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The spinal cord disorders that make up this category take the form mainly of a leukomyelitis based on either demyelination or necrosis of the tracts in the spinal cord The critical factor in their pathogenesis appears to be a disordered immune response, in some cases, to an infection, and in others, idiopathic Varied clinical syndromes are produced, and the basic disease is classi ed in most textbooks under headings such as acute transverse myelitis, postinfectious myelitis, postvaccinal myelitis, acute MS, and necrotizing myelitis While each of these conditions may affect other parts of the nervous system (most often the optic nerves or brain), often the only manifestations are spinal The aforementioned myelopathies are suf ciently distinct to justify their separate classi cation, for in most cases they are isolated syndromes; but transitional cases sharing the clinical and pathologic attributes of more than one disease are encountered in any large clinical and pathologic material Postinfectious and Postvaccinal Myelitides The characteristic features of these diseases are (1) their temporal relationship to certain viral infections or vaccinations (see page 791); (2) the development of neurologic signs over the period of a few days; and (3) a monophasic temporal course, ie, a single attack of several weeks duration with variable degrees of recovery and no recurrence These diseases may involve the brain as well as the spinal cord, in which case the process is properly designated as acute disseminated encephalomyelitis (ADEM) On the basis of the clinical features of disseminated postinfectious encephalomyelitis and the animal model of experimental allergic encephalomyelitis (EAE), postinfectious myelitis is presumed to be immunologic in nature, re ecting an attack that is more or less con ned to spinal cord myelin (see Chap 36) The usual history in these cases is for weakness and numbness of the feet and legs (less often of the hands and arms) to develop over a few days, at times longer, and for the sensory symptoms to ascend from the feet to the trunk Paresthesias in the feet and legs are a common early symptom Sphincteric disturbances and backache are also common in the rst days A slight asymmetry of the symptoms and signs, a sensory level on the trunk, or a Babinski sign clearly marks the disease as a myelopathy and serves to distinguish it from a rapidly progressive polyneuropathy such as the Guillain-Barre syndrome Back pain of varying degree and head ache and stiff neck may or may not be present In about half of cases the patient can identify a recent infectious illness, usually a mundane upper respiratory syndrome, but there is no fever when.

Figure 44-3 MRI in Pott tuberculous spine disease The angulated deformity of the thoracic spine is highly characteristic (Courtesy of Dr Randall Edgell, New York University Medical Center)

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myelitic focus Cryptococcus, which causes meningoencephalitis and rarely a cerebral granuloma, in our experience seldom causes spinal lesions Hematogenous metastases to the spinal cord or meninges may occur in both blastomycosis and coccidioidomycosis Occasionally an echinococcal infection of the posterior mediastinum may extend to the spinal canal (epidural space) via intervertebral foramina and compress the spinal cord Schistosomiasis (bilharziasis) is a recognized cause of myelitis in the Far East, Africa, and South America The spinal cord is a target for all three common forms of Schistosoma: S haematobium, S japonicum, and S mansoni, but particularly the last of these (see page 627) The schistosomal ova evoke an intense granulomatous myelomeningoradiculitis The lesions are destructive of gray and white matter, with ova in arteries and veins leading to vascular obstruction and ischemia (Scrimgeour and Gajdusek) Less often, a localized granuloma gives rise to a compressive cord

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The Windows 9x Control Panel provides you with a safe way to configure many of the system s configuration settings To access the Control Panel, double-click My Computer, then double-click Control Panel, or select Start | Settings | Control Panel A typical Control Panel includes applets for configuring the keyboard, the mouse, and network and date/time settings, among other things To open an applet, double-click its icon, make the necessary changes, then click OK The Registry will be automatically and safely updated with your changes To edit the Registry directly, use the Registry Editor To edit the Registry safely, use the Control Panel

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