Myelitis: Spinal Cord Inflammation – Causes, Symptoms & Diagnosis
Myelitis = inflammation of the spinal cord. It is not caused by fungi (rare fungal infections can involve cord but are distinct entities).
Major Etiologies
| Category | Examples |
|---|
| Infectious | Viruses (enteroviruses, flaviviruses, HSV, VZV, HIV), bacteria (TB, syphilis, Lyme), parasites (schistosomiasis) |
| Autoimmune/Demyelinating | Multiple sclerosis (partial myelitis), NMOSD (longitudinally extensive), MOGAD, ADEM, SLE, Sjögren's |
| Paraneoplastic | Anti-Hu, anti-CV2, anti-amphiphysin |
| Vascular | Spinal cord infarct (rare), arteriovenous fistula |
| Drug/Toxin | Heroin (vascular), checkpoint inhibitors (immune-mediated) |
| Idiopathic | Transverse myelitis (no identifiable cause) |
Clinical Presentation
- Ascending sensory loss (level), motor weakness (paraparesis/quadriparesis), autonomic dysfunction (urinary retention, constipation, orthostasis).
- Nadir hours to days; may progress over weeks.
Diagnostic Workup
- MRI spine with contrast (gold standard: T2 hyperintensity, enhancement).
- LP: CSF pleocytosis, elevated protein, OCBs, IgG index, AQP4/MOG antibodies.
- Infectious panel (PCR, serologies).
- Autoimmune screen (ANA, ANCA, AQP4, MOG, paraneoplastic panel).
- Chest/body CT for malignancy if paraneoplastic suspected.
Treatment
- High-dose IV methylprednisolone (1g × 3–5 days) → oral taper.
- PLEX if steroid-refractory (especially NMOSD).
- IVIG for selected causes.
- Disease-modifying therapy for underlying condition (MS, NMOSD, MOGAD).
- Rehabilitation (PT/OT, bladder/bowel management).
Prognosis varies: MS/NMOSD/MOGAD have recurrence risk; idiopathic transverse myelitis often monophasic.
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