Current Issues in Clinical Neurovirology: Pathogenesis, by Christopher Power, Richard Johnson MD

By Christopher Power, Richard Johnson MD

Neurovirology is the research of neurologic issues attributable to neurotropic viruses. This factor of Neurologic Clinics gains the newest medical advances during this very important subspecialty, together with articles on such issues because the pathogenesis and analysis of viral infections of the anxious process, aseptic meningitis and viral myelitis, arboviruses, rabies, HIV neuropathy and myelopathy, herpetic infections, Epstein-Barr virus, post-infectious encephalomyelitis, and rising neurotropic viruses.

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Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis 2005–2006. Wkly Epidemiol Rec 2007;82:89–92. [60] Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002;59:499–505. [61] Saad M, Youssef S, Kirschke D, et al. Acute flaccid paralysis: the spectrum of a newly recognized complication of West Nile infection. J Infect 2005;51:120–7. [62] Sejvar JJ, Bode AV, Marfin AA, et al. West Nile virus-associated flaccid paralysis.

Computerized tomographic (CT) scans are of less use in the diagnosis because of Fig. 4. An acute HSVE lesion in the medial temporal lobe of a patient with herpes encephalitis. 662 BARINGER Fig. 5. The same area as displayed in Fig. 4 several years later. reduced sensitivity and lesser resolution than MRI scans [25]. Often the diagnosis has been missed early in the disease because CT scans were interpreted as normal or were considered to show ischemic lesions. The CSF is almost always abnormal, although normal CSF has been described in a small proportion of patients early in the disease process.

Reverse transcriptase PCR is highly specific for WNV sequences, but at present seems to be less sensitive than the serologic assays. The virus is only rarely cultured from CSF samples. Diagnostic approach Spinal MRI imaging begins the evaluation of any patient with an acute myelopathy to exclude an extramedullary or extradural compressive lesion. In cases of acute viral myelitis, spinal MRI scans can reveal a wide range of findings from a normal-appearing spinal cord to a swollen, enhancing cord lesion that extends over multiple spinal levels.

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