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Myelitis:
Myelitis refers to a syndrome in which acute or chronic inflammation compromises the function of the gray and/or the white matter of the spinal cord. The specific cause of myelitis is not always known at the time of the initial clinical presentation. Known causes of myelitis include immunological mechanisms such as that seen with viral infection, vascultis, demyelinative disease, reduce blood supply (ischemia), as a side affect of certain drugs such as amphetamines, Lyme disease, syphilis, tuberculosis (TB), parasitic or fungal agents.
The signs and symptoms of myelitis usually involve ascending weakness and numbness of varying degrees involving the feet and legs. There may be disturbances of bladder function. This presentation may progress over several or more days becoming severe, with diffuse sensory loss and motor paralysis occuring below the level of the lesion. The acute condition may result in urinary retention and the loss of bowel control. Certain sensory (posterior spinal cord) functions may be spared at least initially. Local back pain, headache, and stiff neck may be present. The clinical presentation may subside and then come back again.
Acute transverse myelitis can develop as the result of or as a feature of relapsing-remitting multiple sclerosis. Multiple sclerosis is an autoimmune disorder of unknown etiology characterized by an immune-mediated attack against the central nervous system resulting in damage to the nerves and supporting cells within the brain and spinal cord. Patients who aquire myelitis should be screened for MS since treatment strategies may be very different for those patients with likely MS compared to those who do not. The evaluation for multiple sclerosis should include a brain MRI to determine if demyelinating lesions are present elsewhere in the central nervous system and a spinal tap to determine if antibodies are being synthesized within the central nervous system (oligoclonal bands). The workup often includes special electrical testing (electrodiagnostics) with evoked potential studies and cerebrospinal fluid studies. The evoked potential studies may involve somatosensory, brainstem and visual evoked potential studies
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