Spinal Cord Disease
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Two distinct phenotypes: Acute transverse myelitis: Intramedullary infection and associated inflammation.Not specific to cord tracts or cell types.Acute onset of fever with any combination of neurologic deficits attributable to the spinal cord (sensory disturbance, autonomic dysfunction, weakness with hyper- or hyporeflexia, the latter reflecting either anterior horn involvement or spinal shock).Acute flaccid paralysis: Viral affinity for anterior horn cell (poliovirus model).Prodromal illness with fever and mental status changes.Acute onset of a pure LMN pattern of weakness in one or more limbs without sensory or autonomic dysfunction.
Cytomegalovirus
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Transverse myelitis has been associated with CMV infection. CMV-related transverse myelitis has been generally seen in the immunocompromised host, particularly those with abnormalities of cell-mediated immunity, but a handful of cases have been reported in the immunocompetent host [52–55]. A review of the entity in normal hosts in 2012 identified only 10 cases and, of those, only 5 had positive CSF PCR for CMV [55]. Symptoms are comparable to those of transverse myelitis caused by other viral etiologies and include sensory abnormalities and motor deficits at a specific spinal level. The disease process is limited to the spinal cord, and usually does not involve other parts of the nervous system. Additional symptoms may be caused by disseminated CMV infection, such as a mononucleosis-like syndrome or end-organ dysfunction due to viral infection. In a review of 12 cases in normal hosts [56] the mean CSF leukocyte count was 105 + 135.4 (range 0–350 cells/cu mm) with a lymphocyte predominance typically and the CSF protein value was 229.75 + 157 mg/dL (range 37–480 mg/dL).
Inflammatory diseases affecting the spinal cord
Milosh Perovitch in 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.
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.
Myelopathy after zoster virus infection in immunocompetent patients: A case series
Published in The Journal of Spinal Cord Medicine, 2021
Nouha Farhat, Sawsan Daoud, Olfa Hdiji, Salma Sakka, Mariem Damak, Chokri Mhiri
The post-infectious myelitis usually occurs in immunocompetent patients, after acute VZV infections, while the patient is recovering. This is the result of a pathological immune response to the infection rather than a direct effect of the virus.6 CSF analysis usually shows a mild pleocytosis, with normal or slightly elevated protein level. This was observed in three of our five patients (Table 1: patients 2, 3 and 4). Search for the virus in CSF or nervous tissue is always negative (viral culture, polymerase chain reaction …); the virus does not cross the blood-brain barrier and the infection does not reach the nervous parenchyma or meninges.10 The diagnosis was confirmed in all our cases, as well as in the literature, by the presence of anti-VZV IgG in CSF.11 Steroids are used to treat myelitis, although certain patients improve spontaneously.
Related Knowledge Centers
- Axon
- Demyelinating Disease
- Inflammation
- Transverse Myelitis
- Spinal Cord
- Myelin
- Brain
- Acute Flaccid Myelitis
- Polio
- Leukomyelitis