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Updated: Dec 23, 2025
Induction and Diverse Assessment Indicators of Experimental Autoimmune Encephalomyelitis
Published on: September 9, 2022
Acute infectious myelopathies
1Department of Infectious Diseases, Section of Neurologic Infections, Cleveland Clinic, Cleveland, Ohio, USA.
Purpose Of Review:
The patient who presents with an acute spinal cord syndrome with weakness/paralysis of the limbs presents a diagnostic. Two important syndromes are acute transverse myelitis (ATM) and acute flaccid paralysis (AFP). Both can be caused by a number of infectious and noninfectious causes. Since 2014 there have been outbreaks of acute flaccid myelitis (a subgroup of AFP) in the United States, with a national surveillance program underway. In addition, there have been increasing reports of ATM from new and emerging pathogens, and opportunistic infections in immunocompromised hosts.
Recent Findings:
Infectious causes of ATM or AFP need to be ruled out first. There may be important clues to an infectious cause from epidemiologic risk factors, immune status, international travel, MRI, and laboratory findings. We summarize key features for the more common pathogens in this review. Advances in laboratory testing have improved the diagnostic yield from cerebrospinal fluid, including real-time polymerase chain reaction, metagenomic next-generation sequencing, and advanced antibody detection techniques. These tests still have limitations and require clinical correlation.
Summary:
We present a syndromic approach to infectious myelopathies, focusing on clinical patterns that help narrow the diagnostic possibilities.
Insights
Diagnosing acute spinal cord syndromes like acute transverse myelitis (ATM) and acute flaccid paralysis (AFP) requires ruling out infectious causes. This review highlights key features of common pathogens and diagnostic advances.
Area of Science:
- Neurology
- Infectious Diseases
- Spinal Cord Syndromes
Background:
- Acute spinal cord syndromes, including acute transverse myelitis (ATM) and acute flaccid paralysis (AFP), present diagnostic challenges.
- Both ATM and AFP can stem from diverse infectious and noninfectious etiologies.
- Recent years have seen outbreaks of acute flaccid myelitis and increased ATM reports due to emerging pathogens.
Purpose of the Study:
- To review infectious causes of ATM and AFP.
- To outline a syndromic approach for diagnosing infectious myelopathies.
- To highlight clinical patterns aiding in differential diagnosis.
Main Methods:
- Summarizing key features of common pathogens causing ATM/AFP.
- Reviewing diagnostic clues from epidemiology, immune status, travel, MRI, and labs.
- Discussing advances in cerebrospinal fluid testing (PCR, NGS, antibody detection).
Main Results:
- Infectious etiologies must be considered first in patients with ATM or AFP.
- Epidemiological data, clinical presentation, imaging, and laboratory tests are crucial for diagnosis.
- Advanced molecular and serological tests improve diagnostic yield but require clinical correlation.
Conclusions:
- A syndromic approach focusing on clinical patterns is effective for diagnosing infectious myelopathies.
- Early identification of infectious causes is critical for appropriate patient management.
- Continued advancements in diagnostics enhance the ability to detect and identify pathogens responsible for these neurological syndromes.
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