Definition
Myelitis is an inflammation that affects the spinal cord.
From the clinical point of view, it is possible to distinguish:
- Transverse myelitis : limited to one or a few segments of the adjacent spinal cord, longitudinally, generally at the thoracic level;
- Ascending myelitis : it has a tendency to progressively spread to the upper parts of the nervous system.
Furthermore, myelitis can occur in irregularly disseminated foci .
The inflammatory process that is established involves serious damage to the structures involved, which often result in permanent neurological deficits.
Multiple sclerosis is the most common cause of myelitis, but this condition can also occur in patients with vasculitis or those taking amphetamines, heroin and some antiparasitic or antifungal drugs.
The causes also include autoimmune reactions and mycoplasma infections, Lyme disease, syphilis, tuberculosis and viral meningoencephalitis. Some cases are idiopathic (with no known cause).
Most common symptoms and signs *
- Alve alterations
- Asthenia
- bradycardia
- Erectile dysfunction
- Dyspnoea
- Abdominal pain
- Neck pain
- Chest pain
- Back pain
- hemiparesis
- Tingling in the legs
- Fecal incontinence
- Hypertension
- Hypoaesthesia
- weakness
- Headache
- Paraplegia
- Paresthesia
- Stiffness in the muscles of the back and neck
- Urinary retention
- Sense of suffocation
- Muscle spasms
- Fatigue with spasms (spasmophilia)
Further indications
Myelitis is manifested by more or less extensive muscular paralysis, loss of sensitivity and sphincter dysfunction, with uncontrolled emission or retention of urine and faeces.
During the course of the disease, pain may occur in the neck, back or skull. Within a few hours or a few days, the patient may experience an annoying feeling of constriction around the chest or abdomen. In addition, hyposthenia in the limbs, tingling, muscle spasms, numbness in the feet and legs, sexual disorders and difficulty in evacuation may develop.
The deficits may progress for several days until a picture of sensorimotor myelopathy develops, with paraplegia and loss of sensitivity below the lesion. Some forms of myelitis can lead to the death of the patient due to the involvement of respiratory centers.
Generally, the faster the progression of the disorders, the worse the prognosis is; about one third of patients recover, while in the remaining cases there are residual degrees of weakness and urinary incontinence.
The diagnosis usually arises with magnetic resonance imaging (MRI), the analysis of the cerebrospinal fluid (CSF), blood tests and usually other investigations able to identify treatable causes.
The presence of pain suggests a particularly intense inflammatory reaction. MRI typically shows a swelling of the marrow and helps to rule out other conditions.
The differential diagnosis involves acute compressions (for example, epidural abscess and metastasis) and spinal cord infarction. The LCR analysis usually shows a pleocytosis of mononuclear elements, a slight increase in liquor proteins and a high index of IgG synthesis.
The therapy is essentially symptomatic and requires regular assistance to the patient, in order to avoid pressure sores, secondary infections, muscle contractures and malnutrition.
In cases where it is possible, the treatment must also be directed to the correction of all underlying causes. In idiopathic forms, on the other hand, the administration of high doses of corticosteroids is generally expected, sometimes followed by plasmapheresis cycles.
