Neurológia pre prax 1/2011

Acute myelitis – etiology, diagnosis and treatment

The differential diagnosis of acute myelitis is broad. Therefore, neurologists must be aware of many potential etiologies for acute myelopathy and be able to provide an ordered and efficient diagnostic approach based on patient´s history, clinical examination and magnetic resonance imaging (MRI) findigs. When faced with a patient with an acute myelopathy, excluding an acute compressive cause by MRI is of highest priority. Having excluded a compressive cause and having found an intramedullary spinal cord lesion, the diagnosis of an infectious or inflammatory myelopathy becomes a primary consideration. Detailed history, clinical presentation, focused investigations and treatment of infectious and inflammatory myelopathies are reviewed. Infectious myelitis are caused by viral, bacterial, and rarely by fungal or parasitic agents. Acute noninfectious inflammatory myelopathies were previously often categorized as idiopathic acute transverse myelitis. Advances in neuroimaging and in neuroimmunology have allowed in many cases more specific diagnosis, such as neuromyelitis optica, multiple sclerosis, acute disseminated encephalomyelitis, postvaccinial or postinfectious myelitis, inflammatory myelopathies associated with systemic autoimmune diseases and acute paraneoplastic myelopathies. This paper focuses on a prompt ordered approach in diagnostic evaluation and on treatment of infectious and inflammatory causes of acute myelitis.

Keywords: infectious myelitis, inflammatory myelopathies, diagnostic algorithm, treatment.