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Annual Review of Pathology Jan 2022Recent years have seen growing attention to inflammatory and infectious disorders of the spinal cord, not only due to the discovery of autoantibody-mediated disorders of... (Review)
Review
Recent years have seen growing attention to inflammatory and infectious disorders of the spinal cord, not only due to the discovery of autoantibody-mediated disorders of the spinal cord [e.g., aquaporin-4 immunoglobulin G (IgG) antibodies and myelin oligodendrocyte glycoprotein IgG antibodies], but also due to the emergence of clusters of infection-related myelopathy, now known as acute flaccid myelitis. We review the spectrum of infection-related myelopathies and outline a nosological classification system based on association with infection. We describe the epidemiology and definitions of myelopathies, with a discussion of clinical presentation and neuroimaging features, and then turn to specific discussion of myelopathies due to direct pathogen invasion and those considered to be post- or parainfectious.
Topics: Autoantibodies; Humans; Myelitis; Neuroimaging; Spinal Cord Diseases
PubMed: 34637338
DOI: 10.1146/annurev-pathmechdis-040121-022818 -
Neuroimaging Clinics of North America Feb 2023Spinal cord infections can present with a wide variety of imaging findings, depending on the pathogen and the host's immune status. Infectious myelitis can have a... (Review)
Review
Spinal cord infections can present with a wide variety of imaging findings, depending on the pathogen and the host's immune status. Infectious myelitis can have a characteristic distribution of lesions within the spinal cord, which refine the differential disease. Some spinal infections do not show typical imaging features, and many noninfectious may mimic spinal infections with similar MR imaging findings. Infectious arachnoiditis and meningitis must be differentiated from neoplasms. Spondylitis has many mimickers and requires careful interpretations of images, clinical findings, and follow-up information.
Topics: Humans; Spine; Myelitis; Magnetic Resonance Imaging; Communicable Diseases
PubMed: 36404042
DOI: 10.1016/j.nic.2022.07.015 -
Current Opinion in Infectious Diseases Jun 2020The patient who presents with an acute spinal cord syndrome with weakness/paralysis of the limbs presents a diagnostic. Two important syndromes are acute transverse... (Review)
Review
PURPOSE OF REVIEW
The patient who presents with an acute spinal cord syndrome with weakness/paralysis of the limbs presents a diagnostic. Two important syndromes are acute transverse myelitis (ATM) and acute flaccid paralysis (AFP). Both can be caused by a number of infectious and noninfectious causes. Since 2014 there have been outbreaks of acute flaccid myelitis (a subgroup of AFP) in the United States, with a national surveillance program underway. In addition, there have been increasing reports of ATM from new and emerging pathogens, and opportunistic infections in immunocompromised hosts.
RECENT FINDINGS
Infectious causes of ATM or AFP need to be ruled out first. There may be important clues to an infectious cause from epidemiologic risk factors, immune status, international travel, MRI, and laboratory findings. We summarize key features for the more common pathogens in this review. Advances in laboratory testing have improved the diagnostic yield from cerebrospinal fluid, including real-time polymerase chain reaction, metagenomic next-generation sequencing, and advanced antibody detection techniques. These tests still have limitations and require clinical correlation.
SUMMARY
We present a syndromic approach to infectious myelopathies, focusing on clinical patterns that help narrow the diagnostic possibilities.
Topics: Central Nervous System Viral Diseases; Humans; Myelitis; Neuromuscular Diseases; Risk Factors; Spinal Cord Diseases; Travel; United States
PubMed: 32332224
DOI: 10.1097/QCO.0000000000000650 -
Neurologic Clinics Nov 2018Infectious diseases are an important cause of spinal cord dysfunction. Infectious myelopathies are of growing concern given increasing global travel and migration and... (Review)
Review
Infectious diseases are an important cause of spinal cord dysfunction. Infectious myelopathies are of growing concern given increasing global travel and migration and expanding prevention and treatment with vaccinations, antibiotics, and antiretrovirals. Clinicians must recognize these pathologies because outcomes can dramatically improve with prompt diagnosis and management. We provide a complete review of the most frequent infectious agents that can affect the spinal cord. For each pathogen we describe epidemiology, pathophysiology, anatomic location, characteristic clinical syndromes, diagnostic approach, treatment, and prognosis. The review includes spinal imaging from selected cases.
Topics: Humans; Myelitis
PubMed: 30366555
DOI: 10.1016/j.ncl.2018.06.001 -
Seminars in Neurology Jun 2021In the setting of both globalization and increasing use of immunosuppressive therapy, infectious myelopathies are an important cause of morbidity worldwide. Clinical...
In the setting of both globalization and increasing use of immunosuppressive therapy, infectious myelopathies are an important cause of morbidity worldwide. Clinical spinal cord syndromes related to infection are varied, including transverse myelitis, acute flaccid paralysis related to anterior horn cell involvement, spinal cord compression, chronic spastic paraparesis, and myeloradiculitis. Causative pathogens include viruses, parasites, pyogenic and atypical bacteria, and fungi. The epidemiology, clinical characteristics, diagnosis, and treatment of selected organisms will be discussed in this article.
Topics: Central Nervous System Viral Diseases; Humans; Myelitis; Myelitis, Transverse; Neuromuscular Diseases; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases
PubMed: 34010967
DOI: 10.1055/s-0041-1725126 -
Physical Medicine and Rehabilitation... Aug 2021Acute flaccid myelitis (AFM) is an incompletely understood neurologic disorder occurring in epidemic fashion causing weakness ranging from mild paresis to devastating... (Review)
Review
Acute flaccid myelitis (AFM) is an incompletely understood neurologic disorder occurring in epidemic fashion causing weakness ranging from mild paresis to devastating paralysis in children and some adults. This article reviews the case definition of AFM as well as its epidemiology and association with enteroviral infection. The clinical presentation, diagnostic investigation with particular attention to electrodiagnostics, acute management, and surgical options are described. Clinical outcomes and considerations for acute and long-term rehabilitation management are discussed extensively based on review of current literature, highlighting avenues for further study.
Topics: Central Nervous System Viral Diseases; Communicable Diseases, Emerging; Diagnosis, Differential; Enterovirus Infections; Humans; Myelitis; Neuromuscular Diseases; Poliomyelitis; United States
PubMed: 34175008
DOI: 10.1016/j.pmr.2021.02.004 -
Seminars in Ultrasound, CT, and MR Oct 2023Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss... (Review)
Review
Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss infectious myelitis, mainly the patterns of spinal cord involvement caused by each infectious agent and the contribution of magnetic resonance imaging as a major tool to establish the specific diagnosis.
Topics: Humans; Myelitis; Diagnosis, Differential; Magnetic Resonance Imaging; Myelitis, Transverse; Spinal Cord
PubMed: 37555684
DOI: 10.1053/j.sult.2023.03.015 -
Continuum (Minneapolis, Minn.) Apr 2018This article reviews bacterial, viral, fungal, and parasitic pathogens associated with myelopathy. Infectious myelopathies may be due to direct infection or... (Review)
Review
PURPOSE OF REVIEW
This article reviews bacterial, viral, fungal, and parasitic pathogens associated with myelopathy. Infectious myelopathies may be due to direct infection or parainfectious autoimmune-mediated mechanisms; this article focuses primarily on the former.
RECENT FINDINGS
Some microorganisms exhibit neurotropism for the spinal cord (eg, enteroviruses such as poliovirus and flaviviruses such as West Nile virus), while others are more protean in neurologic manifestations (eg, herpesviruses such as varicella-zoster virus), and others are only rarely reported to cause myelopathy (eg, certain fungal and parasitic infections). Individuals who are immunocompromised are at increased risk of disseminated infection to the central nervous system. Within the last few years, an enterovirus D68 outbreak has been associated with cases of acute flaccid paralysis in children, and emerging Zika virus infection has been concurrent with cases of acute flaccid paralysis due to Guillain-Barré syndrome, although cases of myelitis have also been reported. Associated pathogens differ by geographic distribution, with myelopathies related to Borrelia burgdorferi (Lyme disease) and West Nile virus more commonly seen in the United States and parasitic infections encountered more often in Latin America, Southeast Asia, and Africa. Characteristic CSF and MRI patterns have been identified with many of these infections.
SUMMARY
A myriad of pathogens are associated with infectious myelopathies. Host factors, geographic distribution, clinical features, CSF profiles, and MRI findings can assist in formulating the differential diagnosis and ultimately guide management.
Topics: Diagnosis, Differential; Enterovirus D, Human; Enterovirus Infections; Humans; Myelitis; Spinal Cord Diseases; Zika Virus Infection
PubMed: 29613895
DOI: 10.1212/CON.0000000000000597 -
Revue Neurologique May 2021Myelopathy is a term referring to any pathologic process affecting the spinal cord, and encompasses a broad spectrum of etiologies. The first step is to categorize... (Review)
Review
Myelopathy is a term referring to any pathologic process affecting the spinal cord, and encompasses a broad spectrum of etiologies. The first step is to categorize myelopathy, according to the time to reach maximum deficit. Myelopathies are commonly classified as acute, subacute or chronic, for which the etiologies are totally different. Myelopathy is considered acute when the symptoms progress to their nadir in maximum 21 days after onset. Due to heterogeneity in pathogenesis, and the overlap in the clinical and imaging presentation among etiologies, acute myelopathy is considered as a diagnostic dilemma. A simple and efficient algorithm for timely identification of the underlying cause is thus useful. In this review, we provide a simplified approach for the differential diagnosis among all causes of acute myelopathies, and describe the principal clinical and imaging features of the main etiologies in adults, including recently characterized antibody-mediated myelitis, and its mimics.
Topics: Acute Disease; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Myelitis; Myelitis, Transverse; Neuromyelitis Optica; Spinal Cord; Spinal Cord Diseases
PubMed: 34024334
DOI: 10.1016/j.neurol.2020.08.003 -
Current Opinion in Virology Feb 2020Recent outbreaks of limb paralysis similar to poliomyelitis, termed acute flaccid myelitis (AFM), have prompted intense investigation into potential etiology. Peaks of... (Review)
Review
Recent outbreaks of limb paralysis similar to poliomyelitis, termed acute flaccid myelitis (AFM), have prompted intense investigation into potential etiology. Peaks of AFM were seen in the United States in 2012, 2014, 2016 and 2018, coincident with peaks in enterovirus transmission, particularly EV-D68. Similar peaks of AFM and EV-D68 circulation were reported in other parts of the world. The causal relationship between EV-D68 is still not widely accepted as it is for poliovirus and EV-A71, the latter of which is endemic in the US. Recent in vitro and mouse model data as well as enhanced-sensitivity diagnostic assays have provided further evidence linking the causal relationship between EV-D68 and AFM. In addition, an outbreak of EV-A71-associated AFM was recently described, highlighting the possibility of an additional emerging non-polio enterovirus of public health concern. As AFM is a devastating disease with poor prognosis in many children, particularly those with EV-D68, recent studies call for increased surveillance, pursuit of novel therapeutics and strategies to prevent transmission before the next outbreak.
Topics: Animals; Central Nervous System Viral Diseases; Disease Outbreaks; Enterovirus; Enterovirus Infections; Humans; Myelitis; Neuromuscular Diseases; United States
PubMed: 32711392
DOI: 10.1016/j.coviro.2020.06.006