Showing papers on "Myelitis published in 1988"

Spinal infection: evaluation with MR imaging and intraoperative US.

Abstract: Magnetic resonance (MR) images of the spine and/or intraoperative spinal ultrasound (US) in 24 patients with spinal infections were reviewed and correlated with clinical and pathologic data to determine their diagnostic value. In disk space infection with osteomyelitis and in retrospinal abscess, MR images showed characteristic findings, whereas in myelitis, MR images demonstrated nonspecific abnormalities. The appearance on MR images of epidural abscesses ranged from clearly identifiable extradural masses with high-intensity signal on spin-echo T2-weighted images to extensive inhomogeneous collections of mixed signal intensities, difficult to distinguish from adjacent meningitis. Myelography with high-resolution computed tomography (CT) and intraoperative spinal US was superior to MR imaging in demonstrating epidural abscesses when there was concomitant meningitis. With intraoperative spinal US, epidural abscesses could be located and their decompression monitored. MR imaging is recommended as the initial screening procedure in spinal infection; in those few patients with nondiagnostic MR images, myelography with high-resolution CT should be the supplementary study. If surgery is planned, intraoperative spinal US should be used.

Local stem cell depletion model for radiation myelitis

Abstract: We propose a model for normal tissue damage based on the assumption that adult mammalian stem cells have limited mobility and, consequently, for each organ, there is a maximum volume (the "critical volume," Vc), that can be repopulated and repaired by a single surviving stem cell. This concept is applied to a simple, 1-dimensional model of the spinal cord, where the critical volume is a "slice" of "thickness," t, assumed to be small compared to lengths of spinal cord usually irradiated clinically. The probability of myelitis is explicitly obtained as a function of the dose, dose per fraction, length of cord irradiated, slice thickness, number of stem cells per slice and parameters alpha and beta of the stem cell survival curve. The complication probability is expressed as a triple negative exponential function of dose analogous to the double negative exponential function for tumor control, resulting in a steep dose-response curve with short tails in both the high dose and low dose regions. We show that the model predictions are compatible with the experimental data for radiation myelitis in the rat. We discuss how this concept can be applied to other organs such as skin and to organs composed of structurally and functionally distinct subunits, such as the kidney.

Spinal arteriovenous malformation: MR imaging.

Abstract: Ten patients with spinal arteriovenous malformations (AVMs) were examined with high-field-strength (1.5-T) magnetic resonance (MR) imaging and a surface coil (eight patients) or head coil (two patients). Four AVMs were intramedullary, and six were extramedullary. There was one case of Foix-Alajouanine disease (subacute necrotizing myelitis; thrombosed AVM). Three important pathologic findings--myelomalacia, total thrombosis, and wall thickening of the draining vein--were clearly demonstrated at MR imaging and confirmed at autopsy. A flow-sensitive sequence was valuable in the depiction of one intramedullary AVM as hyperintense, the postoperative evaluation of AVM, and the differentiation of nidus from old intramedullary hematoma. In other AVMs, cord edema, periradicular hematoma, and reversible changes of cord scalloping after surgery were demonstrated. MR imaging demonstrated various pathologic changes of the spinal cord that could not be detected with any other imaging method.

Toxoplasmic myelitis mimicking intramedullary spinal cord tumor.

Abstract: Toxoplasma gondii causes cerebral infection in individuals with impaired immunologic defense mechanisms. We report a case of toxoplasmic myelitis. Spinal cord toxoplasmosis has not been previously documented except in congenital infection.

Radiation myelitis and survival in the radiotherapy of lung cancer

Abstract: A previous survey of patients who survived more than 6 months after radiotherapy for carcinoma of the bronchus using a 6 fraction regimen revealed a considerable incidence of radiation myelitis. In a further survey, in which the data bank has been increased from a total of 303 to 754 cases, analyses have confirmed that radiation myelitis occurs once a threshold dose of 33.5 Gy to the spinal cord has been reached. The incidence was positively related to the hemoglobin concentration, but not to the blood pressure at the time of radiotherapy. In the same group of patients survival was positively related to radiation dose, the hemoglobin concentration, and the systolic blood pressure. In other patients who were treated with 6 fractions, but who received a lower minimum tumor dose, either because this was planned or as a result of cord shielding, no relationship was shown between survival and radiation dose, hemoglobin concentration and systolic or pulse pressure. Radiosensitivity is dependent upon the oxygen concentration which, in normal tissues, is related to the hemoglobin concentration and in tumor to both the hemoglobin and the systolic blood pressure. The achievement of a threshold radiation dose appears essential before these prognostic factors become relevant.

Emergency magnetic resonance examination of patients with spinal cord symptoms.

Abstract: Eighteen consecutive patients with spinal cord symptoms of sudden or relatively sudden onset were examined with magnetic resonance imaging (MRI). The examinations were performed on a 0.3 tesla permanent/resistive imaging system using solenoidal surface coils. MRI revealed epidural tumour in five patients, intramedullary tumour in one, epidural abscess in one, myelitis in two, spontaneous intraspinal epidural haematoma in two, disc herniation in two, traumatic lesions in four and no abnormality in one patient. MRI was found to be capable of non-invasively and painlessly detecting and exactly defining the extent of intraspinal and paraspinal lesions. In some cases the nature of the lesion could be inferred from specific signal characteristics, which is a unique property of MRI. The results strongly suggest that MRI is superior to myelography and other imaging methods and should be regarded as the examination of choice in the emergency examination of patients with spinal cord symptoms.

Failure of antiviral therapy for acquired immunodeficiency syndrome-related cytomegalovirus myelitis.

Abstract: • We report the first published case (to our knowledge) of histopathologically documented acquired immunodeficiency syndrome-related cytomegalovirus (CMV) myelitis in which antiviral drug therapy was administered. Despite sensitivity of the patient's CMV isolate to therapy with both ganciclovir and foscarnet, use of neither of these agents halted progression of central nervous system CMV disease. Higher doses of these drugs or combination therapy may be required to treat acquired immunodeficiency syndrome-related CMV myelitis effectively.

MRI appearances of the CNS manifestations of Mycoplasma pneumoniae: a report of two cases.

Abstract: Two patients are reported with Mycoplasma pneumoniae-related cervical myelitis. Magnetic resonance imaging in each case demonstrated clinically silent lesions suggesting more extensive neurological involvement. This supports the concept of widespread immunologically mediated disease occurring as a remote effect of initial M. pneumoniae respiratory infection. Differences from the MRI appearances of a patient with mycoplasma-related Guillian-Barre syndrome imply that more than one antigenic determinant is involved.

Recurrent aseptic meningitis followed by transverse myelitis as a presentation of systemic lupus erythematosus.

Abstract: Recurrent aseptic meningitis as a manifestation of systemic lupus erythematosus (SLE) has most often been reported as an adverse reaction to the use of nonsteroidal antiinflammatory drugs. We present a case of recurrent aseptic meningitis and transverse myelitis as the initial manifestation of SLE.

HTLV-I myelitis: isolation of virus, genomic analysis, and infection in neural cell cultures.

Abstract: Human T-lymphotropic virus type I (HTLV-I) is an exogenous retrovirus originally associated with an endemic malignancy termed adult T-cell leukemia ( ATL). More recently recognized HTLV-I myelitis (HTLV-I M)'.2 is characterized by perivascular infiltration of lymphocytes and foamy cells and predominant involvement of white matter usually without association with ATL. Western blotting analysis of sera from patients with ATL and of sera and cerebrospinal fluid (CSF) of patients with HTLVI M revealed similar antibody binding patterns to HTLV-I antigens. To elucidate the pathogenetic mechanism of HTLV-I M, we established virusproducing T-cell lines from the peripheral blood and CSF mononuclear cells of 25 patients with HTLV-I M. All cell lines were positively stained with HTLV-I M sera, ATL sera, and monoclonal antibodies to HTLV-I gag proteins p15, p19, and p24, and revealed type C viral particles by electron microscopic studies. Cytofluorographic analysis showed most of the line cells have T3', T4', 2H4 , T8 ., TI 1 +, Tac + (IL2R ' ), and Ia + helper inducer surface markers. By restriction map analysis, we found two major subgroups of HTLV-I: MT-2' type and ATK-1 type.4 They were almost equally distributed among the patients with HTLV-I M. We also found two types of the provirus in DNA derived from fresh peripheral blood lymphocytes of patients with ATL. It was concluded that two subgroups of HTLV-I exist in Japan, and both have the ability to cause both ATL and HTLV-I M (FIGS. 1 and 2). Cultured human endothelial cells and glial line cells (GFAP-positive and GFAPnegative) were infected by HTLV-I and showed syncithium formation, degenerative changes, and cell lysis when co-cultured with HTLV-I-producing T-cell lines derived either from HTLV-I M or ATL. GFAP-positive astrocytes in dissociated newborn rat brain cell cultures were also infected with HTLV-I derived from either of the two diseases. Galactocerebroside-positive oligodendrocytes rapidly disappeared in these cultures within a few days after application of irradiated virus-producing T cells, although HTLV-I-antigen-positive oligodendrocytes were only rarely recognized by a double-staining indirect immunofluorescence technique. Application of the conditioned medium of HTLV-I-infected T-cell line cultures did not suppress oligodendrocyte

Survival after herpes simplex type II myelitis.

Abstract: Herpes simplex infection produces ascending necrotizing myelitis. Reports’,* have described patients withprogreasive myelopathy, with the virus isolated at autopsy in tissue culture. One of the difliculties is isolating the virus from the spinal fluid; many cases of idiopathic myelitis with recovery may be due to herpes simplex virus infection. We describe a patient with signs and symptoms of myelopathy. Herpes simplex virus type I1 was isolated from the spinal fluid culture and the patient had a favorable outcome. Case report. A 29-year-old woman was admitted with a 5-day history of weakness in both legs, with gradual progression to both arms. There was no history of optic neuritis or any other neurologic disorder. Family history was noncontributory. On the day of admission her physical examination revealed a temperature of 100 “F, pulse of 92, and respirations of 18 per minute. The rest of the general physical examination, except for the neurologic examination, was normal. She had spastic paraparesis in the legs. In the upper extremities, there was a weakness distally in the small muscles of both hands. Reflexes were brisk in the legs, with bilateral Babinski. There was decreased sensory level at T-2. Bladder was distended. Cranial nerves and mental examination were normal. An emergency EMG up to the foramen magnum was normal. Spinal fluid drawn at the time of myelography revealed a total protein of 180 mg/dl, glucose was 75 mg/ dl; concurrent blood glucose was 120 mg/& and white blood count was 210 (95% lymphocytes). Stain and smear of spinal fluid were negative. Blood chemistries, including liver function test, T,, T,, TSH, and complete white blood cell count were normal. Antinuclear antibodies were negative. Urine screening for heavy metal toxicity was unremarkable. Spinal fluid myelin basic protein was 18.9 ng/ml (normal, (8 ng/ml), and oligoclonal bands were faintly positive. MRI of the cervicalspine and head was normal. No white matter lesions were seen on head wan. Retrospective review of cervical spine MRI revealed no lesions or cord edema. On admission, the patient was treated with dexamethasone (Decadron) IV for 7 days. Spinal fluid culture was reported positive l week later for herpes simplex type 11. Dexamethasone was then stopped, and she was given a 10-day therapy of acyclovir. A repeat spinal fluid examination, performed on the 10th day, showed a protein level of 97 mg/dl. Cell count was 85 WBC (98% lymphocytes). Stain and smear were negative. Spinal fluid myelin basic protein was 5.9 ng/ml. During the first week of admission, there was no progression of neurologic signs. Two weeh after admission, the patient had some improvement in leg weakness. Six weeks after admission, strength in the legs had improved and she was able to walk with assistance. A t the time of discharge, 8 weeh later, she was walkingunaided, but continued to have weakness in the small muscles of the hands. Six months after the initial onset of symptoms, her weakness had improved significantly except for some difficulty with fine finger movements. Discussion. Acute ascending myelitis may sometimes be due to the herpes simplex type I1 infection. Some patients may have a mild course with good recovery. In our case, the myelin basic protein was initially elevated, which can occur in acute myelitis; it subsequently fell to within normal range. This may repreeent a useful biochemical marker of disease activity in viral myelitis and response to treatment. Herpes simplex type I1 infection can produce lethal panmyelitis, encephalitis, nonlethal demyelinating myelitis, or meningitis.3 In experimental herpes simplex type I1 infection through the genital route, the lesions are more limited, with a decreasing gradient from caudal to more rostral region of the spinal cord and brainstem with sparing of the major portion of the rostral neuraxis. With the intracerebral route, demyelinating lesions appear at any level of neuraxis. Multiple sclerosis can have a similar clinical presentation. Therefore, herpes simplex type I1 may be of etiologic importance in human CNS demyelinative diseases. The apparent similarities of herpes simplex type I1 incidence data to that of MS have been noted in their respective epidemiologies.4 In the present case, dexamethasone therapy in the beginning may have temporarily diminished symptoms by decreasing edema al-

Acquired hydrocephalus and hydromyelia in a cat with feline infectious peritonitis: A case report and brief review.

Abstract: A one-year-old domestic long-haired cat was referred to the New York State College of Veterinary Medicine because of acute onset of paraparesis and hyperesthesia associated with trauma. Myelography and cerebrospinal fluid analysis revealed severe hydromyelia and myelitis, respectively. The definitive diagnosis of feline infectious peritonitis was made by histological examination at necropsy. Lesions were confined exclusively to the brain and spinal cord. Partial occlusion of the third and fourth ventricles with pyogranulomatous debris caused hydrocephalus and subsequent hydromyelia. The hydromyelia may have been the primary means of compensation for the hydrocephalus, thus masking subclinical disease.

Rapid recovery of acute transverse myelitis treated with steroids.

Abstract: A case of acute transverse myelitis is described in which steroid therapy was followed by a remarkably rapid clinical and electrophysiological recovery. A possible explanation is proposed.

Acute transverse myelitis associated with ECHO type 5 infection.

Abstract: Sir.—Acute transverse myelitis (ATM), an acute intramedullary spinal cord disease manifested by paraplegia, segmental sensory loss, impaired sphincter control, and a nonprogressive course, may be the result of viral infection. Various viruses, including cytomegalovirus, herpes simplex virus, Epstein-Barr virus, rubella, and mumps, have been reported to cause myelitis, which may also occur rarely after varicella and measles.1,2To our knowledge, only two previous cases of ATM have been reported in association with entero cytopathogenic human orphan (ECHO) virus infection.3,4We describe a child who developed ATM and encephalitis from whom ECHO virus type 5 was recovered from throat, feces, and spinal fluid. Patient Report.—A 3½-year-old boy developed fever, vomiting, and diarrhea four days before hospitalization. Three days later, he complained of pain in both thighs; he was unable to walk and could not urinate. He had no history of antecedent back injury, rash, immunization, or

Comment on the recent results of Hopewell, Morris and Dixon-Brown on radiation myelitis produced by irradiation of very short segments of rat spinal cord

Abstract: Recently, we proposed a model for radiation damage to normal tissue (Yaes & Kalend, 1988), based on the assumption that, because of the limited mobility and reproductive capacity of stem cells (Hellmann & Botnick, 1977) in adult mammalian organs, for each organ there is a maximum volume, which we have called the “critical volume”, that can be repopulated and repaired by a single surviving stem cell. When a critical volume is totally depleted of stem cells, irreparable damage results; however, a single surviving stem cell within the critical volume prevents the damage from occurring. These assumptions constitute the “local stem cell depletion hypothesis” (Yaes & Kalend, 1988). For the spinal cord, we represent the critical volume as a transverse “slice” of thickness t, assumed to be small compared with lengths of spinal cord usually irradiated clinically. If irreparable damage occurs to a single slice, the long motor and sensory tracts passing through it would be damaged, giving rise to radiation myelitis.

Acute syphilitic myelitis in a young man.

Abstract: and transport medium to the cell culture, where the antigen has to multiply in the cytoplasm of the McCoy cells. Positive chlamydia culture is registered if intracytoplasmic inclusions are seen in the McCoy cells. Several factors may, however, affect the vitality of the chlamydial elementary bodies. Some of the most critical points are the collection of samples, the toxicity of the swabs, temperature during transport, transport time, growth medium, and bacterial contamination of the cell culture. Optimum conditions for all these factors are essential for chlamydial antigen to be recovered. The two other test systems are based on identifying non-vital antigen, which means that these factors are less important for the monoclonal antibody test and the enzyme immunoassay. False positive results of cell culture may occur by misreading iodine stained epithelial cells as chlamydial inclusions, but may also be caused by contamination with charcoal particles from charcoal swabs or infection of the cell culture medium with bacteria, viruses, or mycoplasmas. As all the methods available for testing for urogenital chlamydial infection give

Local stem cell depletion model for radiation myelitis

Abstract: We propose a model for normal tissue damage based on the assumption that adult mammalian stem cells have limited mobility and, consequently, for each organ, there is a maximum volume (the “critical volume,” V,), that can be repopulated and repaired by a single surviving stem cell. This concept is applied to a simple, l-dimensional model of the spinal cord, where the critical volume is a “slice” of ‘Thickness,” t, assumed to be small compared to lengths of spinal cord usually irradiated clinically. The probability of myelitis is explicitly obtained as a function of the dose, dose per fraction, length of cord irradiated, slice thickness, number of stem cells per slice and parameters a and @ of the stem cell survival curve. The complication probability is expressed as a triple negative exponential function of dose analogous to the double negative exponential function for tumor control, resulting in a steep doseresponse curve with short tails in both the high dose and low dose regions. We show that the model predictions are compatible with the experimental data for radiation myelitis in the rat. We discuss how this concept can be apl, d to other organs such as skin and to organs composed of structurally and functionally distinct subunits, such as the kidney.