Spine Disorders
SIGNS AND SYMPTOMS Transverse myelitis may be either acute (developing over hours
to several days) or subacute (developing over 1 to 2 weeks). Initial
symptoms usually include localized lower back pain, sudden paresthesias (abnormal sensations
such as burning, tickling, pricking, or tingling) in the legs, sensory loss,
and paraparesis (partial paralysis of the legs). Paraparesis often progresses to paraplegia (paralysis of the legs
and lower part of the trunk). Urinary bladder and bowel dysfunction is common.
Many patients also report experiencing muscle spasms, a general feeling of
discomfort, headache, fever, and loss of appetite. Depending on which segment
of the spinal cord is involved, some patients may experience respiratory
problems as well. From this wide array of symptoms, four classic features of
transverse myelitis emerge: (1) weakness of the legs and arms, (2) pain, (3) sensory
alteration, and (4) bowel and bladder dysfunction. Most patients will
experience weakness of varying degrees in their legs; some also experience it
in their arms. Initially, people with transverse myelitis may notice that they
are stumbling or dragging one foot or that their legs seem heavier than normal.
Coordination of hand and arm movements, as well as arm and hand strength may
also be compromised. Progression of the disease over several weeks often leads
to full paralysis of the legs, requiring the patient to use a wheelchair. Pain is the primary presenting symptom of transverse myelitis in
approximately one-third to one-half of all patients. The pain may be localized
in the lower back or may consist of sharp, shooting sensations that radiate down
the legs or arms or around the torso. Patients who experience sensory disturbances often use terms such
as numbness, tingling, coldness, or burning to describe their symptoms. Up to 80
percent of those with transverse myelitis report areas of heightened
sensitivity to touch, such that clothing or a light touch with a finger causes
significant discomfort or pain (a condition called allodynia). Many also experience
heightened sensitivity to changes in temperature or to extreme heat or cold. Bladder and bowel problems may involve increased frequency of the
urge to urinate or have bowel movements, incontinence, difficulty voiding, the
sensation of incomplete evacuation, and constipation. Over the course of the
disease, the majority of people with transverse myelitis will experience one or
several of these symptoms. What
usually begins as a sudden onset of lower back pain, muscle weakness, or
abnormal sensations in the toes and feet can rapidly progress to more severe
symptoms, including paralysis, urinary retention, and loss of bowel control. |