Acute Myelitis: Overview of the Disease and Treatment

Acute myelitis is a serious medical condition involving acute damage to the spinal cord. It can affect the gray matter, white matter, the entire segment of the spinal cord, or several adjacent segments.

Types of acute myelitis:

• Gray matter myelitis: Damage to the gray matter of the spinal cord.

• White matter myelitis: Damage to the white matter of the spinal cord.

• Transverse myelitis: Damage to the entire segment of the spinal cord.

• Ascending paralysis (Landry’s paralysis): Rapidly progressive paralysis, spreading from bottom to top.

• Disseminated myelitis: Damage to multiple locations of the spinal cord, spreading wider than the length.

• Meningomyelitis: Inflammation of the meninges along with inflammation of the spinal cord.

• Optic neuritis-myelitis: Inflammation of the spinal cord combined with inflammation of the optic nerve.

• Myelitis + spinal nerve inflammation: Combination of myelitis with inflammation of the spinal nerves.

Causes of the disease:

• Bacterial infection: Due to bacteria such as pneumococcus, staphylococcus, streptococcus, syphilis, typhoid, dysentery, etc.

• Virus: Rabies, polio, Epstein-Barr, etc.

• Other causes: Heavy metals, radiation, etc.

Characteristics of pathological damage:

• Early stage: Congestion, edema of the spinal cord, vascular dilation, hemorrhage, neuronal damage, axonal myelin destruction. This stage can be completely recovered with treatment.

• Late stage: Neural tissue is broken down, axons are destroyed.

• Sclerotic stage: Dead neural tissue is replaced by fibrous tissue, creating a sudden impulse flow interruption.

Types of disease:

• Acute myelitis: Symptoms appear quickly, peaking within a few days.

• Subacute myelitis: Progresses over 2-6 weeks.

• Chronic myelitis: Progresses over 6 weeks.

Acute transverse myelitis:

• The most common clinical type, often affecting the thoracic spinal cord, less common in the cervical spinal cord.

• Primarily caused by viruses, rarely secondary.

Clinical symptoms of transverse myelitis:

• Localized neurological syndrome: Fever, pain in the inflamed nerve, etc.

• Localized neurological syndrome combined with spinal cord damage:

• Spinal shock stage: Flaccid paralysis of the lower limbs, loss of deep tendon reflexes, skin reflexes, loss of sensation, muscle atrophy, rapid edema and ulceration, central bowel dysfunction (as the peripheral bowel control center is located in S1-2, while transverse myelitis usually affects the thoracic spinal cord).

• Spinal automatism stage: Appearance of automatic reflexes, increased deep tendon reflexes, predominance of flexor muscles leading to spasticity, automatic bowel function.

Changes in cerebrospinal fluid:

• Increased albumin and white blood cells.

MRI scan:

• Increased T2 signal in the damaged area and increased spinal cord caliber.

Diagnosis:

• Definitive diagnosis: Based on clinical symptoms.

• Localization diagnosis: Based on motor and sensory disturbances.

Differential diagnosis:

• Peripheral flaccid paralysis of both lower limbs: Poliomyelitis, polyradiculitis, polyneuropathy.

• Spinal cord circulatory disturbance: No fever.

• Spinal cord tumor.

• Syphilis of the spinal cord.

• Multiple sclerosis.

Treatment goals:

• Restore neurological function.

• Relieve symptoms.

• Prevent complications.

Treatment of acute myelitis:

• Corticosteroids: Immediate injection.

• Drugs for neural tissue recovery: Drugs promoting myelin sheath regeneration (nucleo CMP), drugs for enhancing neural nutrition, B vitamins.

• Treatment of individual symptoms: Bowel dysfunction, pain, etc.

Acute ascending paralysis (Landry’s syndrome):

• Begins like acute transverse myelitis but progresses quickly, spreading from bottom to top, possibly leading to death due to respiratory failure and cardiovascular collapse when spreading to the brainstem.

Brown-Séquard syndrome:

• Rare clinical syndrome due to uneven spinal cord damage.

• Paralysis on the same side below the lesion level.

• Loss of touch, vibration, position sense on the same side below the lesion level.

• Loss of temperature and pain sense on the opposite side below the lesion level.

• Complete loss of sensation in a narrow band on the same side at the lesion level.

Optic neuritis-myelitis (Devic’s syndrome):

• Combines inflammation of the optic nerve (mainly in the optic chiasm) with transverse myelitis (common in the thoracic spinal cord).

• Sudden onset, decreased vision and lower limb paralysis may occur simultaneously, or decreased vision may precede by a few days/weeks.

Acute gray matter myelitis (Poliomyelitis):

• Poliovirus has a high affinity for motor neurons.

• Destroy motor neurons of the anterior horn of the spinal cord and brainstem.

• Symptoms: Fever, progressive flaccid paralysis, often asymmetrical, usually affecting the limbs, possibly affecting respiratory muscles and the diaphragm.

Diagnosis of gray matter myelitis (poliomyelitis):

• Based on clinical symptoms and cerebrospinal fluid changes (increased white blood cells).

Note: This information is for informational purposes only. Contact your doctor for appropriate diagnosis and treatment.