II. Definitions
- Myelitis
- Spinal Cord Inflammation of various causes including viral infections, toxins, autoimmune or vascular conditions
- Findings include motor weakness, sensory changes (Paresthesias, numbness, pain) and Urinary Incontinence
- Transverse Myelitis
- Spinal cord inflammation of a transverse segment of the cord with demyelination and necrosis
- Myelitis findings occur below the segment of spinal cord involvement
III. Epidemiology
- Incidence (rare): 1.3 to 4.6 per million people
- Ages
- Most common in children and young adults
IV. Pathophysiology
- Spinal cord inflammation due to autoimmune, inflammatory, vascular or infectious causes
- Myelitis may be unilateral or bilateral, and may effect only some long tracts but not others
- The terms Myelitis, Transverse Myelitis and Acute Transverse Myelitis are used interchangeably
- The adjective transverse only describes the distribution, but the causes and management are similar
V. Findings: Symptoms and Signs
- See Spinal Cord Syndrome
- Timing
- Onset over hours to days
- Progression over days to weeks
- Distribution
- Myelitis is typically bilateral but may be unilateral
- Myelitis may only cause sensory and motor changes at a few spinal levels (sparing lower cord levels)
- Myelitis may effect only some long tracts but not others
- Motor weakness
- Leg flexors and arm extensors are preferentially affected (pyramidal distribution)
- Sensory changes
- Paresthesias
- Typically initial sensory symptom
- Paresthesias ascend from the feet proximally
- Numbness
- Pain
- Paresthesias
-
Autonomic Dysfunction
- Urinary Incontinence
- Stool Incontinence
- Temperature dysregulation
- Hypertension
- Associated Symptoms
- Back pain at or near the level of Myelitis (variably present)
VI. Labs
- Cerebrospinal fluid (Lumbar Puncture)
- Indicated after structural causes are excluded by neuroimaging
- Cerebrospinal fluid (CSF) is normal in 50% of cases
VII. Imaging
- MRI Spine with gadolinium contrast
- Imaging to include well above the level of involvement
- May require combined spine MRIs (e.g. cervico-thoracic MRI or thoracolumbar MRI)
- Exclude structural compressive causes (e.g. Epidural Abscess, Epidural Hematoma, acute disc Herniation)
- Surgical emergencies if present
- May also demonstrate inflammatory cord changes
- Imaging to include well above the level of involvement
- CT Myelogram
- Alternative if MRI contraindicated
VIII. Differential Diagnosis
- See Acute Motor Weakness Causes
- See Paresthesia Causes
- See Spinal Cord Syndrome
- See Floppy Infant
- Peripheral Neuropathy
- Structural spinal cord disorders
- Spinal Cord Injury
IX. Causes: Myelitis
- See Acute Flaccid Paralysis
- See Acute Flaccid Myelitis
- Precautions
- Do NOT miss Compressive Neuropathy (e.g. Cauda Equina Syndrome) which is curable with early surgical intervention
- Demyelinating Disease (most common cause)
- Acute Disseminated Encephalomyelitis (ADEM)
- Multiple Sclerosis
- Neuromyelitis optica
- Post-Vaccination Myelitis
- Autoimmune or Inflammatory Myelitis
- Ankylosing Spondylitis
- Antiphospholipid Antibody Syndrome
- Behcet Disease
- Celiac Disease
- Graft-vs-host disease
- Mixed Connective Tissue Disease (MCTD)
- Neurosarcoidosis
- Scleroderma
- Sjogren Syndrome
- Systemic Lupus Erythematosus
-
Bacterial Myelitis
- Bartonella Henselae (Cat Scratch Disease)
- Borrelia Burgdorferi (Lyme Disease)
- Brucellosis melitensis (Brucellosis)
- Campylobacter jejuni (e.g. Acute Diarrhea)
- Chlamydia psittaci (Psittacosis)
- Chlamydia pneumoniae (Chlamydia Pneumonia)
- Coxiella Burnetii (Q Fever)
- Legionella pneumonia
- Leptospira (Leptospirosis)
- Mycobacterium tuberculosis
- Orientia Tsutsugamushi (Scrub Typhus)
- Salmonella paratyphi B (Paratyphoid)
- Streptococcus (Group A and B)
- Treponema pallidum (Syphilis)
- Viral Myelitis
- Coxsackievirus (A and B)
- Cytomegalovirus (Mono-Like Illness)
- DengueVirus
- Echoviruses
- Enterovirus (70 and 71)
- Epstein-Barr Virus (Mononucleosis)
- Hepatitis A Virus
- Hepatitis CVirus
- Herpes Simplex Virus Type 2 (Genital Herpes)
- HIV Infection (see HIV related Myelitis)
- Influenza A Virus (includes H1N1)
- Japanese Encephalitis Virus
- MeaslesVirus
- Mumps Virus
- Poliovirus (1, 2, and 3)
- St. Louis EncephalitisVirus
- Varicella Zoster Virus (Chicken Pox, Shingles)
- West Nile Virus
- Parasitic Myelitis
- Acanthamoeba (Granulomatous Amebic Encephalitis)
- Echinococcus Granulosus (Echinococcosis)
- Gnathostoma Angiostrongylus (Eosinophilic Meningitis)
- Paragonimus westermani fluke (Paragonimiasis)
- Schistomosoma (Schistosomiasis)
- Taenia solium (Neurocysticercosis)
- Toxoplasma gondii (Toxoplasmosis)
- Trypanosoma brucei (African trypanosomiasis, African Sleeping Sickness)
- Fungal Myelitis
- Actinomyces (Actinomycosis)
- Aspergillus (Aspergillosis)
- Blastomyces (Blastomycosis)
- Cryptococcus (Cryptococcosis)
- Coccidioides immitis (Coccidioidomycosis, Valley Fever)
- Paraneoplastic Conditions (Antibody mediated)
- Various antibodies (e.g. ANNA-2, GAD65, NMDAR)
X. Management
- Condition specific management
- Consult neurology
- Consider infectious disease Consultation if infectious Myelitis is suspected (12% of cases)
- Corticosteroids may be indicated in some cases
- Compressive neureopathy causes of acute Myelitis are surgical emergencies
- Emergent Consultation with spine surgery or neurosurgery
XI. Prognosis
- Moderate to severe residual deficits remain in two thirds of Transverse Myelitis patients
XII. Resources
- Transverse Myelitis Fact Sheet (NINDS)
XIII. References
Images: Related links to external sites (from Bing)
Related Studies
Definition (MSHCZE) | Zánět míchy, (srov. encefalomyelitida), ve složenině i dřeně (srov. osteomyelitida). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (NCI_CTCAE) | A disorder characterized by inflammation involving the spinal cord. Symptoms include weakness, paresthesia, sensory loss, marked discomfort and incontinence. |
Definition (NCI) | An inflammatory process affecting the spinal cord. Causes include viral infections, autoimmune disorders, vascular disorders, and toxic agents. Symptoms include weakness, paresthesia, sensory loss, pain, and incontinence. |
Definition (MSH) | Inflammation of the spinal cord. Relatively common etiologies include infections; AUTOIMMUNE DISEASES; SPINAL CORD; and ischemia (see also SPINAL CORD VASCULAR DISEASES). Clinical features generally include weakness, sensory loss, localized pain, incontinence, and other signs of autonomic dysfunction. |
Concepts | Disease or Syndrome (T047) |
MSH | D009187 |
SnomedCT | 192682002, 267682000, 41370002 |
English | Myelitides, MYELITIS, INFLAMM SPINAL CORD, MYELOPATHY INFLAMM, SPINAL CORD INFLAMM, Myelitis, Myelitis NOS, Inflammation, Spinal Cord, Inflammations, Spinal Cord, Spinal Cord Inflammation, Spinal Cord Inflammations, Inflammatory Myelopathies, Inflammatory Myelopathy, Myelopathies, Inflammatory, Myelopathy, Inflammatory, Myelitis [Disease/Finding], spinal cord inflammation, myelitis (diagnosis), myelitis, Myelitis (disorder), inflammation; spinal cord, spinal cord; inflammation, Myelitis, NOS |
French | MYELITE, Myélite SAI, Myélopathie inflammatoire, Myélite, Inflammation de la moelle épinière |
Portuguese | MIELITE, Mielite NE, Inflamação da Medula Espinal, Inflamação da Medula Espinhal, Mielite, Mielopatia Inflamatória |
Spanish | MIELITIS, Mielitis NEOM, mielitis (trastorno), mielitis, Mielitis, Inflamación de la Médula Espinal, Mielopatía Inflamatoria |
German | MYELITIS, Myelitis NNB, Myelitis, Entzündung des Rückenmarks, Myelopathie, entzündliche, Rückenmarkentzündung |
Dutch | myelitis NAO, ontsteking; ruggenmerg, ruggenmerg; ontsteking, myelitis, Myelitis, Myelopathie, inflammatoire, Ruggenmergontsteking |
Italian | Mielite NAS, Infiammazione del midollo osseo, Mielopatia infiammatoria, Infiammazione del midollo spinale, Mielite |
Japanese | 脊髄炎NOS, セキズイエン, セキズイエンNOS, 脊髄炎 |
Swedish | Ryggmärgsinflammation |
Czech | myelitida, mícha - zánět, Myelitida NOS, Myelitida, zánět míchy |
Finnish | Myeliitti |
Russian | MIELIT, МИЕЛИТ |
Croatian | MIJELITIS |
Polish | Zapalenie rdzenia kręgowego, Zapalenie rdzenia |
Hungarian | Myelitis, Myelitis k.m.n. |
Norwegian | Betennelse i ryggmargen, Myelitt, Ryggmargsbetennelse |
Ontology: Myelitis, Transverse (C0026976)
Definition (MSH) | Inflammation of a transverse portion of the spinal cord characterized by acute or subacute segmental demyelination or necrosis. The condition may occur sporadically, follow an infection or vaccination, or present as a paraneoplastic syndrome (see also ENCEPHALOMYELITIS, ACUTE DISSEMINATED). Clinical manifestations include motor weakness, sensory loss, and incontinence. (Adams et al., Principles of Neurology, 6th ed, pp1242-6) |
Concepts | Disease or Syndrome (T047) |
MSH | D009188 |
SnomedCT | 192682002, 16631009 |
LNC | LP128698-0, MTHU040639 |
English | Myelitis, Transverse, MYELITIS TRANSVERSE, Myelitis transverse, Transverse Myelitis, Transverse myelitis NOS, TRANSVERSE MYELITIS ACUTE OR SUBACUTE, transverse myelitis (diagnosis), transverse myelitis, Transverse Myelopathy Syndrome, Transverse Myelopathy Syndromes, Myelitis, Transverse [Disease/Finding], myelitis transverse, Transverse myelopathy syndrome, Transverse myelitis, Transverse myelopathy syndrome (disorder), myelitis; transverse, transverse; myelitis |
Portuguese | MIELITE TRANSVERSA, Mielite Transversa Aguda em Doença Desmielinizante do Sistema Nervoso Central, Mielite transversa, Mielite Transversa |
Spanish | MIELITIS TRANSVERSA, Mielitis Transversa Aguda en Enfermedad Desmielinizante del Sistema Nervioso Central, mielitis transversa, síndrome de mielopatía transversa (trastorno), síndrome de mielopatía transversa, Mielitis transversa, Mielitis Transversa |
German | MYELITIS TRANSVERSA, Myelitis transversa, Querschnittsmyelitis |
Swedish | Myelit, transversell |
Japanese | オウダンセイセキズイエン, 横断脊髄炎, 脊髄炎-横断, 横断性脊髄炎 |
Finnish | Selkäytimen poikittaistulehdus |
Russian | MIELIT POPERECHNYI, МИЕЛИТ ПОПЕРЕЧНЫЙ |
French | MYELITE TRANSVERSE, Myélite transverse |
Czech | Myelitida transverzální, transverzální myelitida, myelitida z příčné léze |
Italian | Mielopatia trasversale, Mielite trasversa |
Polish | Zapalenie rdzenia poprzeczne |
Hungarian | Myelitis transversa |
Norwegian | Transversell myelitt, Myelitt, transversell |
Dutch | myelitis; transversa, transversa; myelitis, myelitis transversa, Myelitis transversa |
Ontology: Myelitis, Acute Transverse (C0270627)
Concepts | Disease or Syndrome (T047) |
MSH | D009188 |
ICD9 | 341.20, 341.2 |
ICD10 | G37.3 |
SnomedCT | 47000000 |
English | Acute (transverse) myelitis NOS, Acute (transverse) myelitis, Acute Transverse Myelitis, Transverse Myelitis, Acute, Acute myelitis NOS, Acute transverse myelitis NOS, acute myelitis transverse, acute transverse myelitis, acute transverse myelitis of central nervous system, acute transverse myelitis of central nervous system (diagnosis), acute transverse myelitis of CNS, Acute transverse myelitis, Acute transverse myelitis (disorder), Myelitis, Acute Transverse |
French | Myélite aigüe transverse, Myélite transverse aigüe, Myélite transverse aiguë, Myélite aiguë transverse |
Norwegian | Akutt transversell myelitt |
Czech | akutní transverzální myelitida |
Spanish | mielitis transversa aguda (trastorno), mielitis transversa aguda |