Transverse Myelitis

Transverse myelitis is an immune-mediated inflammation of the spinal cord. The inflammatory injury disrupts several cord pathways at once: corticospinal tracts that carry motor signals, ascending sensory tracts, and autonomic pathways controlling the bladder, bowel, and sexual function. Because these pathways travel together, the patient develops a recognizable cord-level syndrome rather than an isolated peripheral-nerve deficit. Symptoms usually evolve over hours to days. Weakness may begin asymmetrically but typically affects both sides and can progress to paraplegia or, with cervical involvement, weakness of all four extremities. A distinct sensory level—such as loss of sensation below T10—is particularly useful clinically because it localizes the problem to the spinal cord. Numbness, tingling, burning pain, or a tight “band” around the trunk may occur at the level of inflammation. Autonomic dysfunction is part of the syndrome, not an incidental complication. Urinary retention is common; constipation, impaired bowel control, and sexual dysfunction may also occur. A patient may not feel bladder distention because the same lesion that causes retention can blunt the sensation of fullness. The inflammatory process can follow an infection or, rarely,...