Division of Viral Diseases, National Centers for Immunization and Respiratory Diseases, CDC; Division of Vector-Borne Diseases, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Children's Hospital Colorado; Council of State and Territorial Epidemiologists: Notes from the field: acute flaccid myelitis among persons aged ≤21 years - United States, august 1-november 13, 2014. MMWR Morb Mortal Wkly Rep. 63(53):1243-4, 2015
Maloney JA et al: MRI findings in children with acute flaccid paralysis and cranial nerve dysfunction occurring during the 2014 enterovirus D68 outbreak. AJNR Am J Neuroradiol. 36(2):245-50, 2015
Sejvar JJ et al: Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol. 16(1):93-100, 2010
Blakely PK et al: Disrupted glutamate transporter expression in the spinal cord with acute flaccid paralysis caused by West Nile virus infection. J Neuropathol Exp Neurol. 68(10):1061-72, 2009
Heerlein K et al: Aquaporin-4 antibody positive longitudinally extensive transverse myelitis following varicella zoster infection. J Neurol Sci. 276(1-2):184-6, 2009
Kincaid O et al: Viral myelitis: an update. Curr Neurol Neurosci Rep. 6(6):469-74, 2006
Marjelund S et al: Gadolinium enhancement of cauda equina: a new MR imaging finding in the radiculitic form of tick-borne encephalitis. AJNR Am J Neuroradiol. 27(5):995-7, 2006
Fujimoto H et al: Epstein-Barr virus infections of the central nervous system. Intern Med. 42(1):33-40, 2003
Jeha LE et al: West Nile virus infection: a new acute paralytic illness. Neurology. 61(1):55-9, 2003
Zandman-Goddard G et al: Transverse myelitis associated with chronic hepatitis C. Clin Exp Rheumatol. 21(1):111-3, 2003
Karacostas D et al: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Spinal Cord. 40(3):145-9, 2002
Chen CY et al: Acute flaccid paralysis in infants and young children with enterovirus 71 infection: MR imaging findings and clinical correlates. AJNR Am J Neuroradiol. 22(1):200-5, 2001
McMinn P et al: Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis. 32(2):236-42, 2001
Gruhn B et al: Successful treatment of Epstein-Barr virus-induced transverse myelitis with ganciclovir and cytomegalovirus hyperimmune globulin following unrelated bone marrow transplantation. Bone Marrow Transplant. 24(12):1355-8, 1999
Haanpaa M et al: CSF and MRI findings in patients with acute herpes zoster. Neurology. 51(5):1405-11, 1998
Ku B et al: Acute transverse myelitis caused by Coxsackie virus B4 infection: a case report. J Korean Med Sci. 13(4):449-53, 1998
Nakajima H et al: Herpes simplex virus myelitis: clinical manifestations and diagnosis by the polymerase chain reaction method. Eur Neurol. 39(3):163-7, 1998
Salonen O et al: Myelitis associated with influenza A virus infection. J Neurovirol. 3(1):83-5, 1997
Cheshire WP et al: Spinal cord infarction: etiology and outcome. Neurology. 47(2):321-30, 1996
de Silva SM et al: Zoster myelitis: improvement with antiviral therapy in two cases. Neurology. 47(4):929-31, 1996
Ebo DG et al: Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. J Rheumatol. 23(3):548-50, 1996
Moulignier A et al: AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge. Clin Infect Dis. 22(4):626-31, 1996
Breningstall GN et al: Acute transverse myelitis and brainstem encephalitis associated with hepatitis A infection. Pediatr Neurol. 12(2):169-71, 1995
Campi A et al: Acute transverse myelopathy: spinal and cranial MR study with clinical follow-up. AJNR Am J Neuroradiol. 16(1):115-23, 1995
Caldas C et al: Case report: transverse myelitis associated with Epstein-Barr virus infection. Am J Med Sci. 307(1):45-8, 1994
Gilden DH et al: Varicella-zoster virus myelitis: an expanding spectrum. Neurology. 44(10):1818-23, 1994
Kyllerman MG et al: PCR diagnosis of primary herpesvirus type I in poliomyelitis-like paralysis and respiratory tract disease. Pediatr Neurol. 9(3):227-9, 1993
Chang CM et al: Postinfectious myelitis, encephalitis and encephalomyelitis. Clin Exp Neurol. 29:250-62, 1992
Cumming WJ: Myelitis and toxic, inflammatory and infectious disorders. Curr Opin Neurol Neurosurg. 5(4):549-53, 1992
Hwang YM et al: A case of herpes zoster myelitis: positive magnetic resonance imaging finding. Eur Neurol. 31(3):164-7, 1991
Iwamasa T et al: Acute ascending necrotizing myelitis in Okinawa caused by herpes simplex virus type 2. Virchows Arch A Pathol Anat Histopathol. 418(1):71-5, 1991
Power C et al: Pathological and molecular biological features of a myelopathy associated with HTLV-1 infection. Can J Neurol Sci. 18(3):352-5, 1991
Awerbuch G et al: Demonstration of acute post-viral myelitis with magnetic resonance imaging. Pediatr Neurol. 3(6):367-9, 1987
Wiley CA et al: Acute ascending necrotizing myelopathy caused by herpes simplex virus type 2. Neurology. 37(11):1791-4, 1987
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Acute transverse myelitis (ATM)
Acute flaccid myelitis (AFM)
Definitions
Acute inflammatory insult of spinal cord due to direct viral infection or postviral immunologic attack
IMAGING
General Features
CT Findings
MR Findings
Nonvascular Interventions
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Helfferich J et al: Acute flaccid myelitis and enterovirus D68: lessons from the past and present. Eur J Pediatr. 178(9):1305-15, 2019
Rodríguez Y et al: Guillain-Barré syndrome, transverse myelitis and infectious diseases. Cell Mol Immunol. 15(6):547-62, 2018
Division of Viral Diseases, National Centers for Immunization and Respiratory Diseases, CDC; Division of Vector-Borne Diseases, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Children's Hospital Colorado; Council of State and Territorial Epidemiologists: Notes from the field: acute flaccid myelitis among persons aged ≤21 years - United States, august 1-november 13, 2014. MMWR Morb Mortal Wkly Rep. 63(53):1243-4, 2015
Maloney JA et al: MRI findings in children with acute flaccid paralysis and cranial nerve dysfunction occurring during the 2014 enterovirus D68 outbreak. AJNR Am J Neuroradiol. 36(2):245-50, 2015
Sejvar JJ et al: Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol. 16(1):93-100, 2010
Blakely PK et al: Disrupted glutamate transporter expression in the spinal cord with acute flaccid paralysis caused by West Nile virus infection. J Neuropathol Exp Neurol. 68(10):1061-72, 2009
Heerlein K et al: Aquaporin-4 antibody positive longitudinally extensive transverse myelitis following varicella zoster infection. J Neurol Sci. 276(1-2):184-6, 2009
Kincaid O et al: Viral myelitis: an update. Curr Neurol Neurosci Rep. 6(6):469-74, 2006
Marjelund S et al: Gadolinium enhancement of cauda equina: a new MR imaging finding in the radiculitic form of tick-borne encephalitis. AJNR Am J Neuroradiol. 27(5):995-7, 2006
Fujimoto H et al: Epstein-Barr virus infections of the central nervous system. Intern Med. 42(1):33-40, 2003
Jeha LE et al: West Nile virus infection: a new acute paralytic illness. Neurology. 61(1):55-9, 2003
Zandman-Goddard G et al: Transverse myelitis associated with chronic hepatitis C. Clin Exp Rheumatol. 21(1):111-3, 2003
Karacostas D et al: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Spinal Cord. 40(3):145-9, 2002
Chen CY et al: Acute flaccid paralysis in infants and young children with enterovirus 71 infection: MR imaging findings and clinical correlates. AJNR Am J Neuroradiol. 22(1):200-5, 2001
McMinn P et al: Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis. 32(2):236-42, 2001
Gruhn B et al: Successful treatment of Epstein-Barr virus-induced transverse myelitis with ganciclovir and cytomegalovirus hyperimmune globulin following unrelated bone marrow transplantation. Bone Marrow Transplant. 24(12):1355-8, 1999
Haanpaa M et al: CSF and MRI findings in patients with acute herpes zoster. Neurology. 51(5):1405-11, 1998
Ku B et al: Acute transverse myelitis caused by Coxsackie virus B4 infection: a case report. J Korean Med Sci. 13(4):449-53, 1998
Nakajima H et al: Herpes simplex virus myelitis: clinical manifestations and diagnosis by the polymerase chain reaction method. Eur Neurol. 39(3):163-7, 1998
Salonen O et al: Myelitis associated with influenza A virus infection. J Neurovirol. 3(1):83-5, 1997
Cheshire WP et al: Spinal cord infarction: etiology and outcome. Neurology. 47(2):321-30, 1996
de Silva SM et al: Zoster myelitis: improvement with antiviral therapy in two cases. Neurology. 47(4):929-31, 1996
Ebo DG et al: Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. J Rheumatol. 23(3):548-50, 1996
Moulignier A et al: AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge. Clin Infect Dis. 22(4):626-31, 1996
Breningstall GN et al: Acute transverse myelitis and brainstem encephalitis associated with hepatitis A infection. Pediatr Neurol. 12(2):169-71, 1995
Campi A et al: Acute transverse myelopathy: spinal and cranial MR study with clinical follow-up. AJNR Am J Neuroradiol. 16(1):115-23, 1995
Caldas C et al: Case report: transverse myelitis associated with Epstein-Barr virus infection. Am J Med Sci. 307(1):45-8, 1994
Gilden DH et al: Varicella-zoster virus myelitis: an expanding spectrum. Neurology. 44(10):1818-23, 1994
Kyllerman MG et al: PCR diagnosis of primary herpesvirus type I in poliomyelitis-like paralysis and respiratory tract disease. Pediatr Neurol. 9(3):227-9, 1993
Chang CM et al: Postinfectious myelitis, encephalitis and encephalomyelitis. Clin Exp Neurol. 29:250-62, 1992
Cumming WJ: Myelitis and toxic, inflammatory and infectious disorders. Curr Opin Neurol Neurosurg. 5(4):549-53, 1992
Hwang YM et al: A case of herpes zoster myelitis: positive magnetic resonance imaging finding. Eur Neurol. 31(3):164-7, 1991
Iwamasa T et al: Acute ascending necrotizing myelitis in Okinawa caused by herpes simplex virus type 2. Virchows Arch A Pathol Anat Histopathol. 418(1):71-5, 1991
Power C et al: Pathological and molecular biological features of a myelopathy associated with HTLV-1 infection. Can J Neurol Sci. 18(3):352-5, 1991
Awerbuch G et al: Demonstration of acute post-viral myelitis with magnetic resonance imaging. Pediatr Neurol. 3(6):367-9, 1987
Wiley CA et al: Acute ascending necrotizing myelopathy caused by herpes simplex virus type 2. Neurology. 37(11):1791-4, 1987
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