Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- 74 Bacterial meningitis
- 75 Aseptic meningitis syndrome
- 76 Acute viral encephalitis
- 77 Intracranial suppuration
- 78 Spinal epidural abscess
- 79 Myelitis and peripheral neuropathy
- 80 Reye syndrome
- 81 Progressive multifocal leukoencephalopathy
- 82 Cerebrospinal fluid shunt infections
- 83 Prion diseases
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
79 - Myelitis and peripheral neuropathy
from Part X - Clinical syndromes: neurologic system
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- 74 Bacterial meningitis
- 75 Aseptic meningitis syndrome
- 76 Acute viral encephalitis
- 77 Intracranial suppuration
- 78 Spinal epidural abscess
- 79 Myelitis and peripheral neuropathy
- 80 Reye syndrome
- 81 Progressive multifocal leukoencephalopathy
- 82 Cerebrospinal fluid shunt infections
- 83 Prion diseases
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
Summary
Myelitis and peripheral neuropathy complicate many infections. This chapter discusses major infectious etiologies of myelitis (Table 79.1), peripheral neuropathy (Table 79.2), polymorphic syndromes (Table 79.3), and neuropathic syndromes seen in human immunodeficiency virus (HIV) infection (Table 79.4). Further, an algorithm (Figure 79.1) suggests an approach to the clinical and laboratory diagnosis of myelitis and peripheral neuropathy.
MYELITIS
Myelitis refers to inflammation of the spinal cord. Myelitis may be infectious or noninfectious and primary – directly attacking cord structures – or secondary – adjacent processes altering cord function. Primary myelitis can present as one of three discrete clinical patterns: (1) anterior poliomyelitis, (2) leukomyelitis, or (3) transverse myelitis. Poliomyelitis is inflammation involving gray matter; leukomyelitis is confined to white matter. Transverse myelitis, inflammation of an entire cross section of the spinal cord, can affect more than one spinal segment. A number of infectious agents are known to cause or to be associated with myelitis. Myelitis can also occur after infection or vaccination as in the acute disseminated encephalomyelitis (ADEM) syndrome.
There are five cardinal manifestations of spinal cord disease: pain; motor deficits; sensory deficits; abnormalities of reflexes and muscle tone; and bladder dysfunction. The distribution of neurologic deficits depends on the spinal segment(s) affected. Local pain occurs at the site of the lesion and can assume a radicular quality if the nerve roots are involved. Paresthesias have greater localizing value than radicular pain. Weakness is present in virtually all spinal cord disorders, and in myelitis may progress over hours, days, or weeks. Spinal shock is characterized by absent plantar reflexes, and areflexia and atonia below the level of the lesion. More slowly progressive lesions are associated with hyperreflexia and hypertonia. Bladder dysfunction is usually not an early sign of spinal cord disease, although if spinal shock develops, flaccid bladder paralysis ensues with urinary retention and overflow incontinence. Chronic myelopathies cause a spastic bladder and result in urgency, frequency, and incontinence.
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- Clinical Infectious Disease , pp. 510 - 523Publisher: Cambridge University PressPrint publication year: 2015
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