Inflammatory and infectious myelopathies are common and often treatable. Infectious causes include viral, bacterial, mycobacterial, fungal, and parasitic agents. Noninfectious inflammatory myelopathies were previously often categorized as idiopathic transverse myelitis, but advances in neuroimaging and the discovery of a serum autoantibody marker, neuromyelitis optica immunoglobulin G (NMO-IgG), have allowed more specific diagnoses, such as multiple sclerosis and neuromyelitis optica, to be made more confidently and at an earlier stage than previously possible. This chapter summarizes an approach to evaluation and management of infectious and inflammatory causes of acute and subacute myelitis and chronic progressive myelopathy.
Note: Text referenced in the Quintessentials Preferred Responses, which appear later in this issue, is indicated in the full text by italics throughout this chapter. In the PDF, this text is indicated by yellow shading.
Relationship Disclosure: Dr Wingerchuk has received personal compensation for activities with Genentech, Inc. Dr Wingerchuk has received research support to Mayo Clinic from the National Multiple Sclerosis Society and Genzyme Corporation.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Wingerchuk discusses the unlabeled use of methylprednisolone, plasmapheresis, and cyclophosphamide for the treatment of myelitis attacks; carbamazepine for tonic spasms; and prednisone, azathioprine, mycophenolate mofetil, cyclophosphamide, mitoxantrone, intravenous immune globulin, and rituximab for prevention of relapse of certain inflammatory myelitides.