Inflammation of the spinal cord, known as myelitis, can affect its function and cause a wide range of neurological symptoms. Myelitis can be caused by infections, autoimmune disorders, trauma, or toxins. Myelitis can be acute or chronic, and can affect one or both sides of the spinal cord. Myelitis can result in paralysis, bladder or bowel problems, pain, and disabilities. It can be diagnosed with a neurological exam, blood tests, spinal fluid analysis, and imaging tests. Treatment for myelitis involves addressing the causes, reducing inflammation, and managing the symptoms. By avoiding exposure to risk factors, practicing good hygiene, and getting vaccinated against certain infections, myelitis can be prevented.
There are various factors that trigger an inflammatory response in the spinal cord that can cause myelitis. Some of these factors include:
The spinal cord can be invaded by viruses, bacteria, fungal infections, or parasites. Among the infections that can cause myelitis are herpes simplex, varicella zoster, Epstein-Barr, cytomegalovirus, HIV, syphilis, tuberculosis, Lyme disease, and malaria.
The immune system mistakenly attacks the body's own tissues, including the spinal cord, in autoimmune disorders. There are a number of autoimmune disorders that can cause myelitis, including multiple sclerosis, neuromyelitis optica, systemic lupus erythematosus, Sjogren's syndrome, and sarcoidosis.
Injury to the spine, such as from a fall, accident, or surgery, can cause inflammation and damage to the spinal cord. It can also cause bleeding, compression, or infection.
Various toxins can damage the spinal cord and cause inflammation, including lead, mercury, arsenic, carbon monoxide, methotrexate, and radiation therapy.
The symptoms of myelitis vary depending on the location and extent of the inflammation in the spinal cord. They usually appear over hours or days, and can affect either side of the body.
There can be sharp, dull, burning, or shooting pain in the back, neck, or limbs. The pain can worsen with movement.
A weakness can affect the arms, legs, or trunk, and it can range from mild to severe. The weakness can make it difficult to walk, stand, or hold objects.
There can be numbness in the skin of the chest, abdomen, or limbs, which can affect the ability to feel temperature, pain, or touch.
Spasticity: This is an increased tone or stiffness of the muscles that can cause spasms, cramps, or twitching. Spasticity may affect movement and posture.
Patients with bladder and bowel problems can suffer from urinary or fecal incontinence, retention, urgency, or frequency, which can affect their hygiene and quality of life.
Erectile dysfunction, loss of libido, and vaginal dryness are all sexual problems that can affect intimacy and relationships.
Clinical and laboratory methods can be used to diagnose myelitis.
The doctor will ask about the symptoms, onset, duration, and progression of the condition, as well as any possible exposure to risk factors.
The doctor will examine the patient and check for symptoms of spinal cord dysfunction, such as weakness, numbness, spasticity, and changes in reflexes. The doctor will also check the patient's bladder, bowel, and sexual function.
A doctor may order blood tests to check for infections, inflammation, or metabolic disorders that may cause or mimic myelitis, as well as detect antibodies against certain viruses.
An analysis of spinal fluid may be performed by the doctor by inserting a needle into the lower back and taking a sample of the cerebrospinal fluid surrounding the spinal cord. Infections, inflammation, or cancer cells that can cause myelitis can be detected in the spinal fluid.
A doctor may order imaging tests to look for any abnormalities in the spinal cord, such as inflammation, compression, bleeding, or tumors. Imaging tests can also help determine the extent and location of the myelitis.
Depending on the cause, severity, and complications of myelitis, treatment aims to:
Treat the underlying cause: Antibiotics, antivirals, antifungals, or antiparasitics can be used to treat infections, immunosuppressants or immunomodulators can be used to treat autoimmune disorders, surgery or radiation can be used to treat trauma or tumors, chelation or detoxification can be used to treat toxins.
It may be necessary to use corticosteroids, such as methylprednisolone or dexamethasone, to decrease the swelling and damage in the spinal cord. The inflammation may be reduced with plasmapheresis, a procedure in which the blood is filtered and harmful antibodies are removed.
Symptoms can be managed by taking painkillers, including acetaminophen or ibuprofen, muscle relaxants, such as baclofen or tizanidine, to reduce spasticity, anticholinergics, such as oxybutynin or tolterodine, to control bladder and bowel problems, or phosphodiesterase inhibitors, such as sildenafil or tadalafil, to treat sexual problems.
To improve the strength, mobility, coordination, and communication of the patient, physical therapy, occupational therapy, or speech therapy may be used. As part of the rehabilitation, the patient may also be assisted with daily activities by assistive devices, such as braces, canes, and wheelchairs.
The following preventive measures can reduce the risk or severity of myelitis:
Preventing exposure to risk factors that can cause or trigger myelitis, such as infections, trauma, or toxins.
Good hygiene includes washing hands frequently, covering the mouth and nose when coughing or sneezing, and disinfecting surfaces and objects that may be contaminated.
It is important to get vaccinated against certain infections, such as measles, mumps, rubella, chickenpox, or influenza, that can cause or complicate myelitis.
If you experience any signs or symptoms of myelitis, such as weakness, numbness, or bladder or bowel problems, seek medical attention immediately.
