Transverse Myelitis Rare Spinal Cord Disorder Possible Cause Covid-19

Covid-19 has impacted everyone in so many ways. There is a possible connection between Covid-19 and a rare spinal disorder known as transverse myelitis. There have been three known cases of acute transverse myelitis brought on from covid-19. Although these case reports are not enough to prove that covid is the cause for transverse myelitis, researchers are delving into the possibility of a connection between the virus and this spinal condition.

Transverse Myelitis

Transverse myelitis causes inflammation of the spinal cord. It can be caused by

• Infections
• Immune system disorders
• Disorders that damage/destroy myelin

Myelin is the layer that forms around nerve cell axons or the wiring of the nervous system and insulates them. It consists of protein, fatty substances, and acts as a defensive sheath that allows electrical impulses to transmit properly. The insulation properties are essential for:

• Proper motor function
• Sensory function
• Cognition

Without the insulation, the electrical impulses traveling through the spinal cord dissipate or weaken. The messages don’t reach the nerves and can lead to:

• Muscle spasms
• Twitching
• Numbness

The most common disorder that destroys the myelin known as demyelination is multiple sclerosis. Transverse myelitis can affect individuals of:

• Any race
• Gender
• Age

There are treatments, but there is no cure. Treatments consist of corticosteroids and other therapies to suppress the immune system. However, their focus is on preventing and minimizing permanent neurological damage.

Recognizing and Identifying

Symptoms of transverse myelitis can include:

• Pain that usually starts in the lower back and causes shooting pain/sensations down the legs, arm, and torso
• Leg/s and arm/s weakness
• Sensory changes in the legs, torso, and genital area
• Bladder and Bowel dysfunction
• Muscle spasms
• General discomfort
• Headaches
• Fever
• Loss of appetite

Depending on the segment of the spine where the damage is occurring will determine which parts of the body are affected. Diagnosis begins with a thorough medical evaluation. A doctor will utilize various methods. A thorough neurological exam will be performed to rule out any issues that require emergency intervention. If a doctor suspects transverse myelitis they will order diagnostic tests like:

• Magnetic resonance imaging or an MRI
• Blood tests
• Lumbar puncture

Treatment

As previously stated, there is no cure for transverse myelitis, and treatment focuses on managing complications. Treatments can include:

• Pain medication
• Antiviral medications
• Intravenous corticosteroids
• Immunomodulating agents
• Plasma exchange therapy
• Intravenous immunoglobin treatment

The hard facts are that while most people with transverse myelitis have at least a partial recovery, for some, however, recovery can continue for up to two years and longer. A combination of medications, chiropractic, and physical therapy can help improve physical symptoms.

The National Institute of Neurological Disorders and Stroke is working to understand the process, as to how the immune system destroys or attacks myelin. Hopefully, this will lead to answers, improved treatment, and prevention. It is well-documented that Multiple sclerosis, bacterial infections, and other viruses can cause transverse myelitis, research must continue to see if there is a connection to covid-19.

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References

Chakraborty, Uddalak et al. “COVID-19-associated acute transverse myelitis: a rare entity.” BMJ case reports vol. 13,8 e238668. 25 Aug. 2020, doi:10.1136/bcr-2020-238668