Urinary retention is a frequent feature in patients with acute myelitis (AM). We here describe the result of a survey of 32 consecutive AM patients as to what extent of AM patients initially present with micturition disturbance. Among those, 3 patients (9%) were shown to have urinary retention as the initial sole manifestation, which was followed by dysesthesia of foot in 3 and leg weakness in 1; and the average interval between micturition disturbance and these second-appearing symptoms/signs was 11 days (8-15 days). Although initial presentation of urinary retention was not common, occurring in only 9% of all the AM patients, clinically it has relevance because patients who suffer urinary retention but have no obvious neurological symptoms may first see general physicians or urologists. In those patients, when obstructive disease has been excluded, AM should be considered.