Myelitis: Causes, Symptoms, and Diagnosis

Written by Medicover Team and Medically Reviewed by Dr Prachi Rahul Pawar , Neurologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Myelitis is an inflammation of the spinal cord that can disrupt normal neural signalling and lead to a variety of neurological symptoms. Understanding the symptoms, risk factors and treatment options for myelitis is crucial for early diagnosis and effective management. In this article, we delve deep into the complexities of myelitis, its types, and how it differs from other conditions like multiple sclerosis.

Myelitis is a broad term that encompasses several types of spinal cord inflammation. This condition can severely affect the body's ability to send and receive messages from the brain, often leading to paralysis and sensory loss.

What Are the Types of Myelitis?

Myelitis includes several forms of spinal cord inflammation, each differing in its cause, affected area, and severity. Identifying the specific type of myelitis helps healthcare providers determine the most appropriate treatment and improve patient outcomes.

Transverse Myelitis

Transverse myelitis is characterized by inflammation across both sides of one segment of the spinal cord. This type leads to motor, sensory, and autonomic dysfunction below the level of the lesion.

Acute Flaccid Myelitis (AFM)

AFM is a rarer form that primarily affects the grey matter of the spinal cord, leading to muscle weakness and paralysis. It often affects children and can progress rapidly.

Neuromyelitis Optica (NMO)

NMO, also known as Devic's disease, is an autoimmune disorder that affects the spinal cord and optic nerves, often leading to blindness and paralysis.

What Are the Symptoms of Myelitis?

The symptoms of myelitis can vary widely depending on the affected area of the spinal cord. Common symptoms include:

Weakness: Often starting in the legs, but can affect any part of the body.
Sensory alterations: Including numbness, tingling, or coldness.
Pain: Sharp, shooting pains that radiate down the arms or legs.
Autonomic dysfunction: Issues with bladder and bowel control, as well as sexual dysfunction.
Paralysis: Complete or partial loss of muscle function.

What Causes Myelitis?

Myelitis occurs when inflammation damages the spinal cord, commonly due to infections, autoimmune disorders, or abnormal immune responses that disrupt nerve signalling.

Common Causes of Myelitis Include:

Autoimmune disorders such as multiple sclerosis, neuromyelitis optica (NMO), lupus, and sarcoidosis
Viral infections, including herpes simplex virus, West Nile virus, enteroviruses, and HIV
Bacterial infections such as Lyme disease, tuberculosis, and syphilis
Post-infectious immune reactions, where the immune system attacks the spinal cord after an infection
Rare vaccine-related immune responses that may trigger spinal cord inflammation
Inflammatory disorders affecting the central nervous system
Unknown (idiopathic) causes, where no specific underlying cause can be identified

When Should You See a Doctor for Myelitis?

Consult a neurologist immediately if you experience sudden neurological symptoms or weakness that affects your daily activities.

Sudden weakness in the arms or legs
Numbness or tingling that worsens
Severe back or neck pain
Difficulty walking or maintaining balance
Loss of bladder or bowel control
Vision changes or muscle paralysis

Early diagnosis helps prevent permanent nerve damage and improves treatment outcomes.

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How Is Myelitis Diagnosed?

The diagnosis of myelitis typically involves a combination of clinical evaluation, imaging studies, and laboratory tests.

Clinical Evaluation

A thorough medical history and physical examination are essential. The healthcare provider will assess muscle strength, reflexes, and sensory function.

Imaging Studies

MRI: Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing myelitis. It helps in visualizing the extent and location of inflammation.
CT Scans: While less detailed than MRI, CT scans can provide supplementary information.

Laboratory Tests

Lumbar Puncture: Cerebrospinal fluid (CSF) analysis can reveal elevated white blood cell counts and other markers of inflammation.
Blood Tests: These can help identify underlying infections or autoimmune disorders.

What Are the Treatment Options for Myelitis?

The treatment of myelitis involves a multi-faceted approach aimed at reducing inflammation, managing symptoms, and promoting recovery.

Acute Treatment Corticosteroids

High doses of corticosteroids are often administered to reduce inflammation and immune system activity.

Plasma Exchange Therapy

In cases where corticosteroids are ineffective, plasma exchange therapy can be used to remove harmful antibodies from the bloodstream.

Long-Term Management

Immunosuppressive Drugs

Medications like azathioprine and rituximab can be used to suppress the immune system and prevent further attacks.

Physical Therapy

Physical therapy is crucial for regaining muscle strength and improving mobility. Tailored exercise programs can help patients recover functional abilities.

Pain Management

Neuropathic pain is a common symptom of myelitis, and it can be managed with medications like gabapentin and pregabalin.

Occupational Therapy

Occupational therapy can assist patients in adapting to daily activities and improving their quality of life.

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What Is the Recovery and Prognosis for Myelitis?

Recovery from myelitis can be a long and arduous process, often requiring a multi-disciplinary approach. Factors influencing recovery include:

Severity of Initial Symptoms: More severe initial symptoms often correlate with a more protracted recovery.
Timeliness of Treatment: Early intervention can significantly improve outcomes.
Rehabilitation: Ongoing physical and occupational therapy can aid in functional recovery.

Prognosis

The prognosis for myelitis varies widely. While some patients may recover fully, others may experience long-term neurological deficits. Chronic pain, spasticity, and bladder dysfunction are common long-term issues.

What Are the Risk Factors for Myelitis?

Understanding the risk factors for myelitis can aid in early diagnosis and prevention. Some of the key risk factors include:

Autoimmune disorders: Conditions like lupus, multiple sclerosis, and sarcoidosis can trigger myelitis.
Infections: Viral or bacterial infections, such as herpes, West Nile virus, and Lyme disease, can lead to myelitis.
Vaccinations: Rarely, vaccinations can trigger an immune response that leads to myelitis.
Age and Gender: Some forms of myelitis, like AFM, are more common in children, while others may have a higher prevalence in adults.

How Is Myelitis Different from Multiple Sclerosis?

It is crucial to distinguish myelitis from multiple sclerosis (MS), as the treatment and prognosis can differ significantly.

Key Differences

Lesion Distribution: MS typically features multiple lesions throughout the central nervous system, while myelitis often involves a single, contiguous segment of the spinal cord.
Autoantibodies: Specific autoantibodies, like aquaporin-4, are often present in conditions like NMO but not in MS.
Symptom Onset: Myelitis symptoms can develop rapidly, whereas MS symptoms often progress more slowly.