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Carlos M Isada1, Ryan Miller

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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.

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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.