1
|
Miyoshi IC, de Toledo AHN, Pereira FV, Villarinho LDL, Dalaqua M, de Ávila Duarte J, Reis F. Infectious Myelitis. Semin Ultrasound CT MR 2023; 44:424-435. [PMID: 37555684 DOI: 10.1053/j.sult.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss infectious myelitis, mainly the patterns of spinal cord involvement caused by each infectious agent and the contribution of magnetic resonance imaging as a major tool to establish the specific diagnosis.
Collapse
Affiliation(s)
| | | | | | | | - Mariana Dalaqua
- Departement d'Imagerie Médicale, Réseau Hospitalier Neuchatelois, Pourtalès, Switzerland
| | - Juliana de Ávila Duarte
- Department of Radiology and Diagnostic Imaging, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fabiano Reis
- Medicine Department of Anesthesiology, Oncology and Radiology, UNICAMP, Campinas, SP, Brazil.
| |
Collapse
|
2
|
Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, Çallı SY, Fidan YS, Evlice A, Beştepe EE, İzci F, Küsbeci ÖY, Demirel EA, Velioğlu SK, Ungan M. One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. J Clin Med 2023; 12:5754. [PMID: 37685821 PMCID: PMC10488785 DOI: 10.3390/jcm12175754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.
Collapse
Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Nil Tekin
- Department of Family Medicine, Izmir Faculty of Medicine, University of Health Sciences, İzmir 35330, Türkiye;
- Department of Family Medicine, Tepecik Education and Research Hospital, University of Health Sciences, İzmir 35330, Türkiye
| | - Esra Aydın Sünbül
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Arife Çimen Atalar
- Neurology Department, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Sümeyye Yasemin Çallı
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Yağmur Sever Fidan
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Ahmet Evlice
- Department of Neurology, School of Medicine, Çukurova University, Adana 01330, Türkiye;
| | - Engin Emrem Beştepe
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Filiz İzci
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Özge Yılmaz Küsbeci
- Neurology Department, Medical Faculty, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Esra Acıman Demirel
- Department of Neurology, Zonguldak Bulent Ecevit University of Medicine, Zonguldak 67100, Türkiye;
| | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Neurology Department, Medical Faculty, Karadeniz Technical University, Trabzon 61080, Türkiye;
| | - Mehmet Ungan
- Department of Family Medicine, Medical Faculty, Ankara University, Ankara 06100, Türkiye;
| |
Collapse
|
3
|
Miraclin T A, Mani AM, Sivadasan A, Prabhakar AT, Mannam P, Prakash JAJ, Benjamin RN. Chronic flaccid quadriparesis from tract specific myelopathy in neurosyphilis. Spinal Cord Ser Cases 2023; 9:4. [PMID: 36859517 PMCID: PMC9977962 DOI: 10.1038/s41394-023-00560-y] [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] [Received: 01/07/2022] [Revised: 12/18/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Tract-specific myelopathies with distinctive imaging features are uncommon and typically occur with metabolic or paraneoplastic syndromes. We report a unique case of tract-specific myelopathy with neurosyphilis. CASE PRESENTATION A 53-year-old male presented with a four-month history of flaccid quadriparesis, sensory loss, and bladder dysfunction. His MRIs revealed striking symmetric T2-weighted hyperintensities in the lateral corticospinal tracts and dorsal columns of the cervical spinal cord that extended rostrally into the pyramidal decussation and medial lemnisci of the medulla oblongata. Nerve conduction and needle electromyography studies excluded axonal or demyelinating lower motor neuron disorders. The patient reported previous untreated primary syphilis and was seropositive on the T.pallidum hemagglutination assay. Penicillin therapy resulted in substantial clinical improvement. DISCUSSION Although syphilitic meningomyelitis is well-reported, our patient was unique because of the persistent flaccidity (possibly suggesting prolonged spinal shock) and striking tract-specific MRI patterns. These features are novel in syphilitic myelitis and suggest unknown mechanisms of tract-specific tropism and neuronal injury. CONCLUSIONS "Tract-specific" complete transverse myelopathy with persistent flaccid weakness and areflexia is a novel presentation of neurosyphilis. Early recognition and crystalline penicillin therapy can alleviate morbidity. Our report describes this patient's findings and discusses the differential diagnoses of tract-specific myelopathies.
Collapse
Affiliation(s)
- Angel Miraclin T
- Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Arun Mathai Mani
- Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Ajith Sivadasan
- Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Pavithra Mannam
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - John Antony Jude Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Rohit Ninan Benjamin
- Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
| |
Collapse
|
4
|
Safadi AL, Day D, Nagle B, Di Maria G, Malla P. Treatment Challenges in a Severe Case of Syphilitic Myelitis With a Longitudinally Extensive Spinal Cord Lesion. Neurohospitalist 2022; 12:400-403. [PMID: 35419144 PMCID: PMC8995592 DOI: 10.1177/19418744221075402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Syphilitic myelitis is an unusual manifestation of neurosyphilis, rarely reported in the literature. The best management approach remains unclear in severe cases with longitudinally extensive spinal cord lesions. We describe a 29-year-old man with a history of incompletely treated syphilis after a high-risk sexual encounter, who presented two years later with several weeks of progressive numbness and weakness in both legs. MRI spine showed significant cord expansion from the craniocervical junction to T6 with patchy cord enhancement. He was diagnosed with syphilitic myelitis given his history of inadequately treated syphilis, positive serum rapid plasma reagin at a high titer, and CSF pleocytosis with elevated protein along with a reactive CSF Venereal Disease Research Laboratory test. Alternative infectious or immunological etiologies were excluded. He was treated with IV penicillin and pulse steroid therapy with IV methylprednisolone 1 g daily for 3 days with improvement. However, he was soon readmitted with recurrent weakness requiring an additional course of pulse steroid therapy followed by a short prednisone taper. Afterward, his symptoms recurred with worsened cord expansion on imaging. He was re-treated with IV penicillin and pulse steroid therapy with a more prolonged prednisone taper. The patient subsequently improved and had no further recurrent symptoms on extended outpatient follow-up. This report illustrates the importance of keeping syphilitic myelitis on the differential as a treatable cause of longitudinally extensive myelopathy. The patient may have benefited from high-dose IV steroids with a prolonged taper while waiting for the full treatment effect of antibiotics.
Collapse
Affiliation(s)
- Amy Li Safadi
- Department of Neurology, MedStar Georgetown University
Hospital, Washington, DC, USA
| | - Derek Day
- Department of Rehabilitation Medicine, MedStar Georgetown University
Hospital, Washington, DC, USA
| | - Brian Nagle
- Department of Neurology, MedStar Georgetown University
Hospital, Washington, DC, USA
| | - Gianluca Di Maria
- Department of Neurology, MedStar Georgetown University
Hospital, Washington, DC, USA
| | - Prerna Malla
- Department of Neurology, MedStar Washington Hospital Center, Washington, DC, USA
- Prerna Malla, Department of Neurology, MedStar
Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
| |
Collapse
|
5
|
Jum'ah A, Aboul Nour H, Alkhoujah M, Zoghoul S, Eltous L, Miller D. Neurosyphilis in disguise. Neuroradiology 2021; 64:433-441. [PMID: 34665270 DOI: 10.1007/s00234-021-02827-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Neurosyphilis can mimic different diseases, not only in its clinical presentation but also on imaging. Treponema pallidum is also known as the "great imitator." Having an ultimate diagnosis of neurosyphilis is quite critical as this can affect management drastically. Herein, we discuss the case of a 69-year-old female who was treated for neurosyphilis, while having an atypical imaging finding of anterior temporal lobe enhancement that simulated an infection with herpes simplex virus (HSV); we also review the available literature on different imaging findings in both the early and late stages of the disease. METHODS We performed a literature search using the new PubMed in June 2021. The terms "neurosyphilis", "MRI", and "neuroimaging" were used either alone or in combination with "early neurosyphilis" or "late neurosyphilis". Data on neurosyphilis and imaging findings was mainly derived from review articles, cohort studies, case series, and individual reports. CONCLUSION Neurosyphilis can present with an extensive variation and different patterns on the MRI, and clinicians must be aware of the wide variety in radiological presentations. Anterior temporal lobe involvement is a rare presentation and requires evaluating for neurosyphilis to prevent a missed diagnosis and treatment.
Collapse
Affiliation(s)
- Ammar Jum'ah
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA.
| | - Hassan Aboul Nour
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA
| | - Mohammad Alkhoujah
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA
| | - Sohaib Zoghoul
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Lara Eltous
- Jordan University of Science and Technology, Irbid, Jordan
| | - Daniel Miller
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA
| |
Collapse
|
6
|
Rueda-Lopes FC, da Cruz LCH, Fontes FL, Herlinger AL, da Costa Ferreira Junior O, de Aguiar RS, Vasconcelos CCF, do Nascimento OJM, Alves-Leon SV. Clinical and magnetic resonance imaging patterns of extensive Chikungunya virus-associated myelitis. J Neurovirol 2021; 27:616-625. [PMID: 34227044 DOI: 10.1007/s13365-021-00962-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Chikungunya fever is an arbovirus infection transmitted by the same mosquito vector of dengue and Zika virus. Besides high fever, common clinical symptoms include articular pain and general malaise. Neurological involvement is unusual, but some patients may develop peripheral and central nervous system involvement, including meningoencephalitis, myelitis, Guillain-Barré syndrome, and acute disseminated encephalomyelitis. We present three cases of Chikungunya fever complicated with extensive myelitis. The spinal cord magnetic resonance imaging (MRI) pattern is characterized by multiple dotted-like and longitudinal hyperintense lesions, with contrast enhancement, mostly distributed in the peripheral regions of the spinal cord. It seems that these lesions are mostly located in the perivascular spaces (PVS), related or not to virus attack. Involvement of brain PVS can also be demonstrated, as shown in two of the cases described. Considering the MRI pattern, extensive spinal cord lesion should include Chikungunya as a differential diagnosis, especially during an outbreak.
Collapse
Affiliation(s)
- Fernanda Cristina Rueda-Lopes
- Radiology Department of Fluminense Federal University (UFF), DASA (Diagnósticos da América), Avenida Roberto Silveira, 349/1904, Icaraí, Niteroi, Brazil.
| | | | - Fabrícia Lima Fontes
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Alice Laschuk Herlinger
- Genetics Department, Biology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Renato Santana de Aguiar
- Genetics Department, Biology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Neurology Department, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Claudia Cristina Ferreira Vasconcelos
- Neurology Department of Fluminense Federal University (UFF), Rio de Janeiro, Brazil.,Neurology Department of Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Osvaldo José Moreira do Nascimento
- Neurology Department of Fluminense Federal University (UFF), Rio de Janeiro, Brazil.,Neurology Department of Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Soniza Vieira Alves-Leon
- Genetics Department, Biology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| |
Collapse
|