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In the past, postinfectious myelitis was most often observed in relation to the common exanthems (rubella, rubeola, varicella) The neurologic signs appeared as the rash was fading, often with a slight recrudescence of fever Practically all human viruses have at one time or another been found to precede acute myelitis; the large DNA viruses such as Epstein-Barr and cytomegalovirus are most common, but hepatitis B, varicella, and entero- and rhinoviruses have been detected when sought systematically Mycoplasma is almost unique as a bacterial trigger of the disease, but as noted earlier there is some uncertainty regarding its ability to cause direct infection rather than a postinfectious immune reaction; our interpretation of the existing information still favors a postinfectious etiology In most instances the connection to a preceding infection is presumed but cannot be proved Only the associations with EBV, CMV, and Mycoplasma seem fairly certain based on the regularity of their occurrence or perhaps the relative ease with which a recent infection can be documented by serologic tests The list of antecedent infections is otherwise much the same as that for the Guillain-Barre syndrome with the notable absence of Campy lobacter jejuni, which has not led to myelitis It can be reasonably assumed that pharyngitis, respiratory infection, or conjunctivitis, etc, with or without fever, was a likely trigger for myelitis if it occurred during the several days before or even in a 2- to 3-week period prior to the neurologic symptoms Severe headache with fever and subsequent myelitis suggests Mycoplasma, in uenza or another atypical pneumonia agent, and the nding of abnormal liver function tests or severe pharyngitis with cervical adenopathy usually indicates EBV or, less often, CMV infection More dif cult to understand are the large number of instances

Figure 44-4 MRI of acute postinfectious myelitis in the sagittal (A) and axial (B) planes There is T2 signal change and other images showed mild enhancement after gadolinium infusion The cord is slightly enlarged at the involved level

tral and dorsal roots, and dorsal root ganglia and along the entire length of the peripheral nerves Sparse focal in ltrates of in ammatory cells (lymphocytes and other mononuclear cells) may also be found in lymph nodes, liver, spleen, heart, and other organs Swelling of nerve roots at the site of their dural exit has been emphasized by some authors and theorized to cause root damage Variations of this pattern of peripheral nerve damage have been observed, each perhaps representing a different immunopathology Rarely, in a clinically typical case, there may be widespread demyelinative changes and only a paucity of perivascular lymphocytes In patients whose electrophysiologic tests display severe axonal damage early in the illness as discussed later, the pathologic ndings corroborate the predominantly axonal nature of the disease with secondary myelin damage and little in ammatory response An occasional case has shown an in ammatory process with primary axonal damage rather than demyelination (Honovar et al)

The shading of the chart background, different approaches to use of variables in the report, and just overall eye appeal is much better in this example versus what we just created in the WAD We could easily have included the variables, radio buttons, navigation pane, and so forth into this dashboard, but you can see that this will be fairly straightforward Look at this final dashboard closely and see what you think I believe that this dashboard is a great example of what a true dashboard should look like Be selective with what is incorporated into your dashboards If your business user is interested in having what-if scenarios available on a dashboard, think about putting this type of chart type on a separate tab within your dashboard This will make very clear what is required reading versus what is available to use for estimates

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