HTLV-1–associated myelopathy (HAM)32	adult T-cell leukemia (ATL) and HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP). infective dermatitis (IDH) is a chronic and severe dermatitis that mainly affects children HTLV-1–associated uveitis	TSP – mostly affects CST urinary incontinence, and/or severe lower back pain radiating to the legs autonomic dysfunction leading to constipation, and, in some cases, sexual dysfunction.   Acute ATL Short and aggressive clinical course Hypercalcemia, lytic bone lesions, pulmonary involvement, and lymphocytosis Hepatosplenomegaly Cutaneous lesions (indolent, nodular, indurated, exfoliative, or erythrodermal)	Dx’D by ELISA   CSF: Serum viral load to establish TSP   Tx leukemias as usual   TSP treated with immunomod or antivirals – not very successful
Neurocysticercosis eggs of Taenia solium (ie, pork tapeworm) man as the definitive host carrying the intestinal tapeworm, and pig as the normal intermediate host harboring the larvae or cysticerci utoimmune myelopathies Carcinomatous meningitis Transverse myelitis	Eye Muscle CNS – multiple small mass lesions -epilepsy -strokes -hydrocephalus Myelopathy(rare)		Stool ) & P Serum Elisa is best CSF if floaters   Steroids & anitparasitics   praziquantel (PZQ) and albendazole.
WNV encephalo-myelitis
HIV Vacuolar Myelopathy
Schistosomiasis
Lyme Disease
Neuro-syphilis
Whipple Disease
Neuromyelitis optica Devics – Cord and optic nerve without rest of neuraxis, mono/polyphasic NMO – associated resp muscle weakness, high relapse rateWithin 5 years of onset:50% of patients are blind in both eyes and cannot walk unassisted20% die of respiratory failure due to cervical myelitis			Treatment: azathioprine and rituximab (diff from MS)
ADEM Parainfectious or postvaccinal demyelinating disorders of the CNS encephalopathy, meningismus and multifocal signs of CNS dysfunctions

Spinal ischaemia:

• vasculitis (polyarteritis nodosa, Behcet disease, giant cell arteritis)
• systemic hypoperfusion (in cardiac arrest, aortic rupture, aortic dissecon or coarctation)
• embolism (atrial myxoma, mitral disease, endocarditis, fibrocartilaginous emboli from a ruptured intervertebral disc)
• infectious causes (syphylitic arteritis, bacterial meningitis)

DDx of Acute Non-Traumatic Myelopathy

• ADEM
• MS presentation
• Neuromyelitis optica
• Paraneoplastic
• Hu – Sensory> motor
• Heroin
• Electrocution  (acute/chrnic)
• Infectious
• Vascular Non-Inflammatory

Spinal Cord Infarction

•  usually similar vascular risk factors as stroke

ATM – Differential Diagnosis

• Transvere Myelitis:
• Sjogrens
• SLE – APSS
• Behcet’s and other vasculitis
• Sarcoidosis
• Reported: Ank spon, RA, etc
• As a component of ADEM
• Infectious

• Lyme
• M.Pneumoniae
• EBV
• CMV
• HSV
•  VZV
•  VDRL
•  Enterovirus
•  Parechovirus

40% not documented by MRI

May have increased CSF protein and oligocloncal bands

Spinal Cord Malignancy

• Primary
• Secondary (Mets)
  • Most common primary
  • Breast, lung, prostate, kidney
  • T Spine most common
• Extradural
  • Mets #1
  • Myeloma
  • Neurofibroma
  • BEWARE NF-1
  • Lymphoma
• Intradural
• Intramedullary
  • ASTROCYTOMA
  • EPENDYMOMA
• Extramedullary
  • MENINGIOMA
  • SCHWANNOMA

Insidious Myelopathy DDx

B12 deficiency  SCD

Especially in old gastric bypass patients (Cu, Zn, Vit E)

Cu deficiency

Zn deficiency

Vit E deficiency

Hereditary Spastic Paraparesis

Spinocerebellar ataxia

Adreno myeloneuropathy

Post-Radiation

Toxic

• Hexacarbons
• amphoteracin B
• MTX

Infections and the Cord

• Spinal abscess
• S. Aureus
• Infected hardware
• TB
  • Pott’s disease (extradural)
• Spirochetal        
  • Tabes dorsalis
• Whipple’s disease
  • Tropheryma whippelii
• Lyme disease
  • neuroborreliosis
• Viral      
  • HIV
    • Vacuolar Myelopathy
  • HTLV1
    • TSP (tropical spastic paraparesis)
  • West Nile Virus
  • POLIO
  • Zoster
  • CMV