Current concepts in the diagnosis of transverse myelopathies

Brinar, Vesna; Habek, Mario; Zadro, Ivana; Barun, Barbara; Ozretić, David; Vranješ, Davorka

doi:10.1016/j.clineuro.2008.07.002

Cited by 21 publications

(7 citation statements)

References 45 publications

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“…Previous reports [16] show patients in this group usually have worsening symmetrical clinical symptoms of transverse spinal cord syndrome, in which spinal MRI may show atrophic changes later. There is no evidence in the literature that any effective treatment exists.…”

Section: Discussionmentioning

confidence: 82%

Mycobacteria Infection in Incomplete Transverse Myelitis Is Refractory to Steroids: A Pilot Study

Feng

Guo

Liu

et al. 2011

Clinical and Developmental Immunology

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Incomplete transverse myelitis (ITM) of unknown origin is associated with high rates of morbidity and mortality. This prospective, open-label study was undertaken to determine whether antituberculous treatment (ATT) might help patients with ITM whose condition continues to deteriorate despite receiving IV methylprednisolone treatment. The study consisted of 67 patients with steroid-refractory ITM in whom Mycobacterium tuberculosis (MTB) was suspected clinically and in whom other known causes of myelopathy were excluded. The study occurred from January 2003 to June 2010. Patients underwent trial chemotherapy with ATT. Efficacy was assessed by the American Spinal Injury Association (ASIA) scoring system, the Barthel Index (BI) and the Hauser Ambulation Index (AI) at baseline, 12 months, and 24 months, using magnetic resonance imaging (MRI). Of the 67 patients enrolled, 51 were assessed and 16 withdrew. At 24 months, 49 patients experienced benefits as indicated by significantly increased ASIA and BI scores. The Hauser AI index also improved with markedly decreased abnormal signals in spinal cord MRI over time. The results from this prospective study provide beneficial clinical and MRI data on the efficacy of ATT in ITM patients and suggests mycobacteria may be an important and neglected cause of myelitis.

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Section: Discussionmentioning

confidence: 82%

Mycobacteria Infection in Incomplete Transverse Myelitis Is Refractory to Steroids: A Pilot Study

Feng

Guo

Liu

et al. 2011

Clinical and Developmental Immunology

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“…It has been suggested that post-infective ATM is a localised form of ADEM [9,10], and it has also been emphasised that disseminated encephalomyelitis can produce a broad spectrum of pathological and anatomical manifestations [11]. One would expect, however, such cases to be accompanied by evidence of spinal lesions on MRI scans, and such post-infectious or post-vaccination demyelinating disorders of the CNS are usually characterised by multifocal signs and encephalopathy, leading to the diagnosis of ADEM [12]. …”

Section: Discussionmentioning

confidence: 99%

Post-infective transverse myelitis following Streptococcus pneumoniae meningitis with radiological features of acute disseminated encephalomyelitis: a case report

Williams

Thorpe

2012

J Med Case Reports

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IntroductionPost-infectious autoimmune demyelination of the central nervous system is a rare neurological disorder typically associated with exanthematous viral infections. We report an unusual presentation of the condition and a previously undocumented association with Streptococcus pneumonia meningitis.Case presentationA 50-year-old Caucasian woman presented to our facility with an acute myelopathy three days after discharge following acute Streptococcus pneumoniae meningitis. Imaging studies of the spine ruled out an infective focus and no other lesions were seen within the cord. Diffuse, bilateral white matter lesions were seen within the cerebral hemispheres, and our patient was diagnosed as having a post-infective demyelination syndrome that met the diagnostic criteria for an acute transverse myelitis. Our patient clinically and radiologically improved following treatment with steroids.ConclusionsThe novel association of a Streptococcus pneumoniae infection with post-infectious autoimmune central nervous system demyelination should alert the reader to the potentially causative role of this common organism, and gives insights into the pathogenesis. The unusual dissociation between the clinical presentation and the location of the radiological lesions should also highlight the potential for the condition to mimic the presentation of others, and stimulates debate on the definitions of acute transverse myelitis and acute disseminated encephalomyelitis, and their potential overlap.

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“…The causes of transverse myelopathy include infectious etiology, cord compression (tumor, epidural abscess, or epidural hematoma), connective tissue disease (systemic lupus erythematosus, mixed connective tissue disease, scleroderma, ankylosing spondylitis, or rheumatoid arthritis), multiple sclerosis (MS), neuromyelitis optica, or idiopathic transverse myelitis [1, 2]. Infectious myelitis may be caused by a variety of viral, bacterial, fungal, or parasitic agents.…”

Section: Introductionmentioning

confidence: 99%

Acute transverse myelitis of the cervical spine secondary to psoas abscess

Jin

et al. 2016

BMC Infect Dis

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BackgroundAcute transverse myelitis is uncommon and presumably results from an autoimmune process or a preceding infection. Most cases of bacterial myelitis are due to hematogenous dissemination from urinary or respiratory tract infections or contiguous spreading from a neighboring infected structure. A psoas abscess rarely spreads to higher levels of the spinal cord. No cases of acute cervical myelitis due to a psoas abscess have been previously reported.Case presentationA 34-year-old man was transferred to our hospital due to progressive muscle weakness, sensory deficits and severe hypotension. Two weeks prior to admission, he had received low back injection to relieve back pain in a healthcare clinic. One day prior to admission, his condition had worsened. On admission, he was tetraplegic with absence of sensation below the level of the suprasternal fossa. A lumbar CT scan demonstrated an abscess in the left psoas, and the magnetic resonance imaging (MRI) scan of the entire spinal suggested a cervical spine infection. A cerebrospinal fluid (CSF) analysis performed before surgery indicated the possibility of bacterial infection. An operation was performed to drain the abscess. Microbiological cultivation revealed a Methicillin-resistant Staphylococcus aureus (MRSA) infection. The patient was administered with vancomycin for 10 days and followed by oral formulations of linezolid for 6 weeks. The patient's general condition improved, and he was successfully discharged. Six months later, a follow-up MRI revealed that the lesion of the cervical spine had been ameliorated, and the sensation and myodynamia of his upper limbs had partially recovered.ConclusionThis was a rare case of a high-level cervical spine pyogenic infection complicating psoas abscess. An invasive paravertebral injection procedure was thought to be the initial damaging event that created a port of entry for MRSA into the psoas muscle and caused a subsequent psoas abscess. This case indicated that evaluation of higher levels of the spine is warranted when a psoas abscess coexists with severe weakness.

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Current concepts in the diagnosis of transverse myelopathies

Cited by 21 publications

References 45 publications

Mycobacteria Infection in Incomplete Transverse Myelitis Is Refractory to Steroids: A Pilot Study

Mycobacteria Infection in Incomplete Transverse Myelitis Is Refractory to Steroids: A Pilot Study

Post-infective transverse myelitis following Streptococcus pneumoniae meningitis with radiological features of acute disseminated encephalomyelitis: a case report

Acute transverse myelitis of the cervical spine secondary to psoas abscess

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