Perspectives in MS
Perspectives in MS

Transverse Myelitis, Part 2

TEXT SIZE: A A A

In my previous post I reviewed the basic anatomy of the spinal cord, one of the main site of damage in MS.  As with lesions in the brain, lesions in MS tend to affect the white matter and involvement of the gray matter suggests an illness other than MS. The MRIs below show the spinal cord from different angles affected by plaques in MS.

Transverse MyelitisTransverse Myelitis

Inflammation of the spinal cord is termed myelitis. In MS, symptoms stemming from the spinal cord typically present as an ascending numbness that often starts in one limb and then spreads to include a much wider area.  It is very common for patients to develop numbness in a foot for example, that creeps up their leg.  Over the course of a day or two patients may develop numbness from their waist or chest downwards.  Patients may feel a banding sensation as if they have a tight belt around them.  This is sometimes referred to as the “MS Hug” and this feeling can remain for a long time after the acute inflammation has resolved.  Lesions higher up in the cervical spine may cause similar sensory disturbances in the arms.  When MS patients feel tingling and numbness in their extremities, it is usually due to lesion affecting the sensory pathways of the spinal cord.

Lesions in the uppermost part of the cervical spine may produce what is called Lhermitte’s sign. This refers to an electrical shock sensation in the limbs and body brought on by flexion of the neck.   Although Lhermitte’s sign is common in MS, it can be due to other illnesses of the cervical spine.   Below is the MRI of a patient who presented with this symptom.

Transverse Myelitis

Lesions to the corticopsinal tract produce weakness in the limbs as well as trouble with balance and walking.  And while a single lesion is unlikely to cause the acute onset of bowel and bladder symptoms, the accumulation of lesions in the spinal cord results in these symptoms over time.

As with optic neuritis, transverse myelitis is often a frequent presenting symptom of MS.  However, transverse myelitis can also be a post-infectious process that is not likely to lead to MS.  As with optic neuritis, the presence or absence of additional brain lesions and the presence of absence of oligoclonal bands in the spinal fluid can help doctors and patients alike determine whether treatment for MS is required.  Ultimately, simply waiting to see if there is a second clinical event or changes on the MRI are the only way to know for sure if a patient is going to develop MS or not.

  • 1

Tags: Treatments

Was this article helpful? Yes No

Recommended for You

  • Combination Therapy

    By: Jonathan Howard, MD
    Feb 24, 2012

    One of the interesting questions to emerge in MS therapies in the next few years will be the possibility of using combination therapy to slow down disease progression. This means the use of more than one medication with different mechanisms of ...

    Read more »

  • BG 12, Part 2

    By: Jonathan Howard, MD
    Feb 21, 2012

    In my first post on BG-12, I introduced the two major studies supporting its efficacy. No discussion of medication is complete without acknowledging the downsides, however. The most common side effects of BG-12 were flushing, headache, gastroi...

    Read more »

  • BG 12, Part 1

    By: Jonathan Howard, MD
    Feb 16, 2012

    One of the most exciting disease modifying medications on the horizon in the treatment of MS is currently known as BG-12. It is made by Biogen, the same company that makes Avonex and Tysabri. This is the first oral medication from this company ...

    Read more »

  • Trigeminal Neuralgia

    By: Jonathan Howard, MD
    Jan 19, 2012

    Of all of the symptoms of MS, few make patients as miserable as a syndrome known as trigeminal neuralgia (TN). The trigeminal nerve is the nerve that carries sensation from the face to the brain, and also carries motor fibers for the muscles u...

    Read more »

Advertisement

About the Author

Dr. Howard is a neurologist & psychiatrist, and an expert in multiple sclerosis.

Recent Blog Posts

Advertisement
Advertisement