Myelitis

Clinic

• Myelitis is inflammation of the spinal cord which can disrupt the normal responses from the brain to the rest of the body, and from the rest of the body to the brain. Inflammation in the spinal cord can cause the myelin and axon to be damaged resulting in symptoms such as paralysis and sensory loss. Myelitis is classified to several categories depending on the area or the cause of the lesion; however, any inflammatory attack on the spinal cord is often referred to as transverse myelitis.

Types

• Acute flaccid myelitis: a polio-like syndrome that causes muscle weakness and paralysis.
• Poliomyelitis: disease caused by viral infection in the gray matter with symptoms of muscle paralysis or weakness
• Transverse myelitis: caused by axonal demyelination encompassing both sides of the spinal cord
• Leukomyelitis: lesions in the white matter
• Meningococcal myelitis (or meningomyelitis): lesions occurring in the region of meninges and the spinal cord

Sign / Symptoms

• Most myelitis manifests fast progression in muscle weakness or paralysis starting with the legs and then arms with varying degrees of severity.
• Sometimes the dysfunction of arms or legs cause instability of posture and difficulty in walking or any movement.
• Paresthesia which is a sensation of tickling, tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect.
• Pain in the back, extremities, or abdomen
• Urinary urgency
• Bladder incontinence
• Difficulty or inability to void
• Incomplete evacuation of bowel or constipation
• Respiratory problems
• Intractable vomiting

Entities

• Paresthesia / Hyperstasia / Radiculopathy
• Urinary urgency /Bladder incontinence
• Constipation
• Radiculopathy
• Gait difficulty
• Poly-myelitis like syndrome: MMP
• Myelitis, ascending: SHBV
• Myelitis, Flaccid: ADV, PLV, WNE
• Myelitis, Hemorrhagic: SHBV
• Myelitis, LMN: PLV

Miasmatic analysis

• Myelitis + Incontinence: TBE, HTLV-1
• Myelitis + Urgency: HSV-1, HSV-2, HTLV-1
• Myelitis + Constipation: HSV-1, HSV-2, RBOL, EBV, LBB
• Myelitis + Paresthesia + Hyperstasia: HSV-1, HSV-2 , PLV, LBB
• Myelitis + Radiculopathy: HSV-1, HSV-2 ,LBB
• Myelitis, Flaccid: ADV, PLV, WNE
• Poly-myelitis like syndrome: MMP
• Myelitis, ascending: SHBV
• Myelitis, Hemorrhagic: SHBV
• Myelitis, LMN: PLV

Related diseases

• Acute disseminated encephalomyelitis: autoimmune demyelination of the brain causing severe neurological signs and symptoms
• Multiple sclerosis: demyelination of the brain and spinal cord
• Neuromyelitis optica or Devic's disease: immune attack on optic nerve and spinal cord
• Sjögren's syndrome: destruction of the exocrine system of the body
• Systemic lupus erythematosus: a systemic autoimmune disease featuring a wide variety of neurological signs and symptoms
• Sarcoidosis: chronic inflammatory cells form as nodules in multiple organs
• Atopy: an immune disorder of children manifesting as eczema or other allergic conditions. It can include atopic myelitis, which causes weakness.
• Immune-mediated myelopathies, heterogeneous group of inflammatory spinal cord disorders including autoimmune disorders with known antibodies

Cause

• Direct infection by viruses, bacteria, mold, or parasites such as HIV, HTLV- I and II, EV70 and EV71, CXA, CXB, ECHO, WNE JE, TBE).
• Transverse myelitis or leukomyelitis, or white matter myelitis, are often caused by the herpesviruses and influenza virus
• Syphilis, LBB, and MTB
• Autoimmune causes

Infectious myelitis [edit]

The location of motor neurons in the anterior horn cells of the spinal column will be affected by the polioviruses causing poliomyelitis.

• Viral myelitis

Most viral myelitis is acute, but the retroviruses (such as HIV and HTLV) can cause chronic myelitis. Poliomyelitis, or gray matter myelitis, is usually caused by infection of anterior horn of the spinal cord by the enteroviruses (

• Bacterial myelitis

Bacterial myelitis includes Mycoplasma pneumoniae, which is a common agent for respiratory tract. Studies have shown respiratory tract infections within 4–39 days prior to the onset of transverse myelitis. Or, tuberculosis, syphilis, and brucellosis are also known to cause myelitis in immune-compromised individuals. Myelitis is a rare manifestation of bacterial infection.

• Fungal myelitis

Fungi have been reported to cause spinal cord disease either by forming abscesses inside the bone or by granuloma. In general, there are two groups of fungi that may infect the CNS and cause myelitis - primary and secondary pathogens. Primary pathogens include the following: Cryptococcus neoformans, Coccidioides immitis, Blastomyces dermatitides, and Hystoplasma capsulatum. Secondary pathogens are opportunistic agents that primarily infect immunocompromised hosts such as Candida species, Aspergillus species, and zygomycetes.

• Parasitic myelitis

Parasitic species infect human hosts through larvae that penetrate the skin. Then they enter the lymphatic and circulatory system, and migrate to liver and lung. Some reach the spinal cord. Parasitic infections have been reported with Schistosoma species, Toxocara canis, Echinococcus species, Taenia solium, Trichinella spiralis, and Plasmodium species.

Autoimmune myelitis[edit]

In 2016, it was identified in Mayo clinic an autoimmune form of myelitis due to the presence of anti-GFAP autoantibodies. Immunoglobulins directed against the α-isoform of glial fibrillary acidic protein (GFAP-IgG) predicted a special meningoencephalomyelitis termed autoimmune GFAP Astrocytopathy that later was found also to be able to appear as a myelitis.