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Infectious, Autoimmune and Other Immune-Mediated Causes of Myelitis

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Neurological Aspects of Spinal Cord Injury

Abstract

Autoimmunity, infections and immune-mediated mechanisms associated with pathogens, vaccinations and systemic diseases can damage the spinal cord and its adjacent structures. Multiple sclerosis is the most common cause of autoimmune myelitis, preferably affects young women and takes a relapsing–remitting or progressive course. In children, acute disseminated encephalomyelitis frequently accounts for acute myelitis. The clinical hallmarks of neuromyelitis optica spectrum disorder are recurrent episodes of optic neuritis and longitudinally extensive transverse myelitis. Further immune-mediated causes of myelitis include sarcoidosis, Sjögren’s disease, spinal manifestations of systemic autoimmune and inflammatory diseases as well as paraneoplastic, para-/postinfectious and para-/post-vaccinal aetiologies. Diagnostic criteria rely on clinical and magnetic resonance imaging features together with serum and cerebrospinal fluid examination.

Infections with viruses, bacteria, spirochaetales, fungi, protozoa or helminths can affect the spinal cord, nerve roots and adjacent structures, frequently resulting in severe long-term sequelae. Herpes virus transverse myelitis and the tick-transmitted diseases neuroborreliosis and tick-borne encephalitis are the most common causes of infectious myelitis in Central Europe, whereas on a worldwide scale, myelitis caused by enteroviridae (e.g. poliomyelitis or enterovirus) and spinal neurocysticercosis are more frequent. The diagnosis of infectious spinal cord disease is made by cerebrospinal fluid analysis with elevated cell counts and detection of pathogens by microscopy or polymerase chain reaction or a specific intrathecal antibody reaction. Since infectious and autoimmune myelitis are associated with significant morbidity and mortality and often account for severe neurological deficits as well as long-term sequelae, early and specialised multidisciplinary care are recommended.

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Authors and Affiliations

  1. Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Gudrunstr. 56, 44791, Bochum, Germany

    Ingo Kleiter

  2. Department of Neurology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria

    Erich Schmutzhard

  3. Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Corinna Trebst

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  1. Ingo Kleiter
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  3. Corinna Trebst
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Correspondence to Ingo Kleiter .

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  1. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

    Norbert Weidner

  2. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

    Rüdiger Rupp

  3. Methodist Rehabilitation Center, University of Mississippi Medical Center, Veterans Administration Medical Center, Jackson, Mississippi, USA

    Keith E. Tansey

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Kleiter, I., Schmutzhard, E., Trebst, C. (2017). Infectious, Autoimmune and Other Immune-Mediated Causes of Myelitis. In: Weidner, N., Rupp, R., Tansey, K. (eds) Neurological Aspects of Spinal Cord Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-46293-6_6

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