What Causes Myelitis and How It Can Be Diagnosed and Treated

Myelitis, an inflammation of the spinal cord, can stem from a variety of underlying causes. Among the most common are infectious agents—both viral and bacterial—including pathogens such as herpes viruses, enteroviruses, and even bacteria like tuberculosis. In addition to infections, autoimmune disorders play a significant role; conditions like multiple sclerosis (MS), neuromyelitis optica (NMO), and acute disseminated encephalomyelitis (ADEM) can trigger an abnormal immune response that mistakenly attacks the spinal cord tissue.

Early Warning Signs and Clinical Indicators

Many patients report experiencing flu-like symptoms or a high fever 1–2 weeks before the onset of myelitis. These early signs may include body aches, fatigue, and persistent fever, which can easily be mistaken for a severe cold or upper respiratory infection. However, when these are followed by neurological symptoms such as muscle weakness, numbness, tingling in the limbs, or difficulties with bladder control, it raises red flags for potential spinal cord involvement.

Diagnosis: The Role of Medical Imaging and Spinal Fluid Analysis

If myelitis is suspected, prompt evaluation by a neurologist is essential. One of the key diagnostic tools is a lumbar puncture (also known as a spinal tap), during which cerebrospinal fluid (CSF) is collected from the lower back. This fluid is then analyzed for elevated white blood cells, increased protein levels, and the presence of specific antibodies or infectious organisms. Magnetic resonance imaging (MRI) of the spine is another critical step, helping visualize inflammation, swelling, or lesions along the spinal cord.

Comprehensive Treatment Approaches

Once diagnosed, myelitis typically requires a structured treatment plan tailored to the individual. The primary goals are to reduce inflammation, suppress harmful immune activity, and support nerve recovery. Common treatments include:

Corticosteroids – High-dose intravenous methylprednisolone is often used initially to reduce acute inflammation.
Intravenous immunoglobulin (IVIG) – This therapy helps modulate the immune system, especially in cases linked to autoimmune reactions.
Plasma exchange (plasmapheresis) – Used when steroids are ineffective, this process filters harmful antibodies from the bloodstream.
Neurotrophic medications – Supplements and drugs aimed at supporting nerve repair and function may be prescribed over time.

Treatment duration varies but generally lasts between 3 to 6 months. During this period, consistent medication adherence and regular follow-up MRIs are crucial to monitor healing progress and detect any complications early.

When to Consider Further Investigation

If symptoms persist or worsen despite appropriate treatment, healthcare providers must consider alternative or coexisting diagnoses. Chronic or progressive spinal cord inflammation could indicate an underlying condition such as a spinal tumor, vascular malformation, or a more aggressive autoimmune disease. In such cases, referral to a neurosurgeon or specialized spine center may be necessary for advanced imaging, biopsy, or surgical intervention if needed.

Early recognition, accurate diagnosis, and timely management significantly improve outcomes for individuals with myelitis. With proper medical care and ongoing monitoring, many patients experience partial or full recovery of neurological function.