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What causes transverse myelitis (TM)?

Researchers are uncertain of the exact causes of transverse myelitis (TM). The inflammation that causes such extensive damage to nerve fibers of the spinal cord may result from viral infections, abnormal immune reactions, or insufficient blood flow through the blood vessels located in the spinal cord. TM also may occur as a complication of syphilis, measles, Lyme disease, and some vaccinations, including those for chickenpox and rabies. Cases in which a cause cannot be identified are called idiopathic.

TM often develops following viral infections. Infectious agents suspected of causing TM include varicella zoster (the virus that causes chickenpox and shingles), herpes simplex, cytomegalovirus, Epstein-Barr, influenza, echovirus, human immunodeficiency virus (HIV), hepatitis A, and rubella. Bacterial skin infections, middle-ear infections (otitis media), and Mycoplasma pneumoniae (bacterial pneumonia) have also been associated with the condition.

In post-infectious cases of TM, immune system mechanisms, rather than active viral or bacterial infections, appear to play an important role in causing damage to spinal nerves. Although researchers have not yet identified the precise mechanisms of spinal cord injury in these cases, stimulation of the immune system in response to infection indicates that an autoimmune reaction may be responsible. In autoimmune diseases, the immune system, which normally protects the body from foreign organisms, mistakenly attacks the body's own tissue, causing inflammation and, in some cases, damage to myelin within the spinal cord.

As some affected individuals also have autoimmune diseases, such as systemic lupus erythematosus, Sjogren's syndrome, and sarcoidosis, some scientists suggest that TM may also be an autoimmune disorder. In addition, some cancers may trigger an abnormal immune response that may lead to TM.

An acute, rapidly progressing form of TM sometimes signals the first attack of multiple sclerosis (MS), however, studies indicate that most people who develop TM do not go on to develop MS. Patients with TM should nonetheless be screened for MS because patients with this diagnosis will require different treatments.

This answer is based on source information from National Institute of Neurological Disorders and Stroke.

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