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Viral Myelitis
Lubdha M. Shah, MD; Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Acute transverse myelitis (ATM)
              • 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

                                            1. 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
                                            2. 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. ePub, 2014
                                            3. Sejvar JJ et al: Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol. 16(1):93-100, 2010
                                            4. 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
                                            5. 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
                                            6. Kincaid O et al: Viral myelitis: an update. Curr Neurol Neurosci Rep. 6(6):469-74, 2006
                                            7. 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
                                            8. Fujimoto H et al: Epstein-Barr virus infections of the central nervous system. Intern Med. 42(1):33-40, 2003
                                            9. Jeha LE et al: West Nile virus infection: a new acute paralytic illness. Neurology. 61(1):55-9, 2003
                                            10. Zandman-Goddard G et al: Transverse myelitis associated with chronic hepatitis C. Clin Exp Rheumatol. 21(1):111-3, 2003
                                            11. Karacostas D et al: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Spinal Cord. 40(3):145-9, 2002
                                            12. 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
                                            13. Gorson KC et al: Nonpoliovirus poliomyelitis simulating Guillain-Barre syndrome. Arch Neurol. 58(9):1460-4, 2001
                                            14. 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
                                            15. Andersen O: Myelitis. Curr Opin Neurol. 13(3):311-6, 2000
                                            16. 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
                                            17. Haanpaa M et al: CSF and MRI findings in patients with acute herpes zoster. Neurology. 51(5):1405-11, 1998
                                            18. 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
                                            19. 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
                                            20. Salonen O et al: Myelitis associated with influenza A virus infection. J Neurovirol. 3(1):83-5, 1997
                                            21. Cheshire WP et al: Spinal cord infarction: etiology and outcome. Neurology. 47(2):321-30, 1996
                                            22. de Silva SM et al: Zoster myelitis: improvement with antiviral therapy in two cases. Neurology. 47(4):929-31, 1996
                                            23. Ebo DG et al: Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. J Rheumatol. 23(3):548-50, 1996
                                            24. Moulignier A et al: AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge. Clin Infect Dis. 22(4):626-31, 1996
                                            25. Breningstall GN et al: Acute transverse myelitis and brainstem encephalitis associated with hepatitis A infection. Pediatr Neurol. 12(2):169-71, 1995
                                            26. 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
                                            27. Caldas C et al: Case report: transverse myelitis associated with Epstein-Barr virus infection. Am J Med Sci. 307(1):45-8, 1994
                                            28. Gilden DH et al: Varicella-zoster virus myelitis: an expanding spectrum. Neurology. 44(10):1818-23, 1994
                                            29. 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
                                            30. Chang CM et al: Postinfectious myelitis, encephalitis and encephalomyelitis. Clin Exp Neurol. 29:250-62, 1992
                                            31. Cumming WJ: Myelitis and toxic, inflammatory and infectious disorders. Curr Opin Neurol Neurosurg. 5(4):549-53, 1992
                                            32. Dawson DM et al: Acute nontraumatic myelopathies. Neurol Clin. 9(3):585-603, 1991
                                            33. Hwang YM et al: A case of herpes zoster myelitis: positive magnetic resonance imaging finding. Eur Neurol. 31(3):164-7, 1991
                                            34. 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
                                            35. 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
                                            36. Awerbuch G et al: Demonstration of acute post-viral myelitis with magnetic resonance imaging. Pediatr Neurol. 3(6):367-9, 1987
                                            37. 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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                                            Related Differential Diagnoses
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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)
                                                        • 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

                                                                                      1. 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
                                                                                      2. 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. ePub, 2014
                                                                                      3. Sejvar JJ et al: Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol. 16(1):93-100, 2010
                                                                                      4. 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
                                                                                      5. 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
                                                                                      6. Kincaid O et al: Viral myelitis: an update. Curr Neurol Neurosci Rep. 6(6):469-74, 2006
                                                                                      7. 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
                                                                                      8. Fujimoto H et al: Epstein-Barr virus infections of the central nervous system. Intern Med. 42(1):33-40, 2003
                                                                                      9. Jeha LE et al: West Nile virus infection: a new acute paralytic illness. Neurology. 61(1):55-9, 2003
                                                                                      10. Zandman-Goddard G et al: Transverse myelitis associated with chronic hepatitis C. Clin Exp Rheumatol. 21(1):111-3, 2003
                                                                                      11. Karacostas D et al: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Spinal Cord. 40(3):145-9, 2002
                                                                                      12. 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
                                                                                      13. Gorson KC et al: Nonpoliovirus poliomyelitis simulating Guillain-Barre syndrome. Arch Neurol. 58(9):1460-4, 2001
                                                                                      14. 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
                                                                                      15. Andersen O: Myelitis. Curr Opin Neurol. 13(3):311-6, 2000
                                                                                      16. 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
                                                                                      17. Haanpaa M et al: CSF and MRI findings in patients with acute herpes zoster. Neurology. 51(5):1405-11, 1998
                                                                                      18. 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
                                                                                      19. 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
                                                                                      20. Salonen O et al: Myelitis associated with influenza A virus infection. J Neurovirol. 3(1):83-5, 1997
                                                                                      21. Cheshire WP et al: Spinal cord infarction: etiology and outcome. Neurology. 47(2):321-30, 1996
                                                                                      22. de Silva SM et al: Zoster myelitis: improvement with antiviral therapy in two cases. Neurology. 47(4):929-31, 1996
                                                                                      23. Ebo DG et al: Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. J Rheumatol. 23(3):548-50, 1996
                                                                                      24. Moulignier A et al: AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge. Clin Infect Dis. 22(4):626-31, 1996
                                                                                      25. Breningstall GN et al: Acute transverse myelitis and brainstem encephalitis associated with hepatitis A infection. Pediatr Neurol. 12(2):169-71, 1995
                                                                                      26. 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
                                                                                      27. Caldas C et al: Case report: transverse myelitis associated with Epstein-Barr virus infection. Am J Med Sci. 307(1):45-8, 1994
                                                                                      28. Gilden DH et al: Varicella-zoster virus myelitis: an expanding spectrum. Neurology. 44(10):1818-23, 1994
                                                                                      29. 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
                                                                                      30. Chang CM et al: Postinfectious myelitis, encephalitis and encephalomyelitis. Clin Exp Neurol. 29:250-62, 1992
                                                                                      31. Cumming WJ: Myelitis and toxic, inflammatory and infectious disorders. Curr Opin Neurol Neurosurg. 5(4):549-53, 1992
                                                                                      32. Dawson DM et al: Acute nontraumatic myelopathies. Neurol Clin. 9(3):585-603, 1991
                                                                                      33. Hwang YM et al: A case of herpes zoster myelitis: positive magnetic resonance imaging finding. Eur Neurol. 31(3):164-7, 1991
                                                                                      34. 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
                                                                                      35. 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
                                                                                      36. Awerbuch G et al: Demonstration of acute post-viral myelitis with magnetic resonance imaging. Pediatr Neurol. 3(6):367-9, 1987
                                                                                      37. Wiley CA et al: Acute ascending necrotizing myelopathy caused by herpes simplex virus type 2. Neurology. 37(11):1791-4, 1987