Guide To The Types Of Myelitis

Myelitis is a state of inflammation in an individual's spinal cord that can result in permanent nerve and spinal damage. It can have numerous causes, including damage that results from other diseases, abnormal autoimmune responses, certain types of viruses and bacteria, vascular abnormalities, and cancer. Symptoms of myelitis vary depending on which section of the spinal cord is being affected and damaged from the inflammation. Symptoms include back pain, numbness, tingling, burning sensations, urinary urgency, bowel or bladder incontinence, loss of temperature sensation, abdominal tightness, muscle weakness, paralysis, loss of light touch sensation, and constipation. Myelitis is diagnosed with the use of blood tests, diagnostic MRI imaging, physical exam, and lumbar puncture. Treatment for myelitis is dependent upon its underlying cause, symptomatic challenges, and the extent of spinal damage.

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Transverse Myelitis

Transverse myelitis is a type of myelitis where the patient experiences nerve dysfunction on both sides of their spinal cord in both the sensory and motor pathways. There are a handful of classic symptoms that occur in individuals affected by transverse myelitis. Symptoms include arm and leg weakness, sensations of tingling, discomfort or pain, sensations of numbness, bladder dysfunction, and bowel motility issues. These manifestations of transverse myelitis may occur bilaterally or in both arms and legs, or they may occur unilaterally or in the arm and leg on one side of the body. The word transverse in the name of this classification refers to malfunction at a single level across the entire spinal cord, but inflammation that is focal and produces unilateral dysfunction is included in this myelitis classification. Most cases of transverse myelitis have an unknown cause. When the cause can be identified, the processes of an autoimmune disorder such as neuromyelitis optica, Sjogren's syndrome, multiple sclerosis, systemic lupus erythematosus, and sarcoidosis are commonly implicated.

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Leukomyelitis

Leukomyelitis describes inflammation of the spinal cord limited to an individual's white matter. The brain and spinal cord are composed of different types of tissue that perform different functions. Gray matter contains dendrites, neural cells, and axon terminals, while white matter contains myelin and axons. The white matter may also be referred to as superficial tissue due to its location in the outer parts of the spinal cord and brain. White matter functions to regulate and transmit nerve signals from the cerebrum to the spinal cord and other brain tissues. Within the spinal cord, white matter functions as a complex network of wiring that carries information throughout the central nervous system. When this white matter in the spinal cord becomes inflamed, it is called leukomyelitis. The most common causes of this type of myelitis are cerebral palsy, multiple sclerosis, adrenoleukodystrophy, and other inherited childhood diseases. When there is inflammation in the white matter of the spinal cord, the effectiveness of a patient's blood-brain barrier becomes compromised. This process allows for further infiltration of the central nervous system by antibodies and peripheral immune cells. This compounded inflammation can result in damage to the protective myelin sheathing that insulates the neural axons and allows for the smooth transmission of signals.

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Acute Flaccid Myelitis

Acute flaccid myelitis is the type of myelitis that affects the gray matter inside of an individual's spinal cord. Many cases of acute flaccid myelitis are caused by a viral infection like West Nile virus, enteroviruses, adenovirus, and poliovirus. Classic symptoms seen in acute flaccid myelitis patients include loss of muscle tone, sudden leg or arm weakness, and absent or decreased reflexes. Sometimes the nerves controlling an individual's neck and head can become inflamed as well, resulting in symptoms of eyelid drooping, speaking difficulties, facial weakness, problems swallowing, and difficulty moving the eyes. It can be difficult to pinpoint acute flaccid myelitis as the cause of associated symptoms because the spinal fluid of affected individuals typically does not contain any causative pathogens. Diagnosis has to be made based on a physical examination, evaluation of the nervous system, and diagnostic imaging of the patient's spinal cord. Treatment usually involves occupational or physical therapy to help with symptoms caused by acute flaccid myelitis.

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Poliomyelitis

Poliomyelitis is a form of myelitis caused by an infection of a highly transmittable virus that is part of the Picornaviridae family. The poliovirus infects an individual by invading the oropharynx and then colonizing in their tonsils, neck lymph nodes, Peyer patches, and small intestine. Symptoms begin to manifest anywhere from two to thirty-five days following initial exposure. Initially, the poliovirus produces flu-like symptoms for between three and five days. The virus then enters the bloodstream and moves to the central nervous system, damaging the spinal anterior horn cells. Poliovirus then spreads to the posterior horn cells, hypothalamus, and motor neuron of the thalamus. This central nervous system invasion causes symptoms of paralysis in multiple parts of the body and summons an immune response that characterizes poliomyelitis. This immune response is the congregation of plasma cells, microglia, neutrophils, and other macrophages. The macrophages consume cells infected by poliovirus, resulting in damage to the white matter of the spinal cord. Severe cases of poliomyelitis result in respiratory paralysis. Elimination of the infection and rehabilitation of lost nerve and muscle function are the focuses of poliomyelitis treatment.

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Meningococcal Myelitis

Meningococcal myelitis is inflammation of the spinal cord caused by Meningococci or a type of bacteria with the ability to produce serious infections in the body. Meningococci causes meningitis more often than it does myelitis, but both may occur together. An infection by meningococci starts with symptoms including fever, vomiting, stiff neck, and intense headache. This type of infection can affect both the white and grey matter of the spinal cord, producing classic symptoms seen in myelitis. In such cases, the inflammation of the spinal cord is caused by a direct infiltration and infection of the spinal cord tissues by the bacteria itself. However, meningococcal myelitis can also occur when the immune system responds to the meningococci bacteria that has invaded tissues elsewhere. Typically this is seen with meningococcal encephalitis and meningococcal meningitis. The immune system reacts to the bacteria by destroying different types of healthy cells and infected cells in the central nervous system. This process causes severe inflammation in the spinal cord or myelitis precipitated from the meningococci bacteria.