Myelitis

Myelitis is inflammation of the spinal cord. If a patient has acute onset upper and/or lower extremity weakness (7 days or less), do not miss structural cord compression as this is a neurologic emergency. Obtain STAT MRI of the entire spine without contrast. If there is a history of cancer, obtain the MRI with and without contrast to evaluate for epidural mets. If weakness is hyperacute, get MRI with DWI to assess for spinal cord ischemia. If weakness is <48h, also get CTH and CTA head/neck to rule out basilar artery occlusion. If they are diffusely areflexic/hyporeflexic, also do an LP to evaluate for AIDP. You will also need to order telemetry, NIF/FVC q4h, and start IVIG ideally after serum studies collected unless contraindications.


Establish a Timeline
Time since symptom onset






Duration symptoms have been present






Time to nadir







Prior Workup




Differential Diagnosis
Spinal cord ischemia


Paraneoplastic/Autoimmune






Toxic Myelopathy


Structural







Iatrogenic



Infectious











Metabolic










Rheumatologic






Congenital


Myelitis-Specific Review of Systems








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