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Myelitis

What is Myelitis?

Myelitis refers to inflammation of the spinal cord. This condition can impair the spinal cord’s ability to send and receive signals from the brain, leading to a variety of neurological symptoms. Myelitis can affect any part of the spinal cord and can cause symptoms such as pain, weakness, sensory disturbances, and even paralysis. Depending on the cause and severity, myelitis can be a medical emergency.

Causes of Myelitis

The causes of myelitis can be diverse and may involve infections, autoimmune conditions, or other diseases that affect the spinal cord.

1. Infectious Causes

  • Viral Infections: Many viral infections can lead to myelitis, including:
    • Herpes Simplex Virus (HSV): This virus can cause a condition called herpes myelitis.
    • Enteroviruses: Such as poliovirus and coxsackievirus.
    • HIV: Can lead to inflammatory myelitis, particularly in the later stages of the disease.
    • Influenza and Measles: Both can cause post-infectious myelitis.
    • Zika Virus: Known to cause neurological complications, including myelitis.
  • Bacterial Infections: Certain bacterial infections can also lead to myelitis, especially in cases where the infection spreads to the spinal cord. An example is spinal tuberculosis or syphilis.
  • Fungal and Parasitic Infections: Rarely, fungal or parasitic infections can result in spinal cord inflammation.

2. Autoimmune Causes

  • Multiple Sclerosis (MS): A chronic autoimmune disease in which the immune system mistakenly attacks the protective covering of nerves in the brain and spinal cord, sometimes leading to myelitis.
  • Neuromyelitis Optica (NMO): An autoimmune disease specifically affecting the spinal cord and optic nerves, causing inflammation and myelitis.
  • Systemic Lupus Erythematosus (SLE): A condition in which the immune system attacks the body’s own tissues, including the spinal cord.
  • Rheumatoid Arthritis: An autoimmune disease that can sometimes cause inflammation in the spinal cord.

3. Post-Infectious or Post-Vaccination

Sometimes, myelitis can occur after a viral infection or vaccination, as the immune system may attack the spinal cord as part of its immune response. This is known as post-infectious myelitis. Vaccines for diseases like measles, mumps, and rubella have been linked to rare cases of myelitis.

4. Trauma

Trauma to the spine, such as from a spinal cord injury, can lead to secondary inflammation in the spinal cord.

5. Other Causes

  • Cancer: Cancer affecting the spinal cord, such as metastasis from another area of the body.
  • Chemical Exposure: Exposure to certain chemicals or toxins may lead to inflammation in the spinal cord.

Symptoms of Myelitis

The symptoms of myelitis can vary depending on the location and extent of the inflammation in the spinal cord. They may appear suddenly and progress quickly.

1. Pain

  • Back Pain: The most common symptom of myelitis is back pain, particularly if the inflammation is localized to the spinal cord. The pain may be sharp, burning, or aching.
  • Radicular Pain: Pain that radiates from the spinal cord to other parts of the body, like the arms or legs.

2. Neurological Symptoms

  • Weakness: Weakness in the arms or legs is common, and in severe cases, this can lead to paralysis.
  • Sensory Changes: Numbness, tingling, or a “pins and needles” sensation may occur, particularly in the legs and arms.
  • Loss of Coordination: Difficulty walking or maintaining balance due to motor control issues.
  • Bowel and Bladder Dysfunction: In severe cases, myelitis can affect the autonomic nervous system, causing problems with bladder control or bowel movements.

3. Other Symptoms

  • Fatigue: Many individuals with myelitis experience severe fatigue.
  • Fever: If the myelitis is caused by an infection, a low-grade fever may accompany the condition.
  • Paralysis: In severe cases, paralysis of the limbs or even the entire body can occur, particularly if the inflammation affects the cervical spine.

Diagnosis of Myelitis

Diagnosing myelitis typically involves several tests and a thorough medical evaluation.

1. Medical History and Physical Examination

A doctor will begin by asking about the symptoms, medical history, and any potential exposure to infections or toxins. A detailed neurological examination will help assess the extent of motor and sensory impairment.

2. MRI (Magnetic Resonance Imaging)

MRI is the most useful imaging tool for diagnosing myelitis. It helps identify areas of inflammation in the spinal cord and can show whether there is compression, infection, or other abnormalities.

3. Lumbar Puncture (Spinal Tap)

A lumbar puncture may be performed to obtain cerebrospinal fluid (CSF). This fluid can be tested for signs of infection, inflammation, or autoimmune disorders that could be causing the myelitis.

4. Blood Tests

Blood tests may be used to check for signs of infection or autoimmune conditions. They can also help determine if there is an underlying condition like lupus or MS.

5. Electromyography (EMG)

EMG can assess the electrical activity of the muscles and nerves and is useful in evaluating nerve function.

Treatment of Myelitis

Treatment for myelitis depends on the underlying cause and the severity of the symptoms. Immediate treatment is essential to prevent permanent neurological damage.

1. Medications

  • Corticosteroids: High doses of corticosteroids, such as methylprednisolone, are commonly used to reduce inflammation and manage symptoms.
  • Plasma Exchange (Plasmapheresis): In cases of severe autoimmune myelitis, plasmapheresis may be used to remove antibodies from the blood that are attacking the spinal cord.
  • Antiviral or Antibiotic Drugs: If an infection is determined to be the cause, antiviral or antibiotic medications will be used to treat the infection.

2. Supportive Care

  • Physical Therapy: Physical therapy may be necessary to help restore mobility and strength, especially if there is paralysis or weakness.
  • Pain Management: Pain relievers, including opioids or nerve-blocking agents, may be used to manage pain.
  • Bladder and Bowel Management: If bowel or bladder dysfunction is present, a specialized program to manage these symptoms may be necessary.

3. Surgical Treatment

Surgery may be required if there is spinal cord compression due to a tumor or abscess.

Prognosis of Myelitis

The prognosis for individuals with myelitis depends on the cause and the timeliness of treatment. In cases of viral or bacterial myelitis, if treated early, many people recover completely or experience only mild long-term effects. However, if the myelitis is caused by a more serious condition like multiple sclerosis or neuromyelitis optica, the prognosis may vary, and some degree of disability may persist.

In cases of post-infectious myelitis, the prognosis is often favorable with prompt treatment. However, chronic symptoms such as fatigue or mild weakness may remain in some individuals.

1. Full Recovery

Some individuals may recover fully, especially if myelitis is caused by an infection or inflammation that is successfully treated.

2. Partial Recovery

Others may experience partial recovery, with persistent symptoms such as mild weakness, fatigue, or sensory changes.

3. Permanent Disability

If not treated promptly, or if caused by severe conditions like spinal tumors or multiple sclerosis, myelitis can lead to permanent neurological damage.