myelitis

Myelitis: An Overview

Myelitis refers to inflammation of the spinal cord, which can disrupt normal responses from the brain to the rest of the body and vice versa [11]. This condition can cause damage to the myelin sheath, a fatty covering that surrounds nerve cell fibers, leading to symptoms such as paralysis, sensory loss, and muscle weakness [10].

Types of Myelitis

Myelitis is classified into several categories based on the area or cause of the lesion. It can be acute or subacute, and may present with rapid onset weakness, sensory deficits, and bowel/bladder dysfunction [12]. In some cases, myelitis can be a symptom of an underlying condition such as multiple sclerosis, lupus, or cancer [2].

Characteristics of Myelitis

Myelitis is characterized by inflammation of the spinal cord, which can cause damage to the myelin sheath and disrupt normal nerve function. This can lead to symptoms such as:

• Paralysis
• Sensory loss
• Muscle weakness
• Pain
• Bowel/bladder dysfunction

Recovery from Myelitis

While recovery from myelitis is possible, it may vary depending on the individual case. Some people may experience complete recovery, while others may have partial or absent recovery [14]. Recovery typically begins within one to three months after initial treatment.

References:

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Common Signs and Symptoms of Myelitis

Myelitis, an inflammatory condition affecting the spinal cord, can manifest in various ways. The symptoms can be acute or subacute, sudden or progressive, and may vary in severity.

• Muscle Weakness: One of the most common signs of myelitis is muscle weakness, particularly in the arms and legs [5][6].
• Loss of Muscle Tone: Sudden loss of muscle tone, also known as flaccidity, can occur in the affected areas [11].
• Difficulty Moving the Eyes or Drooping Eyelids: Facial droop or weakness, difficulty with swallowing, and slurred speech are other possible signs [11][15].
• Pain: Pain in the arms, legs, neck, or back is a common symptom of myelitis [9][13].
• Sensory Deficits: Numbness, tingling, or loss of sensation in the affected areas can occur [3][13].
• Bowel or Bladder Problems: Difficulty voiding or constipation are possible symptoms due to the involvement of the autonomic nervous system [8][9].
• Respiratory Failure: In severe cases, myelitis can lead to respiratory failure, requiring immediate medical attention [15].

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Diagnostic Tests for Myelitis

Myelitis, an inflammation of the spinal cord, can be diagnosed through various tests that help identify the underlying cause and extent of the condition. Here are some diagnostic tests commonly used to diagnose myelitis:

• Magnetic Resonance Imaging (MRI): An MRI scan is a crucial test in diagnosing myelitis. It produces detailed images of the spinal cord, allowing doctors to visualize any damage or inflammation [1][2]. An MRI of the entire spine, including cervical, thoracic, and lumbar regions, is often performed to confirm the presence of a damaged area (lesion) within the spinal cord [10].
• Clinical Assessment: A thorough medical history and physical examination are essential in diagnosing myelitis. Doctors will assess nerve function, muscle strength, and reflexes to determine the extent of the condition [4][11].
• Blood Tests: Blood tests may be ordered to rule out other diseases or causes for myelitis, such as infections or autoimmune disorders [3][12].
• Lumbar Puncture (Spinal Tap): A lumbar puncture involves withdrawing a small amount of fluid from the canal next to the spinal cord to look for signs of infection or disorder [7].
• Other Tests: Additional tests may be ordered, such as HIV, syphilis, vitamin B12, and copper levels, to identify underlying causes [8][9].

These diagnostic tests help doctors diagnose myelitis and rule out other conditions. Early diagnosis is crucial in managing the condition effectively.

References:

[1] Context 1: A doctor will diagnose transverse myelitis based on your answers to questions about your signs and symptoms...

[2] Context 5: Transverse myelitis (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.

[3] Context 4: Blood tests and a lumbar puncture (spinal tap) may also be done to rule out other diseases or causes for transverse myelitis.

[4] Context 11: Physicians diagnose transverse myelitis by taking a medical history and performing a thorough neurological examination.

[5] Context 10: MRI of the spinal cord is the most useful diagnostic test in AFM and should be prioritized. Include cervical, thoracic, and lumbar spine.

[6] Context 9: An MRI of the brain is often performed to screen for lesions suggestive of a ...

[7] Context 8: Spinal tap (lumbar puncture): This test withdraws a small amount of fluid from the canal next to your spinal cord to look for signs of infection or disorder.

[8] Context 12: - Serologic tests and autoantibodies - Other studies in select patients; ...

[9] Context 13: To diagnose acute flaccid myelitis, the doctor starts with a thorough medical history and physical exam. The doctor might recommend: ...

Treatment Options for Myelitis

Myelitis, an inflammation of the spinal cord, can be treated with various medications to manage symptoms and prevent further attacks. The primary goal of treatment is to reduce inflammation, relieve pain, and restore motor function.

• Glucocorticoids: These are the first-line treatment for myelitis, particularly intravenous (IV) glucocorticoids. They help reduce inflammation and swelling in the spinal cord.
• Immunosuppressive medications: In some cases, immunosuppressive drugs may be prescribed to suppress the immune system's attack on the spinal cord.
• Pain management: Medications such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and muscle relaxants can help manage pain and discomfort.
• Plasma exchange therapy (PLEX): This treatment involves removing plasma from the blood to reduce inflammation and remove antibodies that may be attacking the spinal cord. PLEX is often used in cases where steroids do not provide relief.

Additional Treatment Options

Other treatments may include:

• Intravenous immune globulin (IVIG): IVIG can help reset the immune system and prevent further attacks.
• Therapeutic plasma exchange: This treatment involves removing plasma from the blood to reduce inflammation and remove antibodies that may be attacking the spinal cord.

Important Considerations

It's essential to note that each individual's response to treatment may vary, and a healthcare provider will work with you to determine the best course of treatment. Additionally, some cases of myelitis may not require treatment, as symptoms can improve on their own.

References:

• [3] The first-line treatment for transverse myelitis is IV (intravenous) glucocorticoids.
• [5] If steroids don't relieve the symptoms of transverse myelitis, your provider may try a procedure called plasma exchange therapy (plasmapheresis).
• [11] IV immunoglobulin (IVIG) is a treatment that can help to reset the immune system.
• [12] PLEX is often initiated in individuals with motor impairment or who show little clinical improvement after intravenous steroid treatment.

Differential Diagnosis of Myelitis

Myelitis, an inflammatory condition affecting the spinal cord, has a broad range of differential diagnoses. The following conditions should be considered in the differential diagnosis of myelitis:

• Autoimmune disorders: Multiple sclerosis (MS), neuromyelitis optica (NMO), and other autoimmune conditions can cause myelitis.
  • [5] reported that NMO was the most common diagnosis in a cohort of patients with longitudinally extensive transverse myelitis (LETM).
  • [10] noted that TM can be a manifestation of autoimmune disorders, including MS.
• Infectious causes: Bacterial, viral, and fungal infections can cause myelitis.
  • [9] listed infectious and other diagnoses to be included in the differential diagnosis of transverse myelitis (TM).
  • [14] mentioned that physicians must be aware of the many potential etiologies for acute myelopathy, including infectious causes.
• Vascular causes: Vascular conditions such as vasculitis or vascular malformations can cause myelitis.
  • [9] listed vascular causes among the differential diagnoses of TM.
  • [11] noted that mimics of transverse myelitis include noninflammatory etiologies, which may mimic the appearance of TM.
• Metabolic/nutritional causes: Metabolic or nutritional disorders can cause myelitis.
  • [9] listed metabolic/nutritional causes among the differential diagnoses of TM.
  • [11] noted that mimics of transverse myelitis include noninflammatory etiologies, which may mimic the appearance of TM.
• Neoplasms: Tumors or cancer can cause myelitis.
  • [9] listed neoplasms among the differential diagnoses of TM.
  • [11] noted that mimics of transverse myelitis include noninflammatory etiologies, which may mimic the appearance of TM.
• Radiation: Radiation therapy can cause myelitis.
  • [9] listed radiation among the differential diagnoses of TM.

It is essential to consider these conditions in the differential diagnosis of myelitis and pursue an ordered, efficient, and cost-effective approach to diagnosis based on the patient's clinical history, examination, and magnetic resonance imaging (MRI) findings.