Acute infectious myelopathies

Abstract

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.

Neurologic complications of coronavirus and other respiratory viral infections

“…Viruses are an important cause of infectious and parainfectious myelitis ( Isada and Miller, 2020 ). Although some viruses are highly cytolytic and directly damage the CNS (e.g., poliovirus), virus-specific and autoimmune host cellular immune responses presumably contribute to spinal cord damage and neurologic dysfunction in acute viral myelitis associated with less virulent or noncytolytic viruses ( Lerner et al, 2021 ).…”

Infectious Myelopathies

“…HSV-2 is mainly responsible for meningoencephalitis in newborns and meningitis in adults. 66 HSV-2 myelitis can present as a mild syndrome with full recovery, as a recurrent meningomyelitis, or as a devastating acute necrotizing myelitis, especially in immunocompromised hosts. Most commonly, patients have radiculomyelitis affecting the conus and lumbosacral dermatomes causing clinical symptoms of urinary sphincteric dysfunction with pain, numbness, and weakness in the legs.…”

“…HSV-1 and HSV-2 may both affect the spinal cord, typically manifesting as inflammatory myelitis. HSV-2 is mainly responsible for meningoencephalitis in newborns and meningitis in adults 66 . HSV-2 myelitis can present as a mild syndrome with full recovery, as a recurrent meningomyelitis, or as a devastating acute necrotizing myelitis, especially in immunocompromised hosts.…”

Principii de tratament a mielopatiilor infecțioase

“…[ Cauzele mielopatiei non-compresive pot fi infecțioase, vasculare, traumatice, autoimune și neoplazice. [6] În funcție de perioada de dezvoltare ,afecțiunea poate fi acută, subacută si cronică. Forma acută prezintă dezvoltarea simptomelor în câteva ore sau zile, subacută atunci când afecțiunea evoluează în 2-6 săptămâni, iar cronică într-un interval ce depășește 6 săptămîni.…”