Transverse myelitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Jan 2026

Last updated: 12 Aug 2025

Transverse myelitis (TM) is a heterogeneous focal inflammatory disorder of the spinal cord characterized by acute or subacute development of motor weakness, sensory impairment, and autonomic dysfunction.

TM causes motor weakness, a sensory impairment below the lesions, and bowel and bladder dysfunction.

Clinical characteristics and magnetic resonance imaging (MRI) of the spinal cord classify TM into acute partial or longitudinally extensive variants.

The presence of TM is confirmed by lumbar puncture demonstrating increased white blood cell count and absence of infection, with or without spinal cord MRI revealing a cord lesion that enhances after gadolinium administration.

For people with a characteristic brain MRI, the acute partial variant suggests a high future risk of developing multiple sclerosis (MS).

For people with aquaporin-4-IgG autoantibody seropositivity, the longitudinally extensive variant suggests a neuromyelitis optica spectrum disorder.

Therapy for acute symptoms includes intravenous corticosteroids or plasma exchange (plasmapheresis).

Preventive therapies include immunomodulatory drugs for acute partial TM in patients at high risk for MS.

Immunosuppressive therapies are used for longitudinally extensive TM in people at high risk for recurrent myelitis or neuromyelitis optica spectrum disorder.

Definition

TM is a pathogenetically heterogeneous focal inflammatory disorder of the spinal cord characterized by acute or subacute development of motor weakness, sensory impairment, and autonomic dysfunction.[1][2] Magnetic resonance imaging of the spinal cord reveals a focal hyperintense lesion and cerebrospinal fluid usually shows pleocytosis.

The causes of TM are heterogeneous, but partial TM (asymmetric, short cord lesions) is typically associated with multiple sclerosis, whereas longitudinally extensive lesions suggest neuromyelitis optica spectrum disorder.[2][3][4][5]

病史和体格检查

关键诊断因素

age 10-19 or 30-39 years
motor weakness
paresthesias or sensory loss
bladder symptoms: urinary frequency, urgency, incontinence, or retention
bowel symptoms: incontinence or constipation
L'hermitte sign
McArdle sign
paroxysmal tonic spasms
upper motor neuron signs: hyperreflexia, positive Babinski sign, limb spasticity
sensory loss/sensory level
dyspnea/respiratory distress

完整详情

其他诊断因素

back pain
trunk/limb pain
areflexia/hyporeflexia
hiccups
nausea/vomiting

完整详情

危险因素

preceding infectious illness
recent vaccination
female sex
history of recent physical trauma
spinal injection

完整详情

诊断性检查

首要检查

MRI spinal cord
MRI brain
serum aquaporin-4 autoantibodies and myelin oligodendrocyte glycoprotein autoantibodies
cerebrospinal fluid cell count, cell differential, protein level, IgG index, oligoclonal bands
cerebrospinal fluid Gram stain, cultures (bacterial, tubercular, fungal), and India ink smear
cerebrospinal fluid, polymerase chain reaction for herpes simplex virus (HSV)-1, HSV-2, varicella zoster virus (VZV), Borrelia burgdorferi (Lyme disease), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and West Nile virus
cerebrospinal fluid Venereal Disease Research Laboratory test
serum anti-nuclear antibody, double-stranded DNA
extractable nuclear antigen (including SSA and SSB autoantibodies)
serum and cerebrospinal fluid paraneoplastic autoantibodies
other neural autoantibodies

完整详情

需考虑的检查

serum and cerebrospinal fluid angiotensin-converting enzyme
CXR
CT body (chest, abdomen, and pelvis)
whole-body PET scan
cerebrospinal fluid cytology and flow cytometry
serology for herpes simplex virus (HSV)-1, HSV-2, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, and West Nile virus
urinalysis
HIV antibodies
visual-evoked potential
optical coherence tomography
therapeutic trial with corticosteroid
spinal cord biopsy

完整详情

治疗流程

急症处理

acute neurologic deficits

持续性治疗

idiopathic transverse myelitis (TM)

at risk for multiple sclerosis (MS) (typical demyelinating lesions on MRI)

aquaporin-4 (AQP4) autoantibody seropositive

myelin oligodendrocyte glycoprotein-IgG autoantibody seropositive

撰稿人

作者

Cristina Valencia-Sanchez, MD, PhD

Department of Neurology

Mayo Clinic

Scottsdale

利益声明

CVS declares that she has served on an advisory board for TG Therapeutics.

鸣谢

Dr Cristina Valencia-Sanchez would like to gratefully acknowledge Dr Dean Wingerchuk, the previous contributor to this topic. DMW has received compensation from MedImmune for service on a clinical trial adjudication committee, from Caladrius for consulting services, and research support paid to Mayo Clinic from Alexion and TerumoBCT. DMW is an author of a number of references cited in this topic.

同行评议者

Alireza Minagar, MD

Assistant Professor of Neurology

LSU Health Sciences Center

Shreveport

利益声明

AM declares that he has no competing interests.

Cory Toth, BSc, MD, FRCP(C)

Assistant Professor of Neurosciences

Hotchkiss Brain Institute

University of Calgary

Alberta

Canada

利益声明

CT declares that he has no competing interests.

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCP

Consultant Neurologist

Clinical Director of Neurosciences

Department of Neurology

Queen's Hospital

Romford

利益声明

AC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002 Aug 27;59(4):499-505. 摘要

Expert Panel on Neurological Imaging, Agarwal V, Shah LM, et al. ACR appropriateness criteria® myelopathy: 2021 update. J Am Coll Radiol. 2021 May;18(5s):S73-82.全文摘要

Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis. Neurology. 2018 Apr 24;90(17):777-88.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Compressive myelopathy
- Infectious myelitis (e.g., tuberculosis)
- Anterior spinal artery occlusion
更多鉴别诊断
指南
- ACR appropriateness criteria: myelopathy
- Practice guideline: disease modifying therapies in adults with multiple sclerosis
更多指南
患者教育信息
Multiple sclerosis
更多患者教育信息
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Transverse myelitis

Summary

Definition

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

acute neurologic deficits

idiopathic transverse myelitis (TM)

at risk for multiple sclerosis (MS) (typical demyelinating lesions on MRI)

aquaporin-4 (AQP4) autoantibody seropositive

myelin oligodendrocyte glycoprotein-IgG autoantibody seropositive

撰稿人

作者

Cristina Valencia-Sanchez, MD, PhD

利益声明

鸣谢

同行评议者

Alireza Minagar, MD

利益声明

Cory Toth, BSc, MD, FRCP(C)

利益声明

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCP

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

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