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The Nervous System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The names of many of the other diseases, syndromes, and symptoms affecting the nervous system are readily decipherable by those with an understanding of the basic terminology of the system. For example, a meningioma is simply a tumor (-oma) of the meninges, while a meningocele is a protrusion (-cele) of the meninges through an opening in the skull or spinal column. Myelitis is any inflammation of the spinal cord since myelo refers to the spinal cord; similarly, neuritis is an inflammation of a nerve. Using the same root, neuralgia is pain along the length of a nerve. From the same prefix, one can decipher the meanings of ataxia and aphasia as indicating a lack (a- means "without") of ability to properly perform a postural (-taxia) or speech (-phasia) function. Table 12.1 lists many of these terms.
Inflammatory diseases affecting the spinal cord
Published in Milosh Perovitch, Radiological Evaluation of the Spinal Cord, 2019
Clinical symptomatology and laboratory findings in myelitis usually lead to the diagnosis. Radiography of the spine may prove useful so that the presence of pathologic alterations of the bony spine can be excluded. Myelography in myelitis is rarely required. For instance, we used gas myelography only in two patients to exclude the presence of an epidural abscess. It demonstrated a diffusely swollen spinal cord from the lower to the upper thoracic region with a narrowed subarachnoid space. Pantopaque® myelography, further on, can demonstrate a complete obstruction of the subarachnoid space resulting from the spinal cord enlargement similar to the one seen in intramedullary tumors.73, 78 It is preferable not to remove the opaque contrast medium fom the subarachnoid space because here a repeated examination is possible and the evaluation of the effect of the treatment can be determined.73 However, Pantopaque® myelography does not yield much information in myelitis, and computed tomography should be considered as a more adequate tool for differential diagnosis in this condition.
Emergencies in systemic lupus erythematosus
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Vishalakshi Viswanath, Rashmi Modak
The prevalence of CNS impairment/involvement ranges from 10% in early stages to 80% in later stages of SLE [43]. A strong association between cerebral infarction, presenting as classical stroke or as transient ischemic attack, and APAs has been noted [44]. These events can lead to a significant cognitive disorder and increase the chances of sudden death. A patient may present to the ED with generalized/partial seizures, with negative findings on computed tomography, magnetic resonance imaging, or angiogram, as a primary symptom of SLE. Seizures can occur due to inflammatory damage resulting from existing vasculopathy or due to APAs [31,45]. Longitudinal myelitis in SLE can occur in two forms, one affecting gray matter (acute catastrophic form) and one involving white matter (resembling neuromyelitis optica) [28]. Myelitis presents as pain, weakness, and sphincteric defects.
Spinal cord involvement in COVID-19: A review
Published in The Journal of Spinal Cord Medicine, 2023
Ravindra Kumar Garg, Vimal Kumar Paliwal, Ankit Gupta
Acute transverse myelitis is clinically characterized by sensorimotor disturbances, bladder/bowel dysfunction, and/or autonomic dysfunction attributable to the spinal cord. Typically, it manifests as a rapid disease progression within a few hours to up to 21 days, with a sharp sensory affection level, bilateral pyramidal signs, and bladder/bowel dysfunction. While neuroimaging is not usually suggestive of compressive myelopathy, cerebrospinal fluid (CSF) examination may reveal inflammatory changes.1,2 Acute demyelinating diseases of the central nervous system, such as multiple sclerosis, neuromyelitis optica spectrum disorder, and acute disseminated encephalomyelitis are other frequently encountered causes of acute myelitis. Moreover, many viruses can be directly implicated in the etiopathogenesis of acute transverse myelitis, including varicella-zoster, herpes simplex, Epstein–Barr, West Nile, Dengue, Japanese encephalitis, Zika, influenza, echovirus & hepatitis B, mumps, measles, and rubella viruses. However, most often, it is difficult to differentiate between a viral-induced and immune-mediated transverse myelitis.2,3 Furthermore, there is an increasing number of reports that have linked the SARS-CoV-2 virus to the pathogenesis of acute transverse myelitis.4–6 The spinal cord involvement can result either from the direct invasion of the spinal cord, cytokine storm, or an autoimmune response.
Current perspectives on the diagnosis and management of acute transverse myelitis
Published in Expert Review of Neurotherapeutics, 2023
Nanthaya Tisavipat, Eoin P Flanagan
Acute transverse myelitis (ATM) is a clinical syndrome that encompasses broad etiologies including immune-mediated, either autoimmune or paraneoplastic, and infectious causes. By definition, myelitis refers to the inflammation of the spinal cord, though the process is not always transverse across the whole section. ATM is defined by the 2002 Transverse Myelitis Consortium as bilateral sensory, motor, or autonomic dysfunction of the spinal cord that progress to nadir between 4 hours to 21 days and is not attributed to extra-axial compression on an MRI [1]. In contrast, chronic myelopathies, which have a different differential diagnosis, progress beyond 21 days (e.g. human T-lymphotropic virus type 1 associated myelopathy). Variants of the presentation include acute flaccid myelitis (AFM) in which the anterior horn of the gray matter is predominantly affected. The diagnosis of AFM can be made when an acute onset, lower motor neuron type of limb weakness occurs and is confirmed by neuroimaging showing predominant gray matter lesions in the spinal cord [2].
Late-onset neuromyelitis optica spectrum disorder mimicking stroke in an elderly Chinese man: Case report
Published in The Journal of Spinal Cord Medicine, 2022
Lei Li, Gao-Li Fang, Yang Zheng, Yin-Xi Zhang
Most patients were diagnosed with NMOSD around the age of 40 years. Late-onset NMOSD (with an onset over 50 years old), and especially very late-onset NMOSD (with an onset over 75 years old) were rarely reported.2 In recent years, the average age of individuals diagnosed with NMOSD was increasing thanks to the advances in detection methods.6 Despite that, there were only eight patients described in detail diagnosed as NMOSD with an onset over 80 years old, with the oldest to be 88 years.2,7–12 Myelitis was the most common presentation in this group of patients, characterized by longitudinal extensive spinal cord lesions on MRI (cervical cord or thoracic cord involvement). By contrast, other core features of NMOSD like optic neuritis were rarely reported as the initial complaint.2,10 Moreover, very late-onset NMOSD presenting with acute-onset lateralizing symptoms is even rarer and easily mimicked a stroke episode, making the diagnostic process challenging, with only one similar case previously reported by Suchdev et al.10 Lack of prominent vascular risk factors, evolution of clinical symptoms (such as the presence of contralateral involvement, visual impairment or sphincter dysfunction), brain imaging lacking evidence of infarction or hemorrhage, and a poor response to treatment, are all helpful to distinguish NMOSD from stroke.