Neuroimaging clinics of North America
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Spinal involvement in human brucellosis is a common condition and a significant cause of morbidity and mortality, particularly in endemic areas, because it is often associated with therapeutic failure. Most chronic brucellosis cases are the result of inadequate treatment of the initial episode. ⋯ Early diagnosis is important to ensure proper treatment and decrease morbidity and mortality. Radiologic evaluation has gained importance in diagnosis and treatment planning, including interventional procedures and monitoring of all spinal infections.
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Neuroimaging Clin. N. Am. · May 2015
ReviewPathologic basis of pyogenic, nonpyogenic, and other spondylitis and discitis.
Pyogenic spondylitis and discitis are usually seen following a recent infection or surgery. A septic embolus causes an infarcted area within the bone. Pyogenic spondylitis is characterized by edema, vascular leakage, and supportive inflammatory reaction characterized with polymorphonuclear leukocytes. ⋯ Mycobacterium tuberculosis can be shown by histochemical stains for acid-fast bacteria or by immunochemistry. In brucella spondylitis, microgranulomatous proliferation composed of histiocytes containing numerous bacilli without caseating necrosis is characteristic. Brucella melitensis can be shown on histochemical Gram stain.
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The pathologic evaluation of spinal cord infections requires comprehensive clinical, radiological, and laboratory correlation, because the histologic findings in acute, chronic, or granulomatous infections rarely provide clues for the specific cause. This brief review focuses on the pathologic mechanisms as well as practical issues in the diagnosis and reporting of infections of the spinal cord. Examples are provided of the common infectious agents and methods for their diagnosis. By necessity, discussion is restricted to the infections of the medulla spinalis proper and its meninges, and not bone or soft tissue infections.
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This article summarizes myelopathy and radiculopathy caused by different viruses. The cases described are divided into three categories: acute myelitis and radiculitis, postinfectious myelopathy and radiculopathy, and chronic myelopathy. ⋯ Magnetic resonance (MR) imaging is an essential tool in diagnosis. However, because imaging findings are often nonspecific, consideration of a combination of diagnostic procedures, including the clinical course, symptoms, and laboratory data, is necessary for making a correct diagnosis.
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Inflammatory and infectious disorders of the spine in children are less common than in adults, and are usually categorized according to location into (1) those predominantly affecting the spinal cord; (2) those predominantly affecting the nerve roots and meninges; and (3) those predominantly affecting the vertebrae, discs, and epidural space. Disorders primitively involving the spinal cord may be grouped into 2 basic categories: (1) inflammatory (represented by acute transverse myelopathy) and (2) infectious (ie, bacterial, viral, fungal, or parasitic). Inflammatory spinal cord diseases are more common than primitive spinal cord infection.