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Emergency: requires immediate attention
Transverse myelitis
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Transverse myelitis

Contributors: Andrea Wasilewski MD, Jamie Adams MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Transverse myelitis is a rare condition involving inflammation of the spinal cord that can be caused by infectious processes, autoimmune disorders, or toxic agents. Infectious agents include tuberculosis, Lyme disease, and syphilis as well as viruses such as varicella zoster and herpes simplex, especially in immunocompromised patients. Travel to geographically endemic areas may lead to exposure of potential causative infectious agents such as West Nile virus, Zika virus, and human T-cell lymphotropic virus 1 (HTLV-1) (tropical spastic paraparesis / HTLV1-associated myelopathy [TSP/HAM]) and parasites such as angiostrongyliasis, schistosomiasis, and cysticercosis.

Symptoms of myelopathy often develop over a few hours and progress over days. These include weakness or paralysis, numbness or paresthesias, and neck, back, abdominal, or extremity pain. There may be bowel and/or bladder symptoms including incontinence, urinary retention, or constipation. It is important to note associated symptoms such as fevers, weight loss, or rashes, which may help identify the cause and guide specific treatments. There is often a history of preceding respiratory, gastrointestinal, or systemic illness.

Most individuals have only one attack, and one-third have complete recovery. However, transverse myelitis may be the initial presentation of multiple sclerosis, neuromyelitis optica, or other autoimmune conditions.


G37.3 – Acute transverse myelitis in demyelinating disease of central nervous system

16631009 – Transverse myelopathy syndrome

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Multiple sclerosis
  • Neuromyelitis optica spectrum disorder
  • Sarcoidosis
  • Lupus myelitis (see Systemic lupus erythematosus)
  • Disk herniation (see Cervical radiculopathy, Lumbar radiculopathy)
  • Spinal stenosis (see Cervical spinal stenosis, Lumbar spinal stenosis)
  • Spinal cord infection (eg, West Nile virus, Poliomyelitis, Human T-cell lymphotropic virus type 1, Tertiary syphilis)
  • Spinal cord infarction
  • Spinal cord hemorrhage (see Spinal cord compression)
  • Spinal cord arteriovenous malformation
  • Spinal cord tumor / extradural tumor (see Spinal cord compression)
  • Radiation myelitis
  • Spinal cord abscess (see Paraspinal abscess)
  • Syringomyelia or syrinx
  • Cauda equina syndrome
  • Conus medullaris syndrome
  • Copper deficiency
  • Vitamin B12 deficiency
  • Acute inflammatory demyelinating polyneuropathy
  • Acute demyelinating encephalomyelitis
  • Fibrocartilaginous emboli

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:08/14/2018
Last Updated:08/31/2023
Copyright © 2024 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Transverse myelitis
A medical illustration showing key findings of Transverse myelitis : Babinski sign, Extremities weakness, Paraplegia, Urinary retention, Paresthesias, Leg hyperreflexia
Copyright © 2024 VisualDx®. All rights reserved.