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Abstract
Myelopathy can present acutely or more insidiously and has a broad differential diagnosis. In addition to the clinical history and neurologic examination, diagnostic testing, including MRI and cerebrospinal fluid analysis, as well as thorough review of patient comorbidities, risk factors, and potential toxic exposures, can help neurohospitalists distinguish between various causes and potentially start appropriate empiric therapy while awaiting definitive testing. This article focuses on how imaging can help in determining the most likely cause of myelopathy and highlights a range of causes, including compressive, vascular, metabolic and toxic, infectious, autoimmune, neoplastic, and paraneoplastic causes of spinal cord dysfunction.
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Affiliation(s)
- Anne G Douglas
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Denise J Xu
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Maulik P Shah
- Department of Neurology, University of California San Francisco, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143, USA.
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2
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Winn A, Martin A, Castellon I, Sanchez A, Lavi ES, Munera F, Nunez D. Spine MRI: A Review of Commonly Encountered Emergent Conditions. Top Magn Reson Imaging 2021; 29:291-320. [PMID: 33264271 DOI: 10.1097/rmr.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last 2 decades, the proliferation of magnetic resonance imaging (MRI) availability and continuous improvements in acquisition speeds have led to significantly increased MRI utilization across the health care system, and MRI studies are increasingly ordered in the emergent setting. Depending on the clinical presentation, MRI can yield vital diagnostic information not detectable with other imaging modalities. The aim of this text is to report on the up-to-date indications for MRI of the spine in the ED, and review the various MRI appearances of commonly encountered acute spine pathology, including traumatic injuries, acute non traumatic myelopathy, infection, neoplasia, degenerative disc disease, and postoperative complications. Imaging review will focus on the aspects of the disease process that are not readily resolved with other modalities.
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Affiliation(s)
- Aaron Winn
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Adam Martin
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Ivan Castellon
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Allen Sanchez
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | | | - Felipe Munera
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Diego Nunez
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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3
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Lebrun Frenay C. Infectious myelitis. Rev Neurol (Paris) 2019; 175:464-468. [PMID: 31375285 DOI: 10.1016/j.neurol.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- C Lebrun Frenay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, Université Nice Côte d'Azur, 30 voie Romaine, 06100 Nice, France.
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Talbott JF, Narvid J, Chazen JL, Chin CT, Shah V. An Imaging-Based Approach to Spinal Cord Infection. Semin Ultrasound CT MR 2016; 37:411-30. [PMID: 27616314 DOI: 10.1053/j.sult.2016.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Infections of the spinal cord, nerve roots, and surrounding meninges are uncommon, but highly significant given their potential for severe morbidity and even mortality. Prompt diagnosis can be lifesaving, as many spinal infections are treatable. Advances in imaging technology have now firmly established magnetic resonance imaging (MRI) as the gold standard for spinal cord imaging evaluation, enabling the depiction of infectious myelopathies with exquisite detail and contrast. In this article, we aim to provide an overview of MRI findings for spinal cord infections with special focus on imaging patterns of infection that are primarily confined to the spinal cord, spinal meninges, and spinal nerve roots. In this context, we describe and organize this review around 5 distinct patterns of transverse spinal abnormality that may be detected with MRI as follows: (1) extramedullary, (2) centromedullary, (3) eccentric, (4) frontal horn, and (5) irregular. We seek to classify the most common presentations for a wide variety of infectious agents within this image-based framework while realizing that significant overlap and variation exists, including some infections that remain occult with conventional imaging techniques.
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Affiliation(s)
- Jason F Talbott
- Department of Radiology, San Francisco General Hospital, San Francisco, CA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA.
| | - Jared Narvid
- Department of Radiology, San Francisco General Hospital, San Francisco, CA
| | - J Levi Chazen
- Department of Radiology, Weill Cornell Medical School, New York, NY
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA; Department of Radiology, San Francisco General Hospital, San Francisco, CA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA; Department of Radiology, Weill Cornell Medical School, New York, NY
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA; Department of Radiology, San Francisco General Hospital, San Francisco, CA
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Abstract
The pathologic evaluation of spinal cord infections requires comprehensive clinical, radiological, and laboratory correlation, because the histologic findings in acute, chronic, or granulomatous infections rarely provide clues for the specific cause. This brief review focuses on the pathologic mechanisms as well as practical issues in the diagnosis and reporting of infections of the spinal cord. Examples are provided of the common infectious agents and methods for their diagnosis. By necessity, discussion is restricted to the infections of the medulla spinalis proper and its meninges, and not bone or soft tissue infections.
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Affiliation(s)
- Tarik Tihan
- Neuropathology Division, Department of Pathology, University of California San Francisco, Room M551, 505 Parnassus Avenue, San Francisco, CA 94143-0102, USA; Koc University School of Medicine, Istanbul, Turkey.
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Jeon JW, Yoon HJ, Kim JS, Ryu IH, Choi JW, Kim MG, Na YM, Yun HJ. A case on streptococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. Tuberc Respir Dis (Seoul) 2014; 76:80-3. [PMID: 24624217 PMCID: PMC3948856 DOI: 10.4046/trd.2014.76.2.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/06/2013] [Accepted: 09/26/2013] [Indexed: 11/24/2022] Open
Abstract
Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations.
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Affiliation(s)
- Jae Woong Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Hee Jung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Seok Kim
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Il Hwan Ryu
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Ji Wook Choi
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Min Gyu Kim
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Young Min Na
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Hyeon Jeong Yun
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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