Transverse myelitis pathophysiology: Difference between revisions

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==Overview==
==Overview==
herpesviridae, enteroviruses, influenza viruses, adenoviruses; coxsackieviruses; enteric cytopathogenic human orphan (ECHO) virus, hepatitis A virus; lymphocytic choriomeningitis virus (LCMV); mumps virus; measles virus, rubella virus, poliovirus, rubeola virus, dengue virus, Russian spring-summer encephalitis virus, varicella virus, mycoplasma pneumonia bacteria, legionella pneumonia bacteria, pulmonary tuberculosis, borrelia (Lyme disease), listeria, and Bartonella (cat scratch disease).
 
* In the pathogenesis of transverse myelitis, a variety of immunological mechanisms may cause pathological substrate and dysfunction of [[Neural|neural cells]] within the [[spinal cord]].
 
* Transverse myelitis is the result of progressive [[demyelination]] and [[axonal]] loss in addition to [[Grey matter|gray matter]] involvement, [[necrosis]] and [[cavitation]].
* It is understood that [[infections]] may cause transverse myelitis by:
** Direct tissue damage
** Immune-mediated infection-triggered tissue damage
* [[Multiple sclerosis]] is the other cause to the transverse myelitis and it sometimes transverse myelitis can appear as the first symptom of [[Multiple sclerosis]].
* Acute partial transverse myelitis may be predictive of a subsequent diagnosis of [[multiple sclerosis]] in children.
* Invariable histopathological findings of transverse myelitis include:
** Perivascular spread of [[Monocyte|monocytes]]
** Focal areas of [[Lymphocyte|lymphocytes]] infiltrating
** [[Astroglia|Astroglial]] and [[Microglia|microglial]] activation
 
* Other histopathological findings of transverse myelitis include:
** Infiltration of [[CD4+ T cells|CD4<sup>+</sup>]] and [[CD8+ T cells|CD8<sup>+</sup> T-lymphocytes]]
** Typically preservation of the subpial parenchyma suggesting ischemia as the ultimate cause of the cord lesions in transverse myelitis
 
Conditions that may cause transverse myelitis include:
 
* Various infectionsin 30% to 60% of the cases:
** [[Herpesviridae]]
** [[Enterovirus|Enteroviruses]]
** [[Influenza virus|Influenza viruses]]
** [[Adenoviridae|Adenoviruses]]
** [[Coxsackievirus|Coxsackieviruses]]
** [[Echovirus|Enteric cytopathogenic human orphan (ECHO) virus]]
** [[Hepatitis A virus]]
** [[Lymphocytic choriomeningitis virus|Lymphocytic choriomeningitis virus (LCMV)]]
** [[Mumps virus]]
** [[Measles virus]]
** [[Rubella virus]]
** [[Poliovirus]]
** [[Rubeola|Rubeola virus]]
** [[Dengue virus]]
** [[Russian Spring Summer encephalitis virus|Russian spring-summer encephalitis virus]]
** [[Varicella virus]]
** [[Mycoplasma pneumonia|Mycoplasma pneumonia bacteria]]
** [[Legionella pneumophila|Legionella pneumonia bacteria]]
** [[Pulmonary tuberculosis]]
** [[Borrelia]] ([[Lyme disease]])
** [[Listeria]]
** [[Bartonella]] ([[cat scratch disease]])
* Vaccination
** About 30% of pediatric cases are preceded with [[immunization]]<nowiki/>s within one month of disease onset
 
[[Infections]] can cause transverse myelitis through two main mechanisms:
 
# Direct tissue damage
# Immune-mediated infection-triggered tissue damage which may be due to: [[Molecular mimicry]] or [[Superantigen|superantigen effect]]
 
* This immune response may be caused either by [[Cell-mediated immunity|T-cell mediated immune response]] or by [[Humoral immunity|antibody-mediated immune response]].
 
A non-microbial related immune dysfunction by the presence of autoantibodies has been also proposed in the immunopathogenesis of transverse myelitis.
 
In the spinal fluid of patients with transverse myelitis, [[Interleukin 6|Interleukin 6 (IL-6)]] levels were also markedly elevated.
 
<br />


==Pathophysiology==
==Pathophysiology==
Line 72: Line 129:
**[[Bartonella]] ([[cat scratch disease]])
**[[Bartonella]] ([[cat scratch disease]])
*Vaccination<ref name="pmid22379456">{{cite journal| author=Awad A, Stüve O| title=Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices. | journal=Curr Neuropharmacol | year= 2011 | volume= 9 | issue= 3 | pages= 417-28 | pmid=22379456 | doi=10.2174/157015911796557948 | pmc=3151596 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379456  }} </ref><ref name="pmid19880568">{{cite journal| author=Agmon-Levin N, Kivity S, Szyper-Kravitz M, Shoenfeld Y| title=Transverse myelitis and vaccines: a multi-analysis. | journal=Lupus | year= 2009 | volume= 18 | issue= 13 | pages= 1198-204 | pmid=19880568 | doi=10.1177/0961203309345730 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19880568  }} </ref>
*Vaccination<ref name="pmid22379456">{{cite journal| author=Awad A, Stüve O| title=Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices. | journal=Curr Neuropharmacol | year= 2011 | volume= 9 | issue= 3 | pages= 417-28 | pmid=22379456 | doi=10.2174/157015911796557948 | pmc=3151596 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379456  }} </ref><ref name="pmid19880568">{{cite journal| author=Agmon-Levin N, Kivity S, Szyper-Kravitz M, Shoenfeld Y| title=Transverse myelitis and vaccines: a multi-analysis. | journal=Lupus | year= 2009 | volume= 18 | issue= 13 | pages= 1198-204 | pmid=19880568 | doi=10.1177/0961203309345730 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19880568  }} </ref>
**About 30% of pediatric cases are preceded with immunizations within one month of disease onset
**About 30% of pediatric cases are preceded with [[immunization]]<nowiki/>s within one month of disease onset
*[Condition


Infections can cause transverse myelitis through two main mechanisms:
[[Infections]] can cause transverse myelitis through two main mechanisms:<ref name="pmid22379456">{{cite journal| author=Awad A, Stüve O| title=Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices. | journal=Curr Neuropharmacol | year= 2011 | volume= 9 | issue= 3 | pages= 417-28 | pmid=22379456 | doi=10.2174/157015911796557948 | pmc=3151596 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379456  }} </ref><ref name="pmid10987731">{{cite journal| author=Salgado CD, Weisse ME| title=Transverse myelitis associated with probable cat-scratch disease in a previously healthy pediatric patient. | journal=Clin Infect Dis | year= 2000 | volume= 31 | issue= 2 | pages= 609-11 | pmid=10987731 | doi=10.1086/313986 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10987731  }} </ref><ref name="pmid10378139">{{cite journal| author=Giobbia M, Carniato A, Scotton PG, Marchiori GC, Vaglia A| title=Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. | journal=Infection | year= 1999 | volume= 27 | issue= 3 | pages= 228-30 | pmid=10378139 | doi=10.1007/bf02561538 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10378139  }} </ref>


# Direct tissue damage
# Direct tissue damage
# Immune-mediated infection-triggered tissue damage which may be due to: [[Molecular mimicry]] or [[Superantigen|superantigen effect]]
# Immune-mediated infection-triggered tissue damage which may be due to: [[Molecular mimicry]] or [[Superantigen|superantigen effect]]


* This immune response may be caused either by [[Cell-mediated immunity|T-cell mediated immune response]] or by [[Humoral immunity|antibody-mediated immune response]].
*This immune response may be caused either by [[Cell-mediated immunity|T-cell mediated immune response]] or by [[Humoral immunity|antibody-mediated immune response]].
 
A non-microbial related immune dysfunction has been also proposed in the immunopathogenesis of TM. Some studies have described the presence of autoantibodies in TM [18, 22, 50]. Interleukin 6 (IL-6) levels were also markedly elevated in the spinal fluid of TM patients in comparison to control patients and to MS patients, and this also correlated with disability [4, 51]. IL-6 is secreted by astrocytes and microglia and binds to oligodendroglia and axons. High levels of IL-6 can cause direct tissue injury and indirect damage by inducing nitric oxide synthetase in microglia. Interestingly, Interferon-beta (IFN-β), a medication used to treat MS, was found to induce IL-6 [52]. IL-6 has probably a bell-shaped effect where at certain levels could cause damage and at different levels can induce repair [51, 53, 54].
 
One study that was conducted in Japan found that several patients with TM have much higher serum IgE levels than MS patients or controls pointing towards the immune-mediated process as well [55]. Concordant with these findings, tissue biopsies of two patients with TM and elevated total and specific serum IgE disclosed the presence of antibody deposition within the spinal cord and perivascular infiltration with eosinophils that could induce tissue damage [56].
 
<br />


==Genetics==
A non-microbial related immune dysfunction by the presence of autoantibodies has been also proposed in the immunopathogenesis of transverse myelitis.<ref name="pmid22379456" /><ref name="pmid2027486">{{cite journal| author=Tippett DS, Fishman PS, Panitch HS| title=Relapsing transverse myelitis. | journal=Neurology | year= 1991 | volume= 41 | issue= 5 | pages= 703-6 | pmid=2027486 | doi=10.1212/wnl.41.5.703 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2027486  }} </ref><ref name="pmid8609515">{{cite journal| author=Pandit L, Rao S| title=Recurrent myelitis. | journal=J Neurol Neurosurg Psychiatry | year= 1996 | volume= 60 | issue= 3 | pages= 336-8 | pmid=8609515 | doi=10.1136/jnnp.60.3.336 | pmc=1073861 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8609515  }} </ref><ref name="pmid11064439">{{cite journal| author=Bashir K, Whitaker JN| title=Importance of paraclinical and CSF studies in the diagnosis of MS in patients presenting with partial cervical transverse myelopathy and negative cranial MRI. | journal=Mult Scler | year= 2000 | volume= 6 | issue= 5 | pages= 312-6 | pmid=11064439 | doi=10.1177/135245850000600503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11064439  }} </ref>
[Disease name] is transmitted in [mode of genetic transmission] pattern.
 
OR
 
Genes involved in the pathogenesis of [disease name] include:
*[Gene1]
*[Gene2]
*[Gene3]
 
OR
 
The development of [disease name] is the result of multiple genetic mutations such as:
 
*[Mutation 1]
*[Mutation 2]
*[Mutation 3]


In the spinal fluid of patients with transverse myelitis, [[Interleukin 6|Interleukin 6 (IL-6)]] levels were also markedly elevated.<ref name="pmid22379456" /><ref name="pmid14977560">{{cite journal| author=Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA| title=Transverse Myelitis: pathogenesis, diagnosis and treatment. | journal=Front Biosci | year= 2004 | volume= 9 | issue=  | pages= 1483-99 | pmid=14977560 | doi=10.2741/1351 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14977560  }} </ref><ref name="pmid16184194">{{cite journal| author=Kaplin AI, Deshpande DM, Scott E, Krishnan C, Carmen JS, Shats I | display-authors=etal| title=IL-6 induces regionally selective spinal cord injury in patients with the neuroinflammatory disorder transverse myelitis. | journal=J Clin Invest | year= 2005 | volume= 115 | issue= 10 | pages= 2731-41 | pmid=16184194 | doi=10.1172/JCI25141 | pmc=1224298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16184194  }} </ref>
==Associated Conditions==
==Associated Conditions==
Conditions associated with [disease name] include:
Conditions associated with transverse myelitis include:<ref name="pmid21621005">{{cite journal| author=Borchers AT, Gershwin ME| title=Transverse myelitis. | journal=Autoimmun Rev | year= 2012 | volume= 11 | issue= 3 | pages= 231-48 | pmid=21621005 | doi=10.1016/j.autrev.2011.05.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21621005  }} </ref><ref name="pmid19662820">{{cite journal| author=Tristano AG| title=[Autoimmune diseases associated with transverse myelitis. Review]. | journal=Invest Clin | year= 2009 | volume= 50 | issue= 2 | pages= 251-70 | pmid=19662820 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19662820  }} </ref><ref name="pmid22379456">{{cite journal| author=Awad A, Stüve O| title=Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices. | journal=Curr Neuropharmacol | year= 2011 | volume= 9 | issue= 3 | pages= 417-28 | pmid=22379456 | doi=10.2174/157015911796557948 | pmc=3151596 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379456  }} </ref><ref name="pmid12045735">{{cite journal| author=Kerr DA, Ayetey H| title=Immunopathogenesis of acute transverse myelitis. | journal=Curr Opin Neurol | year= 2002 | volume= 15 | issue= 3 | pages= 339-47 | pmid=12045735 | doi=10.1097/00019052-200206000-00019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12045735  }} </ref><ref name="pmid24090445">{{cite journal| author=Cobo Calvo A, Mañé Martínez MA, Alentorn-Palau A, Bruna Escuer J, Romero Pinel L, Martínez-Yélamos S| title=Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. | journal=BMC Neurol | year= 2013 | volume= 13 | issue=  | pages= 135 | pmid=24090445 | doi=10.1186/1471-2377-13-135 | pmc=3856522 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24090445  }} </ref>


*Various infections
*Various infections
*[Condition 2]
*Systemic autoimmune diseases like:
*[Condition 3]
**[[Lupus erythematosus]]
**[[Sjögren's syndrome]]
**[[Sarcoidosis]]
**[[Optic neuritis]]
**[[multiple sclerosis]]


==Gross Pathology==
==Microscopic Pathology==
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Findings on microscopic histopathological analysis of transverse myelitis include:<ref name="pmid16635433">{{cite journal| author=Krishnan C, Kaplin AI, Pardo CA, Kerr DA, Keswani SC| title=Demyelinating disorders: update on transverse myelitis. | journal=Curr Neurol Neurosci Rep | year= 2006 | volume= 6 | issue= 3 | pages= 236-43 | pmid=16635433 | doi=10.1007/s11910-006-0011-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16635433  }} </ref><ref name="pmid1763730">{{cite journal| author=Mirich DR, Kucharczyk W, Keller MA, Deck J| title=Subacute necrotizing myelopathy: MR imaging in four pathologically proved cases. | journal=AJNR Am J Neuroradiol | year= 1991 | volume= 12 | issue= 6 | pages= 1077-83 | pmid=1763730 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1763730  }} </ref>


==Microscopic Pathology==
* [[Perivascular cell|Perivascular]] [[Lymphocytic|lymphocytic infiltrates]]
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
* [[Axonal|Axonal injury]]
* [[Necrosis]] and [[demyelination]]


==References==
==References==

Latest revision as of 19:50, 7 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

  • In the pathogenesis of transverse myelitis, a variety of immunological mechanisms may cause pathological substrate and dysfunction of neural cells within the spinal cord.
  • Other histopathological findings of transverse myelitis include:
    • Infiltration of CD4+ and CD8+ T-lymphocytes
    • Typically preservation of the subpial parenchyma suggesting ischemia as the ultimate cause of the cord lesions in transverse myelitis

Conditions that may cause transverse myelitis include:

Infections can cause transverse myelitis through two main mechanisms:

  1. Direct tissue damage
  2. Immune-mediated infection-triggered tissue damage which may be due to: Molecular mimicry or superantigen effect

A non-microbial related immune dysfunction by the presence of autoantibodies has been also proposed in the immunopathogenesis of transverse myelitis.

In the spinal fluid of patients with transverse myelitis, Interleukin 6 (IL-6) levels were also markedly elevated.


Pathophysiology

Physiology

Pathogenesis

  • In the pathogenesis of transverse myelitis, a variety of immunological mechanisms may cause pathological substrate and dysfunction of neural cells within the spinal cord.[3]
  • Other histopathological findings of transverse myelitis include:[1][5]
    • Infiltration of CD4+ and CD8+ T-lymphocytes
    • Typically preservation of the subpial parenchyma suggesting ischemia as the ultimate cause of the cord lesions in transverse myelitis

Conditions that may cause transverse myelitis include:

Infections can cause transverse myelitis through two main mechanisms:[1][14][16]

  1. Direct tissue damage
  2. Immune-mediated infection-triggered tissue damage which may be due to: Molecular mimicry or superantigen effect

A non-microbial related immune dysfunction by the presence of autoantibodies has been also proposed in the immunopathogenesis of transverse myelitis.[1][17][18][19]

In the spinal fluid of patients with transverse myelitis, Interleukin 6 (IL-6) levels were also markedly elevated.[1][8][20]

Associated Conditions

Conditions associated with transverse myelitis include:[21][22][1][3][23]

Microscopic Pathology

Findings on microscopic histopathological analysis of transverse myelitis include:[24][25]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Awad A, Stüve O (2011). "Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices". Curr Neuropharmacol. 9 (3): 417–28. doi:10.2174/157015911796557948. PMC 3151596. PMID 22379456.
  2. ↑ Tavasoli A, Tabrizi A (2018). "Acute Transverse Myelitis in Children, Literature Review". Iran J Child Neurol. 12 (2): 7–16. PMC 5904733. PMID 29696041.
  3. ↑ 3.0 3.1 Kerr DA, Ayetey H (2002). "Immunopathogenesis of acute transverse myelitis". Curr Opin Neurol. 15 (3): 339–47. doi:10.1097/00019052-200206000-00019. PMID 12045735.
  4. ↑ Meyer P, Leboucq N, Molinari N, Roubertie A, Carneiro M, Walther-Louvier U; et al. (2014). "Partial acute transverse myelitis is a predictor of multiple sclerosis in children". Mult Scler. 20 (11): 1485–93. doi:10.1177/1352458514526943. PMID 24619933.
  5. ↑ Moulignier A, Lescure FX, Savatovsky J, Campa P (2014). "CD8 transverse myelitis in a patient with HIV-1 infection". BMJ Case Rep. 2014. doi:10.1136/bcr-2013-201073. PMC 3918629. PMID 24503658.
  6. ↑ Jeffery DR, Mandler RN, Davis LE (1993). "Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events". Arch Neurol. 50 (5): 532–5. doi:10.1001/archneur.1993.00540050074019. PMID 8489410.
  7. ↑ Christensen PB, Wermuth L, Hinge HH, Bømers K (1990). "Clinical course and long-term prognosis of acute transverse myelopathy". Acta Neurol Scand. 81 (5): 431–5. doi:10.1111/j.1600-0404.1990.tb00990.x. PMID 2375246.
  8. ↑ 8.0 8.1 Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA (2004). "Transverse Myelitis: pathogenesis, diagnosis and treatment". Front Biosci. 9: 1483–99. doi:10.2741/1351. PMID 14977560.
  9. ↑ PAINE RS, BYERS RK (1953). "Transverse myelopathy in childhood". AMA Am J Dis Child. 85 (2): 151–63. doi:10.1001/archpedi.1953.02050070160004. PMID 13007166.
  10. ↑ Ropper AH, Poskanzer DC (1978). "The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms". Ann Neurol. 4 (1): 51–9. doi:10.1002/ana.410040110. PMID 697326.
  11. ↑ Knebusch M, Strassburg HM, Reiners K (1998). "Acute transverse myelitis in childhood: nine cases and review of the literature". Dev Med Child Neurol. 40 (9): 631–9. doi:10.1111/j.1469-8749.1998.tb15430.x. PMID 9766742.
  12. ↑ ALTROCCHI PH (1963). "ACUTE TRANSVERSE MYELOPATHY". Arch Neurol. 9: 111–9. doi:10.1001/archneur.1963.00460080021002. PMID 14048158.
  13. ↑ Lerer RJ, Kalavsky SM (1973). "Central nervous system disease associated with Mycoplasma pneumoniae infection: report of five cases and review of the literature". Pediatrics. 52 (5): 658–68. PMID 4598176.
  14. ↑ 14.0 14.1 Salgado CD, Weisse ME (2000). "Transverse myelitis associated with probable cat-scratch disease in a previously healthy pediatric patient". Clin Infect Dis. 31 (2): 609–11. doi:10.1086/313986. PMID 10987731.
  15. ↑ Agmon-Levin N, Kivity S, Szyper-Kravitz M, Shoenfeld Y (2009). "Transverse myelitis and vaccines: a multi-analysis". Lupus. 18 (13): 1198–204. doi:10.1177/0961203309345730. PMID 19880568.
  16. ↑ Giobbia M, Carniato A, Scotton PG, Marchiori GC, Vaglia A (1999). "Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient". Infection. 27 (3): 228–30. doi:10.1007/bf02561538. PMID 10378139.
  17. ↑ Tippett DS, Fishman PS, Panitch HS (1991). "Relapsing transverse myelitis". Neurology. 41 (5): 703–6. doi:10.1212/wnl.41.5.703. PMID 2027486.
  18. ↑ Pandit L, Rao S (1996). "Recurrent myelitis". J Neurol Neurosurg Psychiatry. 60 (3): 336–8. doi:10.1136/jnnp.60.3.336. PMC 1073861. PMID 8609515.
  19. ↑ Bashir K, Whitaker JN (2000). "Importance of paraclinical and CSF studies in the diagnosis of MS in patients presenting with partial cervical transverse myelopathy and negative cranial MRI". Mult Scler. 6 (5): 312–6. doi:10.1177/135245850000600503. PMID 11064439.
  20. ↑ Kaplin AI, Deshpande DM, Scott E, Krishnan C, Carmen JS, Shats I; et al. (2005). "IL-6 induces regionally selective spinal cord injury in patients with the neuroinflammatory disorder transverse myelitis". J Clin Invest. 115 (10): 2731–41. doi:10.1172/JCI25141. PMC 1224298. PMID 16184194.
  21. ↑ Borchers AT, Gershwin ME (2012). "Transverse myelitis". Autoimmun Rev. 11 (3): 231–48. doi:10.1016/j.autrev.2011.05.018. PMID 21621005.
  22. ↑ Tristano AG (2009). "[Autoimmune diseases associated with transverse myelitis. Review]". Invest Clin. 50 (2): 251–70. PMID 19662820.
  23. ↑ Cobo Calvo A, Mañé Martínez MA, Alentorn-Palau A, Bruna Escuer J, Romero Pinel L, Martínez-Yélamos S (2013). "Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series". BMC Neurol. 13: 135. doi:10.1186/1471-2377-13-135. PMC 3856522. PMID 24090445.
  24. ↑ Krishnan C, Kaplin AI, Pardo CA, Kerr DA, Keswani SC (2006). "Demyelinating disorders: update on transverse myelitis". Curr Neurol Neurosci Rep. 6 (3): 236–43. doi:10.1007/s11910-006-0011-1. PMID 16635433.
  25. ↑ Mirich DR, Kucharczyk W, Keller MA, Deck J (1991). "Subacute necrotizing myelopathy: MR imaging in four pathologically proved cases". AJNR Am J Neuroradiol. 12 (6): 1077–83. PMID 1763730.

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