{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:08:02Z","timestamp":1773378482229,"version":"3.50.1"},"reference-count":139,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Neurol"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and\/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.<\/jats:p>","DOI":"10.1055\/s-0041-1725150","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T22:54:15Z","timestamp":1621464855000},"page":"309-326","source":"Crossref","is-referenced-by-count":6,"title":["Metabolic and Toxic Myelopathies"],"prefix":"10.1055","volume":"41","author":[{"given":"Micha\u00ebl C. C.","family":"Slama","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron L.","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,5,19]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/brain\/23.1.39","article-title":"Subacute combined degeneration of the spinal cord","volume":"23","author":"J SR Russell","year":"1900","journal-title":"Brain"},{"key":"ref2","series-title":"Neurologic Aspects of Systemic Disease Part II","first-page":"927","volume-title":"The neurology of folic acid deficiency","author":"E H Reynolds","year":"2014"},{"key":"ref3","first-page":"84","article-title":"Metabolic and toxic causes of myelopathy","volume":"21","author":"B P Goodman","year":"2015","journal-title":"Continuum (Minneap Minn)"},{"key":"ref4","first-page":"427","article-title":"Metabolic and toxic myelopathies","volume":"24","author":"R N Schwendimann","year":"2018","journal-title":"Continuum (Minneap Minn)"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.brainresbull.2018.07.001","article-title":"Konzo: a distinct neurological disease associated with food (cassava) cyanogenic poisoning","volume":"145","author":"E Kashala-Abotnes","year":"2019","journal-title":"Brain Res Bull"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1212\/WNL.0b013e3182840b81","article-title":"Cassava food toxins, konzo disease, and neurodegeneration in sub-Sahara Africans","volume":"80","author":"D Tshala-Katumbay","year":"2013","journal-title":"Neurology"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"e1051","DOI":"10.1371\/journal.pntd.0001051","article-title":"Konzo: from poverty, cassava, and cyanogen intake to toxico-nutritional neurological disease","volume":"5","author":"H Nzwalo","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.fct.2012.02.001","article-title":"Control of konzo in DRC using the wetting method on cassava flour","volume":"50","author":"J P Banea","year":"2012","journal-title":"Food Chem Toxicol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.neuro.2016.05.016","article-title":"Lower sulfurtransferase detoxification rates of cyanide in konzo\u2014a tropical spastic paralysis linked to cassava cyanogenic poisoning","volume":"59","author":"K J Kambale","year":"2017","journal-title":"Neurotoxicology"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/brain\/113.1.223","article-title":"Konzo, an epidemic upper motor neuron disease studied in Tanzania","volume":"113","author":"W P Howlett","year":"1990","journal-title":"Brain"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1093\/brain\/91.2.215","article-title":"An ataxic neuropathy in Nigeria. 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