The spinal cord is the central data highway of the human body. It transmits commands from the brain to the muscles and receives sensory input from the skin. When this delicate bundle of nerves is damaged by inflammation, the condition is referred to as myelitis. This rare but serious neurological disorder can occur suddenly and can severely impact the lives of those affected through paralysis or sensory disturbances. It often presents as an isolated event but may also be an early indicator of a chronic condition such as multiple sclerosis. Prompt recognition of symptoms and rapid initiation of treatment are crucial to prevent long-term damage and preserve nerve function.
27.01.2026
Author
Leading Medicine Guide Editors
ICD codes for this diseases: G04
Brief overview:
Myelitis is defined as an inflammatory disease of the spinal cord that can affect both the gray and white matter. The inflammation damages the myelin sheaths—the protective coverings of nerve fibers—or the nerve cells themselves, thereby disrupting signal transmission. The causes are diverse and range from viral and bacterial infections to autoimmune diseases such as multiple sclerosis or neuromyelitis optica, as well as idiopathic forms in which no clear cause can be identified. Clinically, the condition often presents with muscle weakness, sensory disturbances such as numbness or tingling, and bladder and bowel dysfunction. Diagnosis is typically made using magnetic resonance imaging (MRI) and analysis of the cerebrospinal fluid (CSF). Treatment is usually based on the high-dose administration of corticosteroids or plasmapheresis, followed by intensive rehabilitation.
Article overview
What Is Myelitis?
The term myelitis is derived from Greek (“myelos” meaning marrow) and describes an inflammation of the spinal cord. This inflammation may be limited to a small focal area or may involve large portions of the spinal cord. Anatomically, the spinal cord connects the brain with the peripheral nervous system. Damage at this site leads to impaired transmission of information.
A particular and common form is transverse myelitis. In this condition, the entire cross-section of the spinal cord at a specific level is inflamed, resulting in symptoms similar to those of a spinal cord injury syndrome, although no mechanical trauma is present.
Acute myelitis of the thoracic spine: The reddish swelling and lesion of the spinal cord can interrupt nerve signal transmission, leading to typical symptoms such as paralysis and sensory disturbances.
Causes: How Does the Inflammation Develop?
The triggers of myelitis are complex and are divided into several categories:
- Infectious causes Viruses, bacteria, or fungi may directly invade the spinal cord or trigger an excessive immune response. Common pathogens include herpes viruses (e.g., varicella-zoster), enteroviruses, HIV, and bacteria such as Borrelia (Lyme disease) and Treponema pallidum (syphilis).
- Autoimmune diseases In many cases, the immune system mistakenly attacks the body’s own tissues.
- Multiple sclerosis (MS): Myelitis is often the first relapse or an associated manifestation of MS.
- Neuromyelitis optica (NMO): A rare disease that specifically targets the optic nerve and the spinal cord.
- Systemic lupus erythematosus: A rheumatic disease that can also affect the nervous system.
- Idiopathic myelitis: In some patients, no specific cause can be identified despite extensive diagnostic evaluation. It is assumed that this is often a post-infectious immune reaction in which a preceding, harmless infection misdirects the immune system.
Symptoms: Warning Signs of the Body
The symptoms depend strongly on which region of the spinal cord is affected. They may develop within hours or days. Key symptoms include:
- Motor deficits: These often begin with weakness in the legs (paraparesis) and may progress to complete paralysis. If the cervical spine is affected, the arms may also be involved.
- Sensory disturbances: Patients frequently report numbness, tingling (“pins and needles”), burning sensations, or a feeling as if the torso were tightly constricted (band-like sensation).
- Autonomic dysfunction: Bladder and bowel dysfunction is very common. This may present as urinary retention, incontinence, or constipation. Sexual dysfunction is also possible.
- Pain: Many patients suffer from stabbing back pain at the level of the inflammation or neuropathic pain radiating into the arms and legs.
Diagnostics: Identifying the Site of Inflammation
If myelitis is suspected, urgent evaluation is required. The neurologist will first perform a clinical examination to localize the level of the lesion.
The most important diagnostic tool is magnetic resonance imaging (MRI). With contrast enhancement, inflammatory lesions in the spinal cord and often in the brain can be visualized. This also helps exclude other causes such as tumors or herniated discs.
In addition, a lumbar puncture is almost always performed. Cerebrospinal fluid (CSF) is obtained from the spinal canal and analyzed in the laboratory for inflammatory cells, protein levels, and specific antibodies (oligoclonal bands), which provide clues to MS or infections. Blood tests are also used to detect specific antibodies (e.g., aquaporin-4 in NMO).
Therapy and Rehabilitation
The treatment of myelitis aims to stop the inflammation as quickly as possible and restore nerve function.
Acute therapy In the acute phase, especially when no infectious cause is present, high-dose administration of corticosteroids (steroids) intravenously (pulse therapy) is the standard treatment. Steroids have a strong anti-inflammatory and anti-edematous effect.
If steroids are insufficiently effective, plasmapheresis (plasma exchange) or immunoadsorption is often used. In these procedures, harmful antibodies and inflammatory factors are filtered from the blood. In cases of infectious etiology, targeted antiviral or antibiotic therapy is administered instead.
Rehabilitation After the acute phase, long-term rehabilitation is essential. Because nervous tissue recovers slowly, patients need patience. Physical therapy helps with paralysis and spasticity, occupational therapy supports reintegration into daily life, and speech therapy may be helpful in rare cases of swallowing disorders. Medications may also be used to treat neuropathic pain or bladder dysfunction.
FAQ: The 8 Most Important Questions About Myelitis
What is the difference between myelitis and transverse myelitis?
Myelitis is the general term for any inflammation of the spinal cord. Transverse myelitis is a specific form in which the inflammation affects the entire cross-section of the spinal cord at a particular level. This results in impairment of functions (motor, sensory) below that level on both sides of the body.
Is myelitis curable?
The prognosis is variable. About one third of patients with idiopathic transverse myelitis recover completely. Another third retain moderate impairments (e.g., gait instability, urinary urgency), while the remaining third live with permanent, severe disabilities. Early treatment significantly improves the chances of recovery.
Is myelitis contagious?
Myelitis itself is not contagious. It is an inflammatory reaction within the body. However, if myelitis is caused by a virus (such as enteroviruses or polio), the pathogen itself may be contagious, although it does not necessarily cause myelitis in other individuals.
How can myelitis be distinguished from multiple sclerosis?
Myelitis is often a symptom or a “relapse” in the context of multiple sclerosis (MS). If myelitis occurs as a single event and no additional lesions are found on brain MRI, it is referred to as isolated myelitis. If brain lesions are also present or recurrent inflammatory episodes occur, a diagnosis of MS is more likely.
How long does a myelitis relapse last?
The acute phase with the strongest inflammation usually lasts several days to weeks. The recovery phase often begins after 2 to 12 weeks and may extend for up to two years. The fastest improvements typically occur within the first three to six months after initiation of therapy.
What long-term complications may occur?
The most common long-term sequelae include persistent spasticity (muscle stiffness), chronic neuropathic pain, bladder and bowel dysfunction, and sexual dysfunction. Pronounced fatigue may also persist.
Can vaccination trigger myelitis?
There are very rare reports of myelitis cases following vaccination. However, experts agree that the risk of developing myelitis from the natural infection (against which vaccination is given) is far higher than the extremely low risk of a vaccine-related adverse effect. In most cases, this represents a misdirected immune response.
Which doctor treats myelitis?
The appropriate specialist is a neurologist. In acute cases, a hospital with a neurological department should always be consulted. For follow-up care, rehabilitation physicians, physical therapists, and urologists (for bladder problems) are also important.
