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Seminars in Neurology Apr 2012Acute transverse myelitis is a rare neurologic condition that has an estimated incidence of up to 3 per 100,000 patient years (0.003%). Although rare, acute transverse... (Review)
Review
Acute transverse myelitis is a rare neurologic condition that has an estimated incidence of up to 3 per 100,000 patient years (0.003%). Although rare, acute transverse myelitis can have devastating neurologic effects with up to two-thirds of patients having a moderate to severe degree of residual disability. The term acute transverse myelitis was previously reserved for idiopathic cases, but currently is used to encompass the general clinical syndrome, whether or not the cause is known. Once adequate neuroimaging has ruled out a compressive etiology, and a lumbar puncture has demonstrated signs of inflammation within the cerebrospinal fluid, a workup of causes for an acute transverse myelitis must be undertaken. Determining the etiology of transverse myelitis can be challenging because there are autoimmune, inflammatory, and infectious diseases associated with acute transverse myelitis. The authors discuss an approach to acute transverse myelitis including clinical symptoms, neuroimaging, and biomarkers that may aid the clinician in diagnosis.
Topics: Animals; Demyelinating Diseases; Diagnosis, Differential; Humans; Inflammation; Myelitis; Myelitis, Transverse; Spinal Cord
PubMed: 22961185
DOI: 10.1055/s-0032-1322586 -
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 -
Revue Neurologique 2019Infectious pathogens can directly affect the spinal cord or trigger autoimmune reactions, which may result in permanent damage to cord structures. The most common... (Review)
Review
Infectious pathogens can directly affect the spinal cord or trigger autoimmune reactions, which may result in permanent damage to cord structures. The most common aetiology comes from virus but depend on age, location of the patient and co-morbidities. Acute Flaccid paralysis and acute transverse myelitis are considered as emergencies. Differential diagnosis is mainly relapses of autoimmune diseases, which can mimic infectious myelopathies.
Topics: Humans; Myelitis
PubMed: 31375285
DOI: 10.1016/j.neurol.2019.07.001 -
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 -
Journal of the Pediatric Infectious... Dec 2019With the eradication of poliomyelitis in the United States, the appearance of acute flaccid myelitis outbreaks has raised questions regarding their causation. Review of... (Review)
Review
With the eradication of poliomyelitis in the United States, the appearance of acute flaccid myelitis outbreaks has raised questions regarding their causation. Review of the epidemiology, clinical aspects, and laboratory findings of bygone cases of poliomyelitis have revealed shows important similarities with those of newer cases of acute flaccid myelitis. Many occurrences are preceded by an apparent viral illness, and a number of viruses, particularly enteroviruses A71 and D68, can be isolated from respiratory or stool specimens. Our inability to detect these viruses in cerebrospinal fluid samples from these patients does not eliminate them as etiologic agents, because poliovirus is often not detected in cerebrospinal fluid samples of patients with paralysis caused by poliomyelitis.
Topics: Central Nervous System Viral Diseases; Disease Outbreaks; Enterovirus; Enterovirus Infections; Humans; Myelitis; Neuromuscular Diseases; Paralysis; Poliomyelitis; United States
PubMed: 30888407
DOI: 10.1093/jpids/piz017 -
Seminars in Neurology Apr 2020Acute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the... (Review)
Review
Acute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the spinal cord gray matter on magnetic resonance imaging. In most cases, prodromal fever or respiratory symptoms occur, followed by acute-onset flaccid limb weakness. Respiratory, axial, bulbar, facial, and extraocular muscles may also be affected. The clinical manifestations have been described as "polio-like," due to striking similarities to cases of poliomyelitis. The primary site of injury in AFM is the anterior horn cells of the spinal cord, resulting in a motor neuronopathy. Seasonal peaks of cases have occurred in the United States every 2 years since 2012. However, AFM remains a rare disease, which can make it challenging for physicians to recognize and differentiate from other causes of acute flaccid paralysis such as Guillain-Barre syndrome, spinal cord stroke, and transverse myelitis. Epidemiological evidence suggests that AFM is linked to a viral etiology, with nonpolio enteroviruses (in particular enterovirus D68) demonstrating a plausible association. The epidemiology, possible etiological factors, clinical features, differential diagnosis, treatment, and outcomes of AFM are discussed in this review.
Topics: Central Nervous System Viral Diseases; Child; Humans; Myelitis; Neuromuscular Diseases
PubMed: 32143233
DOI: 10.1055/s-0040-1705123 -
The Veterinary Clinics of North... Jul 1992Animals with meningomyelitis have clinical neurologic signs that typically range from paraspinal discomfort to tetraplegia; however, most affected animals also show... (Review)
Review
Animals with meningomyelitis have clinical neurologic signs that typically range from paraspinal discomfort to tetraplegia; however, most affected animals also show evidence of multifocal CNS involvement with brain stem and cerebral cortical structures being affected most commonly. The cause, duration, and host response to the disease process will determine the clinical signs in individual animals. Confirmation of a specific causative agent is difficult, but CSF analysis and immunotesting of serum and CSF yield the most rewarding diagnostic results. Successful treatment is based on formulation of an appropriate and aggressive therapeutic regimen. In some diseases, no effective treatment is available, and some animals may develop permanent neurologic disabilities.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Meningitis; Myelitis
PubMed: 1641927
DOI: 10.1016/s0195-5616(92)50086-9 -
Journal of Child Neurology May 2021Acute flaccid myelitis is an emerging neurologic disease, first described in 2014 and predominantly affecting young children. Acute flaccid myelitis cases tend to spike... (Review)
Review
Acute flaccid myelitis is an emerging neurologic disease, first described in 2014 and predominantly affecting young children. Acute flaccid myelitis cases tend to spike every 2 years, in the late summer to fall, and the next peak is expected in 2020. The diagnosis of acute flaccid myelitis is often delayed, leading to suboptimal evaluation, including incomplete laboratory assessment. Acute and chronic morbidity are high, and a standardized, multidisciplinary approach to evaluation and treatment is essential to optimizing outcomes. In a review of acute flaccid myelitis patients treated in 2018 at our institution, we noted considerable variability in days to presentation, evaluation, and treatment. In response, the authors developed a protocol for the evaluation and management of pediatric patients suspected of having acute flaccid myelitis. The protocol was developed using local experience/case review, expert consensus, and the relevant literature. The protocol spans the spectrum of care, from initial evaluation in a primary care or emergency setting, to acute hospital management and evaluation and long-term inpatient and rehabilitation settings. The purpose of this report is both to share the findings from our 2018 case review and to disseminate our acute flaccid myelitis protocol. Our hope is that publication of our protocol will both inform the development of a standardized approach to acute flaccid myelitis and to encourage other centers to form a multidisciplinary acute flaccid myelitis team to provide expert care throughout the disease process, from presentation to recovery.
Topics: Adolescent; Central Nervous System Viral Diseases; Child; Child, Preschool; Clinical Protocols; Humans; Infant; Myelitis; Neuromuscular Diseases
PubMed: 33258719
DOI: 10.1177/0883073820975230 -
MBio Apr 2019Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes,... (Review)
Review
Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging globally in epidemic form. This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot therefore explain any aspect of AFM reemergence. Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. This perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.
Topics: Central Nervous System Viral Diseases; Communicable Diseases, Emerging; Disease Management; Global Health; Humans; Myelitis; Neuromuscular Diseases
PubMed: 30940708
DOI: 10.1128/mBio.00521-19 -
Reumatologia Clinica 2017Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple systems. Myelopathy is one of 19 neuropsychiatric syndromes related to SLE... (Review)
Review
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple systems. Myelopathy is one of 19 neuropsychiatric syndromes related to SLE defined by the American College of Rheumatology. Although infrequent, it is a severe manifestation, leading to motor and sensory deficits, and sphincter dysfunction. The pathogenesis is not clearly known, but may be related to arterial thrombosis and vasculitis. Diagnosis is based on clinical findings, laboratory tests and the use of gadolinium-enhanced magnetic resonance imaging. The standard therapy is the combination of intravenous cyclophosphamide and glucocorticoids. In refractory disease, other treatments such as plasmapheresis or rituximab have been used.
Topics: Combined Modality Therapy; Cyclophosphamide; Diagnosis, Differential; Female; Glucocorticoids; Gray Matter; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Myelitis; Neuromyelitis Optica; Plasmapheresis; Practice Guidelines as Topic; Prognosis; Rituximab; White Matter
PubMed: 27567298
DOI: 10.1016/j.reuma.2016.06.004