Myelitis as a differential diagnosis of spinal cord tumors

• Published in: Neuro-chirurgie Vol. 63; no. 5; pp. 349 - 355
• Main Authors: Vermersch, P, Outteryck, O, Ferriby, D, Zéphir, H
• Format: Journal Article
• Language: French
• Published: France 01.11.2017
• Subjects: Diagnosis, Differential; Humans; Multiple Sclerosis - diagnosis; Multiple Sclerosis - etiology; Myelitis - diagnosis; Myelitis - etiology; Neuromyelitis Optica - diagnosis; Neuromyelitis Optica - etiology; Spinal Cord Neoplasms - diagnosis; Myelitis; Sclérose en plaques; Multiple sclerosis; Vasculitis; Neuromyélite optique; Neuromyelitis optica; Myélite; Vascularites
• ISSN: 1773-0619
• DOI: 10.1016/j.neuchi.2017.06.004

Myelitis is common, related to multiple aetiologies and constitute in some cases a differential diagnosis for spinal cord tumors. Our objective was to review the clinical and paraclinical aspects of the main aetiologies of myelitis. These aetiologies will be reviewed based on data not only from the scientific literature but also from our personal experience reported in different cohorts of patients. Multiple sclerosis is the main cause of partial myelitis in young adults. Neuromyelitis optica is now a well-known specific entity frequently revealed by a transverse myelitis. The diagnosis is based on specific criteria, including the presence of anti-NMO antibodies. In our cohorts, approximately 12 % of the patients admitted for an acute or subacute myelitis were related to infections, mainly of a viral origin. Patients with myelitis must be screened for systemic diseases. As for neuromyelitis optica, patients with myelitis related to a systemic disease should be treated in emergency. Acute myelitis is sometimes the first symptom of a systemic lupus or of a sarcoidosis. Sjögren syndrome can mimic myelitis related to primary progressive multiple sclerosis. Spinal cord imaging contributes greatly to defining the myelitis. In most cases, a routine clinical and paraclinical examination and the follow-up of the patients can contribute to establishing the aetiology of a myelitis.