Atopic myelitis (AM) is a relatively mild form of myelitis associated with allergic diathesis, and present with predominant sensory manifestations. Lhermitte's sign has been considered as a relatively non-specific clinical sign suggesting demyelinating lesion in cervical cord. Here we report a patient with recurrent AM who presented with isolated Lhermitte's sign, both in first and second attacks. This report suggests that either the diagnosis or recurrence of AM can be frequently underdiagnosed because of its predominant sensory manifestations.
Diagnosis ; Disease Susceptibility ; Humans ; Myelitis* ; Recurrence

Recurrent zoster myelitis is quite rare. We present a previously healthy 27-year-old woman who developed recurrent attacks of myelopathy shortly after the characteristic skin rashes of herpes zoster. Magnetic resonance imaging studies demonstrated each lesion in the spinal cord at the same segments as the skin lesions. She had two attacks at opposite sites at the same spinal cord level and complete recovery after being treated with intravenous acyclovir. We suspect that direct invasion of varicella zoster virus was the cause of recurrent myelopathy in our patient.
Adult ; Case Report ; Female ; Herpes Zoster/complications* ; Human ; Magnetic Resonance Imaging ; Myelitis/virology* ; Myelitis/diagnosis ; Recurrence

Neurosyphilis is an infection of the brain or spinal cord that is caused by the bacterium Treponema pallidum. Syphilitic myelitis, which involves the spinal cord, is a very rare form of neurosyphilis seen in patients with syphilis. It requires differentiation from other diseases of the spinal cord, including idiopathic transverse myelitis and spinal cord infarction. Herein, we describe the presentation and diagnosis of syphilitic myelitis in a 43-year-old woman, based on a flip-flop sign and candle guttering appearance depicted in magnetic resonance imaging and laboratory tests.
Adult ; Brain ; Diagnosis ; Female ; Humans ; Infarction ; Magnetic Resonance Imaging ; Myelitis ; Myelitis, Transverse ; Neurosyphilis ; Spinal Cord ; Syphilis ; Treponema pallidum

PURPOSE: The purpose of this study is to describe the MR findings of transverse myelitis, especially on T2 weighted images and to determine if there are any MR findings characteristic of transverse myelitis that may bevaluale in the differentiation from intramedullary tumor. MATERIALS AND METHODS: The MR images of 13 patients with the diagnosis of transverse myelitis were retrospectively reviewed. The diagnosis was based on both the clinical and follow-up MR images, and was confirmed by open biopsy in four patients. The MR features were analyzed in terms of the the position and extent of the lesion, signal intensity on all sequences, enhancement patterns(nodular, patchy, linear, punctate, ring, and mixed), and the presence or absence of hemorrhage, cyst, andsyrinx. On T2-weighted images, existence of focal abnormal signal areas compatible with the enhancing lesions and shape of both rostral and caudal ends of the lesions were also evaluated. RESULTS: On MR images, there was fusiform swelling of the spinal cord over variable length from 2 to 10 vertebral segments. The lesions showed diffuse isosignal intensity on T1 weighted images and high signal intensity on T2 weighted images. Contrast-enhanced T1 weighted images revealed variable enhacement pa- tterns ; nodular in 7, patchy in 6, linear in 3, punctate in 2, ring in 1 and mixed in 6 cases. The enhancement occurred usually within the central portion of highsignal intensity lesion of the swollen cord. The cranial and caudal ends of the high signal lesion usually showed smooth tapered appearance in 12 cases(both ends in 10 and one end in 2). There was no focal abnormal signal lesion compatible with the enhancing area. No case demonstrated any hemorrhage, cyst, and syrinx. CONCLUSION: Segmental cord swelling, diffuse high signal intensity with tapered appearance of both cranial and caudal ends, and no focal abnormal signal intensity that is compatible with the enhancing lesion, suggest transverse myelitis. Therefore, if above MR findings are seen, follow-up study is recommended to avoid the invasive surgical procedures.
Biopsy ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Myelitis, Transverse* ; Retrospective Studies ; Spinal Cord

Neuromyelitis optica spectrum disorder (NMOSD) can present with various symptoms including optic neuritis, transverse myelitis, and area postrema syndrome. However, acute memory loss is an uncommon clinical presentation of NMOSD. We report a patient with NMO-IgG-antibody-positive NMOSD presenting with only acute memory loss, which suggested the presence of bilateral thalamic lesions. This case indicates that NMOSD needs to be considered in the differential diagnosis of acute memory loss.
Area Postrema ; Diagnosis, Differential ; Humans ; Memory Disorders* ; Memory* ; Myelitis, Transverse ; Neuromyelitis Optica* ; Optic Neuritis

Acute transverse myelitis (ATM) is an upper motor neuron disease of the spinal cord, and concomitant association of peripheral polyneuropathy, particularly the axonal type, is rarely reported in children. Our cases presented with ATM complicated with axonal type polyneuropathy. Axonal type polyneuropathy may be caused by acute motor-sensory axonal neuropathy (AMSAN) or critical illness polyneuropathy and myopathy (CIPNM). These cases emphasize the need for nerve and muscle biopsies to make the differential diagnosis between AMSAN and CIPNM in patients with ATM complicated with axonal polyneuropathy.
Axons* ; Biopsy ; Child* ; Diagnosis, Differential ; Humans ; Motor Neuron Disease ; Muscular Diseases ; Myelitis, Transverse* ; Polyneuropathies* ; Spinal Cord

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.
Diagnosis, Differential ; Eosinophils ; Hypersensitivity ; Immunoglobulin E ; Mites ; Myelitis ; Rare Diseases ; Spinal Cord ; Toxocariasis

PURPOSE: The purpose of this study is to correlate the MR findings with clinical stage and clinical outcome, and to describe the evolutional changes of abnormal MR findings of transverse myelitis. MATERIALS AND METHODS: Medical records and spinal MR images of 23 patients with both clinical and radiological diagnosis of transverse myelitis were retrospectively reviewed. MR findings were correlated with clinical stages including interval between MR imaging and full development of clinical symptoms, and compared with the clinical outcome. RESULTS: Diffuse high signal intensity of the spinal cord on T2-weighted image with mild cord bulging (67%) and focal contrast enhancement of the cord (75%) were observed within the first four weeks after full development of clinical symptoms. The findings decreased in extent or vanished later than four weeks on either initial or follow-up MR images. Most patients with either cord atrophy or focal hemorrhagewithin the cord lesion had poor clinical outcome. CONCLUSION: The MR findings of transverse myelitis are nonspecific, which may be seen in a variety of diseases. Serial MRIs, especially follow up examination over at least one month after full development of clinical symptoms are useful in the diagnosis of transverse myelitis and predicting its prognosis.
Atrophy ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Myelitis, Transverse* ; Prognosis ; Retrospective Studies ; Spinal Cord

Radiation myelitis is a rather rare, but irreversible fatal complication, Etiology, pathologic change, clinical symptoms and the method of diagnosis have been studies, pathogenesis of post-irradiation myelitis and the level of tolerance dose still remain controversial. Thoracolumbar spine of 110 hybrid mice were irradiated with orthovoltage x-ray machine. Mild capillary congestion and axonal welling were observed in 1,000rad irradiated specimens were also observed. These results suggest that 5,000 rad is not a completely safe tolerable dose which have been accepted and we cannot exclude direct radiation damage to nerve tissue as the causative pathology of radiation myelitis in addition to blood vessel damage.
Animals ; Axons ; Blood Vessels ; Capillaries ; Diagnosis ; Estrogens, Conjugated (USP) ; Mice* ; Myelitis ; Nerve Tissue ; Pathology ; Spinal Cord* ; Spine

The popularity of spinal anesthesia has decreased to some extent due to the widespread use of a balanced anesthesia technique, increasing interest in epidural anesthesia and fear of neurologic sequelae resulting from spinal anesthesia. The complication once most feared was adhesive arachnoiditis. However, in many study reports there were no instances of adhesive arachnoiditis, cauda equina syndrome or transverse myelitis. The majority of serious neurological symptoms appearing after spinal anesthesia can be attributed to coincidence or previously unrecognizaed disease. This is a case report in which the patient developed syringomyelia with chronic adhesive arachnoiditis. A 27-year-old patient, known to have adhesive arachnoiditis which developed after spinal anesthesia, was admitted to this institution for treatment of syringomyelia. He had history of a simple appendectomy done under spinal anesthesia on the 24th of November in 1976 and had experienced sensory changes and progressive motor weakness in the lower extremities 4 months after surgery. In January, 1978 he received an adhesiolysis operation after conservative therapy using steroid injections. Afterward, he developed syringomyelia resulting from adhesive arachnoiditis and had shunt surgery. He went home without significant improvement. However, it is unwise to make a final diagnosis and assume that the sequela was attributed only to the spinal anesthesia. It is important to seek other causes rather than to ascribe all to the spinal anesthesia because there are many other causative factors. In this case, it was not certain that adhesive arachnoiditis was a possible cause, but this could not be ruled out either. The prevention of complications and their causative factors must be carefully considered at all times in the practice of spinal anesthesia.
Adhesives ; Adult ; Anesthesia, Epidural ; Anesthesia, Spinal* ; Appendectomy ; Arachnoid* ; Arachnoiditis* ; Balanced Anesthesia ; Diagnosis ; Humans ; Lower Extremity ; Myelitis, Transverse ; Polyradiculopathy ; Syringomyelia*