1
|
Zhang L, He L, Huang J, Ren S, Wang J. Transverse spinal cord infarction following immunoglobulin treatment in a patient with exfoliative dermatitis: A case report. Medicine (Baltimore) 2024; 103:e37719. [PMID: 38608119 PMCID: PMC11018161 DOI: 10.1097/md.0000000000037719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/05/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Transverse spinal cord infarction (SCI) is rare but highly disabling. Aortic thrombosis was described as one of the most common etiologies. Thromboembolic complications associated with intravenous immunoglobulin (IVIG) have been reported. PATIENT CONCERNS A previously well, 64-year-old man who was given the treatment of IVIG (0.4 g/kg/d for 5 days) for exfoliative dermatitis 2 weeks before, progressively developed flaccid paraplegia of lower extremities, loss of all sensations below T3 level and urinary incontinence within 50 minutes. DIAGNOSES A diagnosis of SCI and pulmonary embolism was made. IVIG was considered the possible cause. INTERVENTIONS Anticoagulation treatment and continuous rehabilitation were administered. OUTCOMES The neurologic deficiency of the patient was partially improved at the 3-year follow-up. LESSONS The rapid development of severe deficits within 4 hours mostly contributes to the diagnosis of SCI. Heightened awareness of possible thrombotic events is encouraged for a month-long period following IVIG therapy.
Collapse
Affiliation(s)
- Lili Zhang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Lanying He
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Jing Huang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Sixie Ren
- Department of Medical Imaging, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Jian Wang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| |
Collapse
|
2
|
Corrêa DG, da Cruz LCH, da Rocha AJ, Pacheco FT. Imaging Aspects of Toxic and Metabolic Myelopathies. Semin Ultrasound CT MR 2023; 44:452-463. [PMID: 37555682 DOI: 10.1053/j.sult.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Metabolic and toxic myelopathies usually occurs due to several different causes. Metabolic myelopathy usually occurs due to deficiency of a nutrient, such as vitamin B12. Toxic myelopathy occurs secondary to the exposure to an external toxic agent. Although they may have a difficult diagnosis, determination of the specific cause of myelopathy is of utmost importance, because many causes are amenable to treatment. Although they have many clinical, electrophysiologic, and neuropathologic similarities, imaging may aid in the suspicion of toxic or metabolic myelopathy. The aim of this article, is to review the imaging features of the main toxic and metabolic myelopathies.
Collapse
Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Stasolla A, Prosperini L, Haggiag S, Pezzella FR, Pingi A, Cozzolino V, Pampana E, Cotroneo E, Tortorella C, Menniti A, Gasperini C. Non-traumatic acute myelopathies: Clinical and imaging features in a real world emergency setting. Neuroradiol J 2022; 35:727-735. [PMID: 35575188 PMCID: PMC9626837 DOI: 10.1177/19714009221096823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aetiologic diagnosis of non-traumatic acute myelopathies (AMs), and their differentiation from other mimicking conditions (i.e. 'mimics'), are clinically challenging, especially in the emergency setting. Here, we sought to identify: (i) red flags suggesting diagnoses alternative to AMs and (ii) clinical signs and magnetic resonance imaging (MRI) features differentiating non-compressive from compressive AMs. MATERIALS AND METHODS We retrospectively retrieved MRI scans of spinal cord dictated at emergency room from January 2016 to December 2020 in the suspicion of AMs. Patients with traumatic myelopathies and those with subacute/chronic myelopathies (i.e. MRI scans acquired >48 h from symptom onset) were excluded from analysis. RESULTS Our search retrieved 105 patients; after excluding 16 cases of traumatic myelopathies and 14 cases of subacute/chronic myelopathies, we identified 30 cases with non-compressive AMs, 30 cases with compressive AMs and 15 mimics. The presence of pyramidal signs (p = 0.012) and/or pain (p = 0.048) correctly identified 88% of cases with AMs. We failed to identify clinical indicators for distinguishing non-compressive and compressive AMs, although cases with inflammatory AMs were younger than cases with all the remaining conditions (p < 0.05). Different MRI patterns could be described according to the final diagnosis: among non-compressive AMs, inflammatory lesions were more often posterior or central; vascular malformation had a fairly widespread distribution; spine ischaemia was more often central. Anterior or lateral compression were more often associated with neoplasms and disc herniation , whereas hemorrhages and infections produced spine compression on all sides. CONCLUSION We propose a simple clinical indicator (i.e. pyramidal signs and/or pain) to distinguish AMs from their mimics in an emergency setting. Urgent spinal cord MRI remains essential to discriminate compressive and non-compressive aetiologies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Enrico Cotroneo
- Neuroradiology Unit, S. Camillo-Forlanini Hospital
- Neurology Unit, S. Camillo-Forlanini Hospital
- Stroke Unit, S. Camillo-Forlanini Hospital
- Neurosurgery Unit, S. Camillo-Forlanini Hospital
| | | | | | | |
Collapse
|
4
|
Hao Y, Xin M, Wang S, Ma D, Feng J. Myelopathy associated with mixed connective tissue disease: clinical manifestation, diagnosis, treatment, and prognosis. Neurol Sci 2019; 40:1785-1797. [DOI: 10.1007/s10072-019-03935-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 05/09/2019] [Indexed: 11/27/2022]
|
5
|
Sarbu N, Lolli V, Smirniotopoulos JG. Magnetic resonance imaging in myelopathy: a pictorial review. Clin Imaging 2019; 57:56-68. [DOI: 10.1016/j.clinimag.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
|
6
|
Okumura A, Mori H, Fee Chong P, Kira R, Torisu H, Yasumoto S, Shimizu H, Fujimoto T, Tanaka-Taya K. Serial MRI findings of acute flaccid myelitis during an outbreak of enterovirus D68 infection in Japan. Brain Dev 2019; 41:443-451. [PMID: 30594353 DOI: 10.1016/j.braindev.2018.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 12/31/2022]
Abstract
OBJECIVE To clarify the neuroimaging findings of children with acute flaccid myelitis during an outbreak of EV-D68 infection. METHODS We performed a detailed review of the spinal and cranial MRI results of 54 children with acute flaccid myelitis. We focused on the range of longitudinal lesions, the localization and appearance of lesions within a horizontal section, Gadolinium-enhancement, and changes over time. RESULTS All children had longitudinal spinal lesions involving central gray matter. Twenty-six children had lesions spanning the entire spine. Six of them had weakness in all limbs, whereas seven had weakness of only one limb. Thirty-eight children had lesions in both gray and white matter and limb weakness tended to be more severe in these children. During the acute period, spinal lesions showed bilateral ill-defined widespread T2 hyperintensity. During the subacute period, lesions were well defined and confined to the anterior horn. The distribution of limb weakness was correlated with the appearance of lesions during the subacute period. Gadolinium enhancement was performed in 37 children, and enhancement was seen in the cauda equina in 29 children. Enhancement was infrequent within 2 days after onset but was seen in almost all children thereafter. Twenty-two children had brainstem lesions continuous with spinal lesions. CONCLUSION Extensive longitudinal spinal lesions were characteristic in children with acute flaccid myelitis. Lesions were usually bilateral and widespread during the acute period, whereas localization to the anterior horn could become obvious. Although enhancement of the cauda equina was often observed, its appearance was sometimes delayed.
Collapse
Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Harushi Mori
- Department of Radiology, Graduate School and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Hiroyuki Torisu
- Department of Pediatrics, Fukuoka Dental College Medical and Dental Hospital, Fukuoka, Japan
| | - Sawa Yasumoto
- Medical Education Center, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | |
Collapse
|
7
|
Miao J, Aboagye DE, Chulpayev B, Liu L, Ishkanian G, Kolanuvada B, Alaie D, Petrillo RL. Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:41-46. [PMID: 29321467 PMCID: PMC5772341 DOI: 10.12659/ajcr.906150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 58 Final Diagnosis: NMO Symptoms: New-onset right leg weakness and pain Medication: — Clinical Procedure: Progressive and recurring Specialty: Neurology
Collapse
Affiliation(s)
- Jing Miao
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Doreen E Aboagye
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Boris Chulpayev
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Lin Liu
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Gary Ishkanian
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Bangaruraju Kolanuvada
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Dariush Alaie
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Richard L Petrillo
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| |
Collapse
|
8
|
Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
Collapse
|
9
|
Morales H, Betts A. Abnormal Spinal Cord Magnetic Resonance Signal: Approach to the Differential Diagnosis. Semin Ultrasound CT MR 2016; 37:372-83. [PMID: 27616311 DOI: 10.1053/j.sult.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
T2-hyperintense signal abnormalities within the spinal cord on magnetic resonance imaging can evoke a broad differential diagnosis and can present a diagnostic dilemma. Here, we review and provide a succinct and relevant differential diagnosis based on imaging patterns and anatomical or physiopathologic correlation. Clues and imaging pearls are provided focusing on inflammatory, infectious, demyelinating, vascular, and metabolic involvement of the spinal cord.
Collapse
Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Aaron Betts
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH
| |
Collapse
|