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Overview

What Is Myelitis?

Myelitis is inflammation of the spinal cord, the bundle of nerves that carries messages between the brain and body. This inflammation can disrupt movement, strength, sensation, and control of the bladder or bowel. Myelitis may affect people of any age and can have several underlying causes, including immune-related conditions and infections.

Symptoms

Symptoms of Myelitis

Myelitis symptoms can develop over hours to days, although the pattern varies. Symptoms depend on which part of the spinal cord is inflamed and how much of the cord is affected. Some people develop symptoms on both sides of the body, while others have more noticeable problems in one area.

  • Weakness in the arms or legs
  • Numbness or altered sensation, such as tingling or burning
  • Pain in the back, neck, or limbs
  • Muscle stiffness or spasms (spasticity)
  • Difficulty walking or maintaining balance
  • Bladder problems, such as urgency or inability to urinate
  • Bowel problems, such as constipation or loss of control
  • Sexual dysfunction

Causes

What Causes Myelitis?

Myelitis often results from an abnormal immune response that causes inflammation in the spinal cord. It may occur after an infection, with autoimmune diseases such as lupus, or as part of neurologic disorders including multiple sclerosis, neuromyelitis optica spectrum disorder, or MOG-antibody disease. In some cases, a specific cause is not found; this is called idiopathic transverse myelitis.

  • Autoimmune disease can cause the immune system to attack spinal cord tissue, as may occur with lupus or other inflammatory conditions.
  • Post-infectious inflammation may develop after the immune system responds to an infection.
  • Direct infection of the nervous system can inflame the spinal cord, although this is less common.
  • Associated neurologic disorders, including multiple sclerosis, neuromyelitis optica spectrum disorder, and MOG-antibody disease, may cause myelitis.
  • Idiopathic myelitis is diagnosed when testing does not identify a confirmed cause.

Risk Factors

Risk Factors for Myelitis

  • A known autoimmune or inflammatory disease, such as lupus, may be associated with a higher likelihood of myelitis.
  • Multiple sclerosis or another demyelinating disorder can increase the risk of spinal cord inflammation.
  • A recent infection may be followed by an abnormal immune response affecting the spinal cord.
  • Some immune responses after infection or vaccination have been reported in association with myelitis, but this does not prove that vaccination caused it.
  • A previous episode of neurologic inflammation may increase the chance of another episode, depending on the underlying disorder.

Many people with myelitis have no identifiable risk factor. Having a risk factor does not establish a diagnosis, and myelitis disease can occur in people without a known autoimmune condition, recent infection, or prior neurologic inflammation.

Complications

Complications of Myelitis

  • Persistent weakness
  • Impaired walking or reduced mobility
  • Chronic nerve pain
  • Muscle spasticity or stiffness
  • Ongoing bladder dysfunction
  • Ongoing bowel dysfunction
  • Pressure injuries caused by reduced mobility or sensation
  • Blood clots related to immobility
  • Emotional or psychological effects, including anxiety or depression

Complications vary widely from person to person. Early treatment, physical rehabilitation, occupational therapy, and supportive care can reduce disability, improve safety, and help people maintain as much independence as possible.

Diagnosis

How Myelitis Is Diagnosed

Clinicians assess the pattern and timing of symptoms and perform a detailed neurologic examination. Testing helps identify inflammation and distinguish myelitis from spinal cord compression, infection, vascular problems, and other neurologic conditions.

  • Spinal MRI, often with contrast, can show an inflamed segment and help identify its location and extent.
  • A lumbar puncture collects cerebrospinal fluid for analysis of inflammation, infection, and other clues.
  • Blood tests may look for infections, autoimmune conditions, and antibodies linked with disorders such as neuromyelitis optica spectrum disorder or MOG-antibody disease.
  • Additional brain or spinal imaging may be recommended when clinicians need to evaluate multiple sclerosis, other demyelinating disorders, or another cause.

Treatment Options

Transverse Myelitis Treatment Options

Treatment for transverse myelitis focuses on reducing inflammation, treating the underlying cause, and managing symptoms. Early treatment may help reduce spinal cord damage and improve recovery.

Corticosteroids

High-dose intravenous corticosteroids, such as methylprednisolone, are commonly used as an initial treatment. They help reduce inflammation and swelling in the spinal cord.

Plasma Exchange

Plasma exchange (plasmapheresis) may be used when symptoms are severe or when there is little improvement after corticosteroid treatment. It removes harmful antibodies and other substances from the blood.

Immunotherapy

Other immunosuppressive or immunomodulating treatments may be considered in patients who do not respond adequately to initial therapy. The choice depends on the underlying cause and clinical condition.

Treatment of the Underlying Cause

If transverse myelitis is associated with an infection, autoimmune disease, or another neurological condition, specific treatment may be required. Treating the underlying disease can help prevent further neurological problems.

Outlook and Prognosis

Outlook and Prognosis for Myelitis

The outlook for myelitis ranges from substantial recovery to lasting disability. Prognosis depends on the severity and speed of onset, the area of the spinal cord affected, the underlying cause, how quickly treatment begins, and the early response to therapy.

Recovery often begins within weeks to months but may continue for a year or longer. Follow-up with neurology and rehabilitation specialists helps track function, address persistent symptoms, and adjust therapies that support mobility and independence.

When Should You See a Doctor

When Should You See a Doctor for Myelitis Symptoms?

Seek urgent care

Urgent neurologic symptoms

Seek emergency care for rapidly worsening weakness, new difficulty walking, loss of sensation, new bladder or bowel control problems, severe back pain with neurologic changes, trouble breathing, or symptoms that develop suddenly. Contact a clinician promptly for any new or progressive neurologic symptoms.

Myelitis can worsen over hours or days, and other urgent conditions can cause similar symptoms. Prompt assessment is important because early treatment may limit spinal cord injury.