating pain, or a band-like sensation around the trunk.
- A patient-described sensory level or boundary below which sensation feels abnormal.
- Urinary, bowel, and sexual symptoms, including their timing relative to motor and sensory symptoms.
- Respiratory difficulty, breathlessness, or a weak cough, particularly when cervical spinal cord involvement is possible.
- Previous episodes of myelitis, optic neuritis, otherwise unexplained visual loss, or brainstem symptoms.
Motor symptoms
Motor symptoms may include:[1][2]
- Limb heaviness or weakness.
- Difficulty walking, climbing stairs, rising from a chair, or maintaining balance.
- Weakness that commonly affects the lower extremities but may also affect the upper extremities when the cervical spinal cord is involved.
- Reduced hand or arm dexterity and difficulty coordinating purposeful upper-limb movements when the cervical spinal cord is involved.
- Paraparesis, which may progress to paraplegia in severe cases.
- Weakness involving all four limbs when a cervical spinal cord lesion is present.
- Stiffness, painful tightness, or muscle spasms.
- Respiratory muscle weakness in severe high-cervical spinal cord involvement.[3]
The severity of motor impairment varies from mild weakness to severe paralysis; progression to complete paralysis is not inevitable.[2]
Sensory symptoms
Patients may describe positive sensory phenomena, reduced or absent sensation, painful sensory phenomena, or a combination of these. Sensory symptoms may include:[1][2]
- Paresthesias, such as tingling, pins-and-needles sensations, burning, prickling, buzzing, electric-shock-like sensations, or abnormal cold sensations.
- Dysesthesia, described as an unpleasant abnormal sensation that may occur spontaneously or after touch.
- Numbness, loss of sensation, or reduced ability to perceive touch, pain, or temperature below the affected spinal cord level.
- Increased sensitivity to touch or temperature.
- Hyperalgesia, in which a painful stimulus produces an exaggerated painful response.
- Pain caused by a normally non-painful stimulus, known as allodynia.
- Neuropathic itching (pruritus).
- A tight, constricting, or girdle-like sensation around the trunk, particularly with thoracic spinal cord involvement.
- A patient-perceived sensory level, described as a boundary on the trunk below which sensation becomes reduced, absent, or otherwise abnormal.
- Sensory symptoms in the upper extremities when the cervical spinal cord is involved.
Under the proposed criteria for idiopathic acute transverse myelitis, sensory symptoms affect both sides of the body, although their distribution and severity may be asymmetric.[1]
Pain
Pain may occur during a myelitis attack and should be characterized by its onset, location, severity, quality, and relationship to the neurological symptoms. In inflammatory myelitis, particularly myelitis associated with neuromyelitis optica spectrum disorder, reported pain syndromes include:[2]
- Neuropathic pain described as burning, electric, shooting, or stabbing.
- Girdle-like pain or abnormal sensation around the trunk.
- Painful tonic spasms or episodic painful muscle contractions.
- Pain associated with spasticity.
Autonomic symptoms
Autonomic symptoms may include:[1][2]
- Urinary retention or difficulty initiating urination.
- Urinary urgency, increased urinary frequency, incomplete bladder emptying, or urinary incontinence.
- Constipation, difficulty with bowel evacuation, loss of bowel control, or fecal incontinence.
- Sexual dysfunction, including erectile, arousal, orgasmic, or genital sensory dysfunction.
- Reduced or altered awareness of bladder or bowel fullness.
Bladder, bowel, and sexual symptoms should be asked about directly as part of the focused history.[2]
Associated systemic history and symptoms
The history should document symptoms of a recent or concurrent infection and other systemic symptoms:[2]
- Fever or recent respiratory or gastrointestinal symptoms should be elicited. An infection may precede an inflammatory myelitis attack, but fever is not a defining manifestation of transverse myelitis.
- Headache may occur in disease-associated myelitis but is not a defining spinal cord symptom.
- General malaise or reduced appetite is nonspecific and should not be presented as a characteristic manifestation of transverse myelitis.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59(4):499–505. Digital object identifier (DOI): 10.1212/WNL.59.4.499. PubMed identifier (PMID): 12236201.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Jarius S, Aktas O, Ayzenberg I, et al.; Neuromyelitis Optica Study Group (NEMOS). Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD)—revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. Journal of Neurology. 2023;270(7):3341–3368. DOI: 10.1007/s00415-023-11634-0. PMID: 37022481.
- ↑ Giorgi L, Marignier R, Pique J, et al.; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) Network. French guidelines for the diagnosis and management of neuromyelitis optica spectrum disorder. Revue Neurologique (Paris). 2026 Jul 21:S0035-3787(26)00562-X. Online ahead of print. DOI: 10.1016/j.neurol.2026.06.004. PMID: 42481362.