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Francis A, Santos M, Leal Rato M, Wintle YM, Brex P, Chen B, Cooper S, Dobson R, Geraldes R, Hemingway C, Huda S, Messina S, Ramdas S, Leite MI, Palace J. Study of seasonality of attacks in MOG antibody-associated disease. Mult Scler Relat Disord 2024; 90:105814. [PMID: 39151237 DOI: 10.1016/j.msard.2024.105814] [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: 02/11/2024] [Revised: 05/21/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Seasonal variation in attacks of acute disseminated encephalomyelitis (ADEM1) is reported in some studies. Myelin oligodendrocyte glycoprotein (MOG) antibodies are found in up to 50 % of ADEM cases. Despite this, there has been no adequately powered study of seasonality in MOG antibody-associated disease (MOGAD). We sought to determine whether there was an effect of season on incidence of total attacks and onset attacks of MOGAD. METHODS We searched the large national Oxford-based NMO Service database to identify attacks of MOGAD occurring between 2010 and 2021. Month of each attack was extracted and Edwards' test of seasonal variation was applied to determine whether there was a seasonal effect on total attacks and onset attacks. RESULTS Neither incidence of total attacks nor incidence of onset attacks varied significantly by month. CONCLUSION There is no evidence of seasonal fluctuations in the incidence of MOGAD attacks in the UK.
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Affiliation(s)
- Anna Francis
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Monica Santos
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Miguel Leal Rato
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Peter Brex
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Bo Chen
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology: Wuhan, Hubei, China
| | - Sarah Cooper
- Neurology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ruth Dobson
- Department of Neurology, Royal London Hospital, London, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Saif Huda
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sithara Ramdas
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | | | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
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Hwang J, Chae SA, Lim BC, Choi SA. Incidence of Pediatric Acute Disseminated Encephalomyelitis During the Coronavirus Disease 2019 Pandemic in South Korea. Pediatr Neurol 2023; 146:44-49. [PMID: 37429226 DOI: 10.1016/j.pediatrneurol.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/03/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder of the central nervous system that is usually triggered by infections. We aimed to determine the temporal trends in the incidence of ADEM before and during the pandemic and their correlation with viral epidemiology. METHODS We conducted a nationwide, population-based, retrospective, ADEM cohort study by using the Health Insurance Review and Assessment Service database. New-onset ADEM was defined as a patient (age <19 years) who was hospitalized with a diagnostic code of G04.0, G36.8, and G36.9 and a prescription of intravenous methylprednisolone. The National Infectious Disease Surveillance System was used to collect the nationwide viral epidemics. RESULTS A total of 185 new-onset pediatric ADEM cases were included. The mean patient age was 7.0 ± 4.9 years. The incidence of ADEM was 0.34 to 0.48 of 100,000 persons per year before the pandemic, which dropped to 0.22 of 100,000 persons per year during the first pandemic year. The risk of ADEM occurrence was approximately 1.74% higher during the prepandemic years compared with the first pandemic year (odds ratio = 1.017, P = 0.009). There was a weak positive correlation between acute respiratory viral infection and ADEM incidence (r = 0.28, P = 0.03). CONCLUSION This study demonstrates how infection control during the early coronavirus disease 2019 (COVID-19) pandemic influenced the incidence of ADEM. The low incidence of ADEM in the early COVID-19 pandemic may be related to the decline in acute respiratory viral infections, which are potential triggers of ADEM.
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Affiliation(s)
- Junho Hwang
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Ah Choi
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
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3
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Beshay L, Wei K, Yang Q. Newly diagnosed autoimmune Addison's disease in a patient with COVID-19 with autoimmune disseminated encephalomyelitis. BMJ Case Rep 2022; 15:15/12/e250749. [PMID: 36593594 PMCID: PMC9723877 DOI: 10.1136/bcr-2022-250749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
A man in his 20s with a history of acute disseminated encephalomyelitis (ADEM) was brought into the emergency department (ED) after his family found him at home collapsed on the floor unresponsive with a blood glucose of 28 mg/dL at the field. In the ED, the patient was tachycardic, tachypnoeic and hypotensive, requiring pressors and intubation at 9 hours and 12 hours after arrival, respectively. Laboratory results revealed a positive COVID-19 test, serum sodium of 125 mmol/L and persistent hypoglycaemia. The patient was given a high dose of dexamethasone for COVID-19 treatment 1 hour before pressors were started. He was then continued on a stress dose of intravenous hydrocortisone with rapid clinical improvement leading to his extubation, and discontinuation of vasopressors and glucose on day 2 of admission. The patient received his last dose of intravenous hydrocortisone on day 4 in the early afternoon with the plan to order adrenal testing the following morning prior to discharge. On day 5, the aldosterone <3.0 ng/dL, adrenocorticotropic hormone (ACTH) level >1250 pg/mL, and ACTH stimulation test showed cortisol levels of 3 and 3 µg/dL at 30 and 60 min, respectively. The anti-21-hydroxylase antibody was positive. The patient was discharged on hydrocortisone and fludrocortisone. The patient's symptoms, elevated ACTH, low cortisol and presence of 21-hydroxylase antibodies are consistent with autoimmune Addison's disease. This is the first case reporting autoimmune Addison's disease in a patient with COVID-19 with a history of ADEM. The case highlights the importance of considering adrenal insufficiency as a diagnostic differential in haemodynamically unstable patients with COVID-19.
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Affiliation(s)
- Lauren Beshay
- Endocrinology, University of California Irvine, Irvine, California, USA
| | - Kevin Wei
- Endocrinology, University of California Irvine, Orange, California, USA
| | - Qin Yang
- Endocrinology, University of California Irvine, Irvine, California, USA
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4
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Abstract
Hintergrund Die akute disseminierte Enzephalomyelitis (ADEM) gehört zu den seltenen demyelinisierenden Erkrankungen, die meistens bei Kindern auftreten. ADEM gehört laut Leitlinien zu den Myelin-Oligodendrozyten-Glykoprotein(MOG)-assoziierten Krankheiten und manifestiert sich in der Regel nach febrilen Infektionen (auch nach SARS-CoV-2) oder, deutlich seltener, nach Impfungen. Fragestellung Inzidenz, Verlauf und klinische sowie radiologische Diagnostik sowie Entwicklung und Therapieoptionen von ADEM. Material und Methode Analyse und Auswertung der Literatur über ADEM sowie Analyse der bemerkenswerten Fälle und Leitlinien. Ergebnisse Zu den ersten Anzeichen von ADEM gehören Fieber, Nausea bis zum Erbrechen sowie Kopfschmerzen und Meningismus sowie per definitionem eine Enzephalopathie, die am Anfang wenig ausgeprägt sein kann und sich meistens als Schläfrigkeit und Verwirrung manifestiert. Die radiologische Diagnose wird in der Magnetresonanztomographie (MRT) gestellt. Hier sind asymmetrisch verteilte, unscharf abgrenzbare, tumorsimulierende Läsionen supra- und infratentoriell abgrenzbar. In der akuten Phase nehmen die Läsionen meistens ringförmig Kontrastmittel auf und zeigen eine Diffusionsrestriktion. Spinaler Befall der grauen Substanz mit dem typischen H‑Muster mit Myelitis transversa ist nicht selten. Die ADEM hat meistens einen monophasischen Verlauf, wobei eine rekurrierende Form („relapsing ADEM“) in 1–20 % der Fälle zu erwarten ist. Bei der Behandlung kommen Steroide und in schweren Fällen Immunsuppressiva zum Einsatz. Schlussfolgerung ADEM ist eine meist monophasische Erkrankung, deren Symptome nach einigen Wochen/Monaten abklingen sollten. Es ist wichtig, sie von anderen demyelinisierenden Krankheiten wie der multiplen Sklerose zu unterscheiden, um die nötige Therapie nicht zu verzögern.
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Affiliation(s)
- Malgorzata Wolska-Krawczyk
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Uniklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland.
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Acute haemorrhagic leukoencephalitis (AHLE) - our experience and a short review. J Neuroimmunol 2021; 361:577751. [PMID: 34739912 DOI: 10.1016/j.jneuroim.2021.577751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute haemorrhagic leukoencephalitis (AHLE), a rare variant of acute disseminated encephalomyelitis (ADEM), often presents differently from classical ADEM, thereby posing a diagnostic challenge to the clinician. AIM To report AHLE, its clinic-radiological manifestations, process of diagnosis and prognosis. METHOD AND RESULTS Eight patients presented with altered sensorium, acute focal deficits with or without seizures. Initial workup showed evidence of haemorrhagic lobar or thalamic lesions in seven patients. All patients underwent extensive evaluation for collagen vascular disease and vasculitis profile, autoimmune encephalitis panel and aquaporin-4 antibody, which were found to be normal. Cerebrospinal fluid (CSF) biochemistry and microscopy was non-contributory and CSF viral PCRs, toxoplasma antibodies, cryptococcal antigen were also negative. All patients had progressively worsening sensorium and neurological deficits. Repeat MRIs showed increase in oedema in the lesions and appearance/expansion of haemorrhage in the thalamic/hemispherical lesions. All patients received intravenous methylprednisolone (IVMP) without any benefit. Four patients underwent plasmapheresis (PLEX), one received intravenous immunoglobulin (IVIG) and one received both second line immunotherapies, without significant improvement. Brain biopsy (performed in three patients) showed inflammatory demyelination and areas of haemorrhage, thus confirming the diagnosis. Six patients succumbed in 7-30Â days of the illness, despite aggressive treatment and only two survived, albeit with a significant disability. CONCLUSION AHLE is a rare, yet very severe variant of ADEM. MRI shows lesions with haemorrhages, oedema and mass effect and histology findings reveal inflammatory infiltrates, haemorrhagic foci and fibrinoid necrosis of vessel walls. Prognosis is worse as compared to the classic ADEM, with a high mortality rate. To the best of our knowledge, this is one of the largest series of AHLE to have been reported anywhere in the world. KEYMESSAGE Acute encephalopathy, multifocal deficits accompanied by haemorrhagic CNS demyelinating lesions with oedema and mass effect are the key features of AHLE. It is a rare, yet very severe form of ADEM with very high morbidity and mortality.
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6
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Hamedani AG, Blank L, Thibault DP, Willis AW. Impact of ICD-9 to ICD-10 Coding Transition on Prevalence Trends in Neurology. Neurol Clin Pract 2021; 11:e612-e619. [PMID: 34840874 DOI: 10.1212/cpj.0000000000001046] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/28/2020] [Indexed: 01/17/2023]
Abstract
Objective To determine the effect of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) coding transition on the point prevalence and longitudinal trends of 16 neurologic diagnoses. Methods We used 2014-2017 data from the National Inpatient Sample to identify hospitalizations with one of 16 common neurologic diagnoses. We used published ICD-9-CM codes to identify hospitalizations from January 1, 2014, to September 30, 2015, and used the Agency for Healthcare Research and Quality's MapIt tool to convert them to equivalent ICD-10-CM codes for October 1, 2015-December 31, 2017. We compared the prevalence of each diagnosis before vs after the ICD coding transition using logistic regression and used interrupted time series regression to model the longitudinal change in disease prevalence across time. Results The average monthly prevalence of subarachnoid hemorrhage was stable before the coding transition (average monthly increase of 4.32 admissions, 99.7% confidence interval [CI]: -8.38 to 17.01) but increased after the coding transition (average monthly increase of 24.32 admissions, 99.7% CI: 15.71-32.93). Otherwise, there were no significant differences in the longitudinal rate of change in disease prevalence over time between ICD-9-CM and ICD-10-CM. Six of 16 neurologic diagnoses (37.5%) experienced significant changes in cross-sectional prevalence during the coding transition, most notably for status epilepticus (odds ratio 0.30, 99.7% CI: 0.26-0.34). Conclusions The transition from ICD-9-CM to ICD-10-CM coding affects prevalence estimates for status epilepticus and other neurologic disorders, a potential source of bias for future longitudinal neurologic studies. Studies should limit to 1 coding system or use interrupted time series models to adjust for changes in coding patterns until new neurology-specific ICD-9 to ICD-10 conversion maps can be developed.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AGH, DPT), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Departments of Neurology and Population Health Science and Policy (LB), Icahn School of Medicine at Mount Sinai, New York; and Departments of Neurology and of Biostatics and Epidemiology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AWW), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Leah Blank
- Department of Neurology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AGH, DPT), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Departments of Neurology and Population Health Science and Policy (LB), Icahn School of Medicine at Mount Sinai, New York; and Departments of Neurology and of Biostatics and Epidemiology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AWW), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dylan P Thibault
- Department of Neurology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AGH, DPT), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Departments of Neurology and Population Health Science and Policy (LB), Icahn School of Medicine at Mount Sinai, New York; and Departments of Neurology and of Biostatics and Epidemiology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AWW), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Allison W Willis
- Department of Neurology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AGH, DPT), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Departments of Neurology and Population Health Science and Policy (LB), Icahn School of Medicine at Mount Sinai, New York; and Departments of Neurology and of Biostatics and Epidemiology and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AWW), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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7
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Gubernot D, Jazwa A, Niu M, Baumblatt J, Gee J, Moro P, Duffy J, Harrington T, McNeil MM, Broder K, Su J, Kamidani S, Olson CK, Panagiotakopoulos L, Shimabukuro T, Forshee R, Anderson S, Bennett S. U.S. Population-Based background incidence rates of medical conditions for use in safety assessment of COVID-19 vaccines. Vaccine 2021; 39:3666-3677. [PMID: 34088506 PMCID: PMC8118666 DOI: 10.1016/j.vaccine.2021.05.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating impact on global health, and has resulted in an unprecedented, international collaborative effort to develop vaccines to control the outbreak, protect human lives, and avoid further social and economic disruption. Mass vaccination campaigns are underway in multiple countries and are expected worldwide once more vaccine becomes available. Some early candidate vaccines use novel platforms, such as mRNA encapsulated in lipid nanoparticles, and relatively new platforms, such as replication-deficient viral vectors. While these new vaccine platforms hold promise, limited safety data in humans are available. Serious health outcomes linked to vaccinations are rare, and some outcomes may occur incidentally in the vaccinated population. Knowledge of background incidence rates of these medical conditions is a critical component of vaccine safety monitoring to aid in the assessment of adverse events temporally associated with vaccination and to put these events into context with what would be expected due to chance alone. A list of 22 potential adverse events of special interest (AESI), including neurologic, autoimmune, and cardiovascular disorders, was compiled by subject matter experts at the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention. The most recently available U.S. background rates for these medical conditions, overall and by age, sex, and race/ethnicity (when available), were sourced from reported statistics (data published by medical panels/ associations or federal government reports), and literature reviews in PubMed. This review provides estimates of background incidence rates for medical conditions that may be monitored or studied as AESI during safety surveillance and research for COVID-19 vaccines and other new vaccines.
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Affiliation(s)
- Diane Gubernot
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993.
| | - Amelia Jazwa
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Manette Niu
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993.
| | - Jane Baumblatt
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993.
| | - Julianne Gee
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Pedro Moro
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Jonathan Duffy
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Theresa Harrington
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Michael M McNeil
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Karen Broder
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - John Su
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Satoshi Kamidani
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Room 534, Atlanta GA 30322, United States.
| | - Christine K Olson
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Lakshmi Panagiotakopoulos
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Tom Shimabukuro
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Richard Forshee
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993.
| | - Steven Anderson
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993.
| | - Sarah Bennett
- CDC 2019 COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
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8
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Waubant E. Incidence of Acute Disseminated Encephalomyelitis in China: First National Survey. Neurosci Bull 2021; 37:761-762. [PMID: 34033060 DOI: 10.1007/s12264-021-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Emmanuelle Waubant
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA.
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9
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Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review. Neuroradiology 2021; 63:653-661. [PMID: 33575849 PMCID: PMC7878029 DOI: 10.1007/s00234-021-02667-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
Purpose Acute hemorrhagic leukoencephalitis (AHLE) is a rare and severe form of acute disseminated encephalomyelitis (ADEM). Only a few reports of AHLE in coronavirus disease 2019 (COVID-19) patients have been described to date. We report a case of COVID-19-related AHLE along with a literature review describing salient clinical and imaging characteristics. Methods A literature search was performed on Medline (2020-present), PubMed, Cochrane Library, CINAHL, and Google scholar on 28 January 2021 for all articles published using MeSH terms “COVID-19” or “SARS-CoV-2” with “Acute hemorrhagic leukoencephalitis” or “Acute hemorrhagic encephalitis.” Relevant case reports and case series describing clinical and imaging features of AHLE associated with SARS-CoV-2 infection were included, data compiled, and critically reviewed. Results Acute onset encephalopathy and rapidly deteriorating neurological status is the common clinical presentation in AHLE. CSF analysis reveals elevated proteins and lymphocytic pleocytosis. Typical neuroimaging features include multifocal, variable-sized, poorly defined cerebral white matter lesions with cortical sparing. Involvement of the brainstem, cerebellar peduncles, and deep grey matter can also occur, although rarely. Lesions are hyperintense on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images, hypointense on T1W images, and show microhemorrhages, variable diffusion restriction, and post-contrast enhancement. Extensive microhemorrhages, brainstem involvement, and gross hemorrhage often portend a poor prognosis. Conclusion Heightened awareness about the clinical and imaging presentation of COVID-19-related AHLE can positively alter the outcome in a select few by enabling early diagnosis and aggressive management.
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10
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Da Silva RC, Aguiar GB, Kamer C, Farias L, Matsuda J. Acute Disseminated Encephalomyelitis Related to a Cytomegalovirus Infection in an Immunocompetent Patient. Cureus 2021; 13:e12795. [PMID: 33628664 PMCID: PMC7892279 DOI: 10.7759/cureus.12795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cytomegalovirus (CMV) infection can cause acute disseminated encephalomyelitis (ADEM). However, it is rare in immunocompetent people. We describe a 17-year-old patient who was brought with flu-like symptoms. After one week, she experienced rapidly progressive weakness in all four extremities, followed by coma. The neurologic examination showed no response to verbal and pain stimuli. A Babinski sign was noted in both lower extremities, along with clonus and hyperreflexia in all four limbs. Brain magnetic resonance imaging (MRI) demonstrated extensive areas of hyperintense signal on fluid-attenuated inversion recovery (FLAIR) sequences in the white matter which was asymmetrically distributed in both hemispheres, as well as in the brainstem and cerebellar peduncles, compatible with acute demyelinating lesions. Cerebrospinal fluid (CSF) showed mild lymphocytic pleocytosis and normal glucose levels. Polymerase chain reaction to herpes simplex virus was negative. Serum immunoglobulin G (IgG) and immunoglobulin M (IgM) were positive for cytomegalovirus. The patient was treated with methylprednisolone pulse therapy for five days. Subsequently, the patient showed neurologic improvement with the recovery of consciousness and muscle strength. In terms of prognosis, in patients with ADEM, the sooner the diagnosis, the better the outcome. The cornerstone of treatment is immunosuppression with steroids. Some patients require intravenous immunoglobulin G (IVIG) or plasmapheresis, and in refractory cases, cyclophosphamide is used.Â
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Affiliation(s)
- Rafael C Da Silva
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | - Carolina Kamer
- Medicine, School of Medicine, Universidade para o Desenvolvimento do Alto, Rio do Sul, BRA
| | - Lais Farias
- Medicine, School of Medicine, Universidade para o Desenvolvimento do Alto, Rio do Sul, BRA
| | - Josie Matsuda
- Medicine, School of Medicine, Universidade para o Desenvolvimento do Alto, Rio do Sul, BRA
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11
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Bhatt P, Yagnik PJ, Saikumar P, Parmar N, Dave M, Amponsah JK, Bhatt NS, Sharma M, Thakkar B, Donda K, Dapaah-Siakwan F. Surgery and Resource Utilization Trends for Pediatric Intussusception From 2005 Through 2014. Cureus 2020; 12:e10611. [PMID: 33133808 PMCID: PMC7586500 DOI: 10.7759/cureus.10611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Air or barium enema reduction is becoming increasingly common and safer for pediatric intussusception. However, little is known about trends of pediatric intussusception requiring surgical intervention in the United States. Methods: National Inpatient Sample database was analyzed from 2005-2014 to identify pediatric (≤18 years) intussusceptions along with procedures such as enema and/or surgical intervention. Trends in the rates of surgical intervention were examined according to encounter-level (age, gender, race, comorbidities) and hospital-level (hospital census region, teaching status) characteristics. Outcomes of pediatric intussusception requiring surgical intervention were analyzed in terms of length of stay and cost of hospitalization. Factors associated with surgical intervention were also analyzed. P value of < 0.05 was considered significant. Results: Out of 21,835 intussusception hospitalizations requiring enema or surgical intervention, 14,415 (66%) had surgical intervention; 90% of which (12,978) had no preceding enema. Surgical intervention rates among intussusception hospitalizations varied by age (highest < 1 year), gender (male > females) and race (Hispanics > Whites and Blacks). During the study period, overall surgical intervention rate remained stable (2.2 to 1.7, P=0.07) although it declined in those under 1 year of age. Children with severe disease, gastrointestinal comorbidities over the age of 4 years had increased odds of surgical intervention, whereas hospitalization in large and urban teaching hospitals had decreased odds of surgical intervention. Length of stay and hospital cost remained stable from 2005-2014. CONCLUSION The rates of surgical intervention and resource utilization for pediatric intussusception remained stable from 2005-2014, however they declined significantly in infants. The proportion of intussusception hospitalization requiring surgery remains high and further studies are needed to explore the possible factors.
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Affiliation(s)
- Parth Bhatt
- Pediatrics, United Hospital Center, Bridgeport, USA
| | - Priyank J Yagnik
- Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Pavithra Saikumar
- Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, USA
| | | | - Mihir Dave
- Internal Medicine, University of Nevada Reno, School of Medicine, Reno, USA
| | - Jason K Amponsah
- Public Health, Emory University School of Medicine, Atlanta, USA
| | - Neel S Bhatt
- Pediatric Hematology and Oncology, University of Washington School of Medicine, Seattle, USA
| | | | - Badal Thakkar
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Keyur Donda
- Pediatric, University of South Florida, Tampa, USA
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12
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Otallah S. Acute disseminated encephalomyelitis in children and adults: A focused review emphasizing new developments. Mult Scler 2020; 27:1153-1160. [PMID: 32552256 DOI: 10.1177/1352458520929627] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) was originally described in the medical literature more than 200 years ago. However, consensus clinical diagnostic criteria are less than 15 years old. Accurate diagnostic testing for myelin oligodendrocyte glycoprotein (MOG) autoantibodies has only become clinically available in the last 3-5 years and has facilitated a rapidly evolving understanding of patients with recurrent demyelination following ADEM. The field is working to optimize treatment for these patients with hopes of prospective treatment studies in the not too distant future. New imaging data suggest that even monophasic demyelination may have long-term impacts that were previously unrecognized. Recent developments in the literature are described in order to guide practice for providers who treat both adults and children with monophasic and recurrent forms of ADEM with and without MOG antibodies.
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Affiliation(s)
- Scott Otallah
- Wake Forest Baptist Health, Winston-Salem, NC, USA/Pediatric Multiple Sclerosis and Demyelinating Disorders Clinic, Wake Forest University, Winston-Salem, NC, USA
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13
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Santoro JD, Chitnis T. Diagnostic Considerations in Acute Disseminated Encephalomyelitis and the Interface with MOG Antibody. Neuropediatrics 2019; 50:273-279. [PMID: 31340401 PMCID: PMC7117081 DOI: 10.1055/s-0039-1693152] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Acute disseminated encephalomyelitis (ADEM) is a common yet clinically heterogenous syndrome characterized by encephalopathy, focal neurologic findings, and abnormal neuroimaging. Differentiating ADEM from other demyelinating disorders of childhood can be difficult and appropriate interpretation of the historical, clinical, and neurodiagnostic components of a patient's presentation is critical. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases are a recently recognized set of disorders, which include ADEM presentations, among other phenotypes. This review article discusses the clinical diagnosis, differential diagnosis, interpretation of data, and treatment/prognosis of this unique syndrome with distinctive review of the spectrum of MOG antibodies.
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Affiliation(s)
- Jonathan D. Santoro
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States,Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States,Department of Neurology, Children’s Hospital of Los Angeles, Los Angeles, California, United States,Keck School of Medicine, University of Southern California, Los Angeles, California, United States,Address for correspondence Jonathan D. Santoro, MD Department of Neurology, Massachusetts General Hospital55 Fruit Street, ACC 708, Boston, MA 02114United States
| | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States,Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
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