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Arnett SV, Prain K, Ramanathan S, Bhuta S, Brilot F, Broadley SA. Long-term outcomes of ADEM-like and tumefactive presentations of CNS demyelination: a case-comparison analysis. J Neurol 2024; 271:5275-5289. [PMID: 38861035 PMCID: PMC11319424 DOI: 10.1007/s00415-024-12349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 06/12/2024]
Abstract
A minority of initial multiple sclerosis (MS) presentations clinically or radiologically resemble other central nervous system (CNS) pathologies, acute disseminated encephalomyelitis (ADEM) or tumefactive demyelination (atypical demyelination presentations). With the aim of better defining the long-term outcomes of this group we have performed a retrospective cohort comparison of atypical demyelination versus 'typical' MS presentations. Twenty-seven cases with atypical presentations (both first and subsequent demyelinating events) were identified and compared with typical MS cases. Disease features analysed included relapse rates, disability severity, whole brain and lesion volumes, lesion number and distribution. Atypical cases represented 3.9% of all MS cases. There was considerable overlap in the magnetic resonance imaging (MRI) features of ADEM-like and tumefactive demyelination cases. ADEM-like cases tended to be younger but not significantly so. Atypical cases showed a trend towards higher peak expanded disability severity score (EDSS) score at the time of their atypical presentation. Motor, cranial nerve, cerebellar, cerebral and multifocal presentations were all more common in atypical cases, and less likely to present with optic neuritis. Cerebrospinal fluid (CSF) white cell counts were higher in atypical cases (p = 0.002). One atypical case was associated with peripheral blood myelin oligodendrocyte glycoprotein (MOG) antibodies, but subsequent clinical and radiological course was in keeping with MS. There was no difference in long-term clinical outcomes including annualised relapse rates (ARR), brain volume, lesion numbers or lesion distributions. Atypical demyelination cases were more likely to receive high potency disease modifying therapy early in the course of their illness. Despite the severity of initial illness, our cohort analysis suggests that atypical demyelination presentations do not confer a higher risk of long-term adverse outcomes.
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Affiliation(s)
- Simon V Arnett
- School of Medicine, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
- Griffith university, Gold Coast Campus, Gold Coast, Queensland, Australia.
| | - Kerri Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Faculty of Medicine and Health, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, 2145, Australia
- Department of Neurology, Concord Hospital, Sydney, NSW, 2139, Australia
| | - Sandeep Bhuta
- Department of Neurology, Concord Hospital, Sydney, NSW, 2139, Australia
| | - Fabienne Brilot
- Neuroimmunology Group, Kids Neurosciences Centre, Faculty of Medicine and Health, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, 2145, Australia
| | - Simon A Broadley
- School of Medicine, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
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2
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Biddle G, Beck RT, Raslan O, Ebinu J, Jenner Z, Hamer J, Hacein-Bey L, Apperson M, Ivanovic V. Autoimmune diseases of the spine and spinal cord. Neuroradiol J 2024; 37:285-303. [PMID: 37394950 PMCID: PMC11138326 DOI: 10.1177/19714009231187340] [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: 07/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) and clinicopathological tools have led to the identification of a wide spectrum of autoimmune entities that involve the spine. A clearer understanding of the unique imaging features of these disorders, along with their clinical presentations, will prove invaluable to clinicians and potentially limit the need for more invasive procedures such as tissue biopsies. Here, we review various autoimmune diseases affecting the spine and highlight salient imaging features that distinguish them radiologically from other disease entities.
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Affiliation(s)
- Garrick Biddle
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ryan T Beck
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Osama Raslan
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Julius Ebinu
- Neurosurgery Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Zach Jenner
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - John Hamer
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lotfi Hacein-Bey
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Michelle Apperson
- Neurology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
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3
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Hernández-Lima AE, Pulido-Amaro MF, González-Rivera CY, Moreno-Madrigal LG, Reyes-Vanegas D. [Weston-Hurst syndrome. A case report and literature review]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:695-701. [PMID: 37773190 PMCID: PMC10599785 DOI: 10.5281/zenodo.8316485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/28/2023] [Indexed: 10/01/2023]
Abstract
Background Acute disseminated encephalomyelitis is an autoimmune and demyelinating disease. It is rare in adults. It has 3 main variants. One of them is Weston-Hurst syndrome, also called acute hemorrhagic leukoencephalitis. The objective was to share the experience in the diagnostic and therapeutic approach of this rare disease, as well as make a review of the current bibliography, in order to collaborate in the knowledge of this disease. Clinical case 27-year-old woman, with a viral respiratory infection 2 weeks prior to the development of a neurological syndrome characterized by paresthesia, motor deficit, status epilepticus and acute encephalopathy, progressing rapidly to coma, with evidence in MRI of diffuse hemorrhagic lesions in cerebral white matter with demyelination and peripheral edema. It was administered steroid treatment for 5 days, with improvement of symptoms, but with motor and sensory deficits persisting. Conclusion Acute disseminated encephalomyelitis and its variants are rare entities, with an important range of differential diagnosis, which must be identified and quickly treated to avoid their lethal or disabling outcome.
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Affiliation(s)
- Arturo Eduardo Hernández-Lima
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - María Fernanda Pulido-Amaro
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Carlos Yammir González-Rivera
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Luis Guillermo Moreno-Madrigal
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Diego Reyes-Vanegas
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Campbell D, Wong GS, Park H, McLeod G. An Adult Case of Adenovirus-Associated Acute Disseminated Encephalomyelitis. Case Rep Infect Dis 2023; 2023:5528198. [PMID: 37261248 PMCID: PMC10228215 DOI: 10.1155/2023/5528198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune neurological disease that predominately affects pediatric population. Only a single fatal adult case of adenovirus-associated ADEM has previously been published by Qamar et al. in 2021. Here, we present an adult case of adenovirus-associated ADEM, which was diagnosed early in her clinical course. The patient was treated with the prompt initiation of steroids, intravenous immune globulin (IVIG), and plasmapheresis (PLEX), and the patient recovered fully. This case highlights the importance of early accurate diagnosis for other clinicians to treat adenovirus-associated ADEM in a timely fashion to prevent a potentially fatal outcome.
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Affiliation(s)
- Dewayne Campbell
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Gordon S. Wong
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Hyun Park
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Gavin McLeod
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
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Kim J, Young GS. Neuroimaging of COVID-19. Semin Neurol 2023; 43:205-218. [PMID: 37379850 DOI: 10.1055/s-0043-1767771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
We review the wide variety of common neuroimaging manifestations related to coronavirus disease 2019 (COVID-19) and COVID therapies, grouping the entities by likely pathophysiology, recognizing that the etiology of many entities remains uncertain. Direct viral invasion likely contributes to olfactory bulb abnormalities. COVID meningoencephalitis may represent direct viral infection and/or autoimmune inflammation. Para-infectious inflammation and inflammatory demyelination at the time of infection are likely primary contributors to acute necrotizing encephalopathy, cytotoxic lesion of the corpus callosum, and diffuse white matter abnormality. Later postinfectious inflammation and demyelination may manifest as acute demyelinating encephalomyelitis, Guillain-Barré syndrome, or transverse myelitis. The hallmark vascular inflammation and coagulopathy of COVID-19 may produce acute ischemic infarction, microinfarction contributing to white matter abnormality, space-occupying hemorrhage or microhemorrhage, venous thrombosis, and posterior reversible encephalopathy syndrome. Adverse effects of therapies including zinc, chloroquine/hydroxychloroquine, antivirals, and vaccines, and current evidence regarding "long COVID" is briefly reviewed. Finally, we present a case of bacterial and fungal superinfection related to immune dysregulation from COVID.
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Affiliation(s)
- Jisoo Kim
- Division of Neuroradiology, Department of Radiology, Harvard Medical School & Brigham and Women's Hospital, Boston, Massachusetts
| | - Geoffrey S Young
- Division of Neuroradiology, Department of Radiology, Harvard Medical School & Brigham and Women's Hospital, Boston, Massachusetts
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6
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Heimann MA, Hataway FR. Young Woman With COVID-19 Unable to Walk. Ann Emerg Med 2023; 81:439-491. [PMID: 36948685 PMCID: PMC10026368 DOI: 10.1016/j.annemergmed.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 03/22/2023]
Affiliation(s)
- Matthew A Heimann
- Department of Emergency Medicine, University of Alabama-Birmingham, Birmingham, AL
| | - Felicia R Hataway
- Department of Neurology, University of Alabama-Birmingham, Birmingham, AL
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Muacevic A, Adler JR. Acute Disseminated Encephalomyelitis Following Thoracic Endovascular Aortic Repair. Cureus 2022; 14:e30562. [PMID: 36415419 PMCID: PMC9676073 DOI: 10.7759/cureus.30562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 01/25/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a central nervous system demyelinating condition. The postulated etiology is an autoimmune reaction, however, the mechanistic details are yet unknown. While infection and immunization are the most prevalent precipitating causes of ADEM, we postulate that radiopaque contrast material might have played a role as an immunological trigger. This presentation is unusual and has not been recorded so far. This case also emphasizes the challenges involved in evaluating emerging neurological problems following a period of intubation/sedation among these patients. We present a patient who passed away due to the manifestations of ADEM following admission to the intensive care unit after thoracic endovascular aortic repair for type B aortic dissection. Magnetic resonance imaging (MRI) performed following multiple attempts at sedation weaning demonstrated typical features of this condition. Clinicians and radiologists should be diligent and consider ADEM as a differential diagnosis when treating patients who present with neurological symptoms following radiological interventional procedures and have a high index suspicion to reduce mortality and achieve satisfactory clinical outcomes.
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Acute disseminated encephalitis (ADEM) as the first presentation of COVID-19; a case report. Ann Med Surg (Lond) 2022; 77:103511. [PMID: 35369575 PMCID: PMC8958253 DOI: 10.1016/j.amsu.2022.103511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/08/2022] [Accepted: 03/26/2022] [Indexed: 01/02/2023] Open
Abstract
Introduction and importance: Neurological ailments are reported during and after SARS-COV-2 infection. Case presentation We report a 67-year-old Iranian man with COVID-19 infection and Acute Disseminated Encephalomyelitis (ADEM) whose neurological symptoms appeared before clinical and radiological pulmonary manifestations. Clinical discussion COVID-19 can cause neurological complication without entering the CNS via para infectious inflammatory mechanisms. Conclusions This report shows that ADEM might be among primary presentations of COVID-19.
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Desmet P. Rapidly progressive dementia in a nonagenarian with acute disseminated encephalomyelitis. Acta Clin Belg 2022; 77:130-136. [PMID: 32602408 DOI: 10.1080/17843286.2020.1784613] [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: 10/24/2022]
Abstract
We describe a case of rapidly progressive dementia (RPD) in a nonagenarian. Dementia was caused by an acute disseminated encephalomyelitis (ADEM). Although not frequently diagnosed in the very elderly acute disseminated encephalomyelitis should not be overlooked for it is a treatable condition. A recent infection followed by rapid cognitive deterioration and multifocal neurologic signs should raise the attention to curable autoimmune diseases. Although the cause of ADEM is still unclear, immune suppression is the mainstay of treatment. Most patients improve on high-dose glucocorticoids and eventually immune globulin treatment or plasma exchange if steroid-unresponsive.
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Affiliation(s)
- Peter Desmet
- Department of Geriatric Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
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Garg A, Batra PK, Gupta P. Post COVID-19 Vaccination Acute Disseminated Encephalomyelitis: A Case Report. Curr Med Imaging 2022; 19:91-95. [PMID: 35579135 DOI: 10.2174/1573405618666220509205457] [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: 12/10/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A 67-year-old female with no significant past medical history presented to the critical care department with symptoms of encephalopathy. CASE PRESENTATION The patient's Main Concerns and the Important Clinical Findings: The patient had a history of COVID -19 vaccination (recombinant ChAdOX1 nCoV-19) 14 days prior to the symptoms. She underwent an MRI of the brain and cervical spine and a lumbar puncture. The Primary Diagnoses, Interventions, and Outcomes: The patient was examined and sent for an MRI of the brain and cervical spine, followed by extensive blood and CSF investigations to rule out any infective, paraneoplastic, connective tissue disorder, or inflammatory disorder. The patient was given steroids, and a good response was reported. The primary diagnosis was made as vaccine-induced ADEM. CONCLUSION The clinical exam, location, sparse contrast enhancement, and CSF findings were all consistent with an acute demyelinating event, and the history of vaccination, together with the clinical situation, was found to be favourable for the development of acute disseminated encephalomyelitis.
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Affiliation(s)
- Amit Garg
- Department Radiology, Fortis Escorts Heart Institute & Research Centre, New Delhi, Delhi 110025, India
| | - Parveen Kumar Batra
- Department Radiology, Fortis Escorts Heart Institute & Research Centre, New Delhi, Delhi 110025, India
| | - Pranav Gupta
- Department Radiology, Fortis Escorts Heart Institute & Research Centre, New Delhi, Delhi 110025, India
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Berrichi S, Bouayed Z, Berrajaa S, Bahouh C, Oulalite AM, Douqchi B, Bella I, Bkiyar H, Housni B. Acute Disseminated Encephalomyelitis: A rare form of COVID-19's neurotropism. Ann Med Surg (Lond) 2021; 71:102940. [PMID: 34659750 PMCID: PMC8504072 DOI: 10.1016/j.amsu.2021.102940] [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] [Received: 09/07/2021] [Revised: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction the COVID-19 pandemic still accounts for thousands of cases every day. It's neurological involvement has been well documented most likely due to auto-immune mechanisms than the virus itself. Case report we report the case of a 38 years old women who developed an Acute Disseminated Encephalomyelitis following a COVID-19 infection, with a favorable outcome after immunosuppressive therapy. Discussion In this chapter, we discuss ADEM's pathogenesis as well as its clinical and radiological features before detailing its relationship with infectious and vaccination episodes. We also discuss how our patient disease evolved. Conclusion Acute Disseminated Encephalomyelitis is an immune-mediated disorder in which the widespread inflammation of the brain and spinal cord is responsible for a variety of symptoms. The novel COVID-19 virus and its vaccine are both a newly incriminated etiologies of this demyelinating disorder. COVID-19 neurotropism has been well established and its neurological manifestations are varied. Demyelinating disorders are immune-induced disease most likely due to an antigenic analogy between the virus and myelin constituents. COVID-19 induced ADEM is extremely rare, only a dozen cases have been reported worldwide, and ours is the only case reported in our country.
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Affiliation(s)
- Samia Berrichi
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
- Corresponding author. Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Zakaria Bouayed
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
- Corresponding author. Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco.
| | - Sara Berrajaa
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Choukri Bahouh
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Amine Mohammed Oulalite
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Badie Douqchi
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Islam Bella
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Brahim Housni
- Department of Anesthesiology, Intensive Care Medicine and Resuscitation, MOHAMMED VI University Hospital Center, Oujda, Morocco
- Simulation Center, Faculty of Medicine and Pharmacy, Oujda, Morocco
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Neppala S, Sundarakumar DK, Caravella JW, Chigurupati HD, Patibandla P. COVID-19-associated familial acute disseminated encephalomyelitis (ADEM): A case report. IDCases 2021; 26:e01264. [PMID: 34485076 PMCID: PMC8407943 DOI: 10.1016/j.idcr.2021.e01264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2023] Open
Abstract
Background Several neurological complications are being reported in hospitalized patients with severe COVID-19 infection. This is presumed due to direct spread of infection or due to immunological response. Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory and demyelinating disorder of the central nervous system that is often preceded by infection or vaccination. Very few cases of ADEM have been reported in the literature that are associated with COVID-19 infection. Case Report Here we demonstrate familial cases of ADEM in a hospitalized father and son, who presented to the emergency department with fever and shortness of breath, later diagnosed with COVID-19, and subsequently requiring mechanical ventilation. Both patients developed neurological symptoms with upper motor neuron involvement at approximately day 30 of admission. MRI of the brain demonstrated bilateral multifocal periventricular white matter FLAIR signal hyperintensities consistent with ADEM. The patients were treated with medium dose IV methylprednisolone with variable outcomes. The 49-year-old son developed severe residual neurological deficits with encephalomalacic changes on MRI which required extensive rehabilitation; meanwhile, the 68-year-old father predominantly had pulmonary sequelae including fibrosis and the development of a pneumatocele, but he had a better neurological outcome. Conclusion To our knowledge, this is the first reported case report of ADEM involving father and son in severe COVID-19 infection. Final neurological outcomes in these patients appeared to be in line with the severity of COVID-19 infection. More research is needed to better understand the management of ADEM in patients with severe COVID-19 infection.
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Affiliation(s)
- Sivaram Neppala
- Department of Inte\rnal Medicine, University of Incarnate Word at Laredo Medical Center, Laredo, TX, 78041 USA
| | - Dinesh Kumar Sundarakumar
- Department of Interventional Radiology, University of Incarnate Word at Laredo Medical Center, Laredo, TX, 78041 USA
| | - Joseph W Caravella
- Department of Inte\rnal Medicine, University of Incarnate Word at Laredo Medical Center, Laredo, TX, 78041 USA
| | - Himaja Dutt Chigurupati
- Department of Inte\rnal Medicine, University of Incarnate Word at Laredo Medical Center, Laredo, TX, 78041 USA
| | - Prateek Patibandla
- Department of Internal Medicine, Reading Hospital, West Reading, PA 19611, USA
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State-of-the-Art Review: Demyelinating Diseases in Indonesia. Mult Scler Int 2021; 2021:1278503. [PMID: 34327021 PMCID: PMC8277524 DOI: 10.1155/2021/1278503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
Demyelinating diseases are more common in Indonesia than previously believed. However, it is still a challenge for a country such as Indonesia to implement the scientific medical advances, especially in the diagnostic process of demyelinating diseases, to achieve the best possible outcome for these groups of patients, within the constraints of what is socially, technologically, economically, and logistically achievable. In this review, we address the 4 major classes of demyelinating disease: multiple sclerosis (MS), neuromyelitis optica (NMO), anti-MOG-associated encephalomyelitis (MOG-EM), and acute disseminated encephalomyelitis (ADEM), and discuss their prevalence, demographics, clinical diagnosis workup, and imaging features in the Indonesian population, as well as the challenges we face in their diagnosis and therapeutic approach. We hope that this overview will lead to a better awareness of the spectrum of demyelinating diseases of the central nervous system in Indonesia.
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14
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Surve RM, Pendharkar HS, Bansal S. Paralytic rabies mimicking Guillain-Barré syndrome: the dilemma still prevails. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Hon KLE, Leung AK, Au CC, Torres AR. Autoimmune Encephalitis in Children: From Suspicion to Diagnosis. Cureus 2021; 13:e13307. [PMID: 33732562 PMCID: PMC7955954 DOI: 10.7759/cureus.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
There are several well-described and studied autoimmune diseases that affect different organ systems, and a limited number of these affect the central nervous system. Autoimmune encephalitis represents a disease with a wide spectrum of clinical manifestations and different levels of severity, from mild cognitive impairment to complex encephalopathy. Immune-mediated encephalitis refers to a diverse and rare group of conditions in children associated with nonspecific symptomatology, altered mental state, and recalcitrant seizures. Infectious etiology must be excluded. Immune-mediated encephalitis syndromes could be associated with paraneoplastic or primarily autoimmune mechanisms. The newest scientific advantages have concluded that autoimmune encephalitis may be further divided into different groups of diseases depending on the immune response; examples are antibodies to cell surface proteins, antibodies to intracellular synaptic proteins, T-cell response with antibodies to intracellular antigens, among others. Treatment consists of supportive therapy, ranging from supplemental oxygen, fluid restriction to mechanical circulatory support. Specific treatment includes immunoglobulin infusion, plasmapheresis, and pulse steroid treatment. Prognosis is poor if specific treatment is not timely instituted. The diagnosis of autoimmune encephalitis could be challenging to clinicians due to its diverse clinical features, which can mimic a variety of other pathologic processes. Screening for cancer and proper management that includes immune therapy are fundamental, although some patients will need immune suppression for weeks or months as autoimmune encephalitis may relapse; therefore, follow-up is always necessary.
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Affiliation(s)
- Kam Lun Ellis Hon
- Pediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, HKG
| | | | - Cheuk Chung Au
- Pediatric Intensive Care Unit, Hong Kong Children's Hospital, Hong Kong, HKG
| | - Alcy R Torres
- Pediatrics, Boston University School of Medicine, Boston, USA
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Tsubouchi S, Hayashi H, Tahara K, Ishii K, Yasuda T, Yamamoto Y, Mizuuchi T, Mori H, Tago M, Kato E, Sawada T. Clinical presentation of a neuropsychiatric lupus patient with symmetrical basal ganglia lesions containing cytotoxic oedema cores surrounded by vasogenic oedema. Mod Rheumatol Case Rep 2020; 4:39-46. [PMID: 33086978 DOI: 10.1080/24725625.2019.1651955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Neuropsychiatric (NP) manifestations of systemic lupus erythematosus (SLE) are diverse, but involvement of basal ganglia is rare. We describe here a 28-year-old woman with NPSLE presenting aseptic meningitis accompanied by elevated interleukin-6 levels in the cerebrospinal fluid, who developed symmetrical basal ganglia lesions, containing a cytotoxic oedematous core, surrounded by vasogenic oedema upon magnetic resonance imaging. We were able to observe these lesions from a de novo appearance during the disease onset to its disappearance during immunosuppressive treatment. Reversibility upon immunosuppressive treatment indicated that autoimmune mediated mechanisms could contribute to the basal ganglia lesions in NPSLE.
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Affiliation(s)
- Syoko Tsubouchi
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kayo Ishii
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takuya Yasuda
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yusuke Yamamoto
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takahiro Mizuuchi
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mayu Tago
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Eri Kato
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
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17
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Md Noh MSF. Myelin oligodendrocyte glycoprotein-antibody (MOG-IgG) associated disease with centrally located long spinal cord lesion in a 14-month old child. J Cent Nerv Syst Dis 2020; 12:1179573520955008. [PMID: 32973377 PMCID: PMC7495514 DOI: 10.1177/1179573520955008] [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] [Received: 04/01/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022] Open
Abstract
Myelin oligodendrocyte glycoprotein-antibodies (MOG-IgG) are associated with acquired
inflammatory demyelinating syndromes, seen predominantly in children and young adults. The
overlapping clinical and radiological features of the heterogenous spectrum of
demyelinating central nervous system (CNS) diseases makes the detection of MOG-IgG
antibodies important for prognosis and treatment decisions. Herein, we describe the
occurrence of MOG-IgG associated disease presenting as acute disseminated
encephalomyelitis (ADEM), with spinal MRI findings of centrally located long cord lesion
in a 14-month old child.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Radiology, Universiti Putra Malaysia (UPM) Teaching Hospital, Persiaran MARDI-UPM, Serdang, Selangor, Malaysia.,Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
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18
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Murta V, Villarreal A, Ramos AJ. Severe Acute Respiratory Syndrome Coronavirus 2 Impact on the Central Nervous System: Are Astrocytes and Microglia Main Players or Merely Bystanders? ASN Neuro 2020; 12:1759091420954960. [PMID: 32878468 PMCID: PMC7476346 DOI: 10.1177/1759091420954960] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
With confirmed coronavirus disease 2019 (COVID-19) cases surpassing the 18 million mark around the globe, there is an imperative need to gain comprehensive understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the main clinical manifestations of COVID-19 are associated with respiratory or intestinal symptoms, reports of neurological signs and symptoms are increasing. The etiology of these neurological manifestations remains obscure, and probably involves several direct pathways, not excluding the direct entry of the virus to the central nervous system (CNS) through the olfactory epithelium, circumventricular organs, or disrupted blood–brain barrier. Furthermore, neuroinflammation might occur in response to the strong systemic cytokine storm described for COVID-19, or due to dysregulation of the CNS rennin-angiotensin system. Descriptions of neurological manifestations in patients in the previous coronavirus (CoV) outbreaks have been numerous for the SARS-CoV and lesser for Middle East respiratory syndrome coronavirus (MERS-CoV). Strong evidence from patients and experimental models suggests that some human variants of CoV have the ability to reach the CNS and that neurons, astrocytes, and/or microglia can be target cells for CoV. A growing body of evidence shows that astrocytes and microglia have a major role in neuroinflammation, responding to local CNS inflammation and/or to disbalanced peripheral inflammation. This is another potential mechanism for SARS-CoV-2 damage to the CNS. In this comprehensive review, we will summarize the known neurological manifestations of SARS-CoV-2, SARS-CoV and MERS-CoV; explore the potential role for astrocytes and microglia in the infection and neuroinflammation; and compare them with the previously described human and animal CoV that showed neurotropism to propose possible underlying mechanisms.
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Affiliation(s)
- Veronica Murta
- Laboratorio de Neuropatología Molecular, Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis," Facultad de Medicina, UBA-CONICET, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Alejandro Villarreal
- Laboratorio de Neuropatología Molecular, Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis," Facultad de Medicina, UBA-CONICET, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Alberto J Ramos
- Laboratorio de Neuropatología Molecular, Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis," Facultad de Medicina, UBA-CONICET, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
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19
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Handa R, Nanda S, Prasad A, Anand R, Zutshi D, Dass SK, Bedi PK, Pahuja A, Shah PK, Sharma B. Covid-19-associated acute haemorrhagic leukoencephalomyelitis. Neurol Sci 2020; 41:3023-3026. [PMID: 32876775 PMCID: PMC7462963 DOI: 10.1007/s10072-020-04703-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rahul Handa
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India.
| | - Satyan Nanda
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | - Atul Prasad
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | - Rajiv Anand
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | - Dhruv Zutshi
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | - Sujata K Dass
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | | | - Aarti Pahuja
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | - Pankaj Kumar Shah
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
| | - Bipan Sharma
- Department of Neurology, BLK Super Speciality Hospital, New Delhi, India
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20
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Elkhayat HA, El-Rashidy OF, Elagouza IA, Zaitoun R, Abbas YAA. Childhood acute disseminated encephalomyelitis: an Egyptian pilot study. Acta Neurol Belg 2020; 120:549-555. [PMID: 29222716 DOI: 10.1007/s13760-017-0869-5] [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: 06/30/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Abstract
Describing the variable clinical features, laboratory findings, neuroimaging findings, and treatments given to children who presented with ADEM and following them up both clinically and radiologically. 21 patients were recruited: 14 new cases, and 7 old ones presenting over the preceding 5 years (retrospective review of existing data). 11 males and 10 females, with a mean age of 4.4 years ± 2.7 SD, were included. All new patients were subject to full history, examination and a panel of investigations including MRI of the brain. Treatment was given in the form of pulsed methyl prednisolone or intravenous immunoglobulin (IVIG), followed by clinical and radiological follow-up every 3 months as needed. 11 cases occurred in spring, 8 post vaccine, of which 5 were after oral polio vaccine (OPV). MRI was done for all 21 patients and was abnormal in all of them, CT was done in only 10 patients as was normal in 9. Hyponatremia was seen in 11 patients. All patients who received corticosteroids showed prompt improvement. 6 out of 10 patients who received IVIG first failed treatment. Of the 17 treated patients, 10 had no sequelae and 10 had total lesion resolution on MRI at 3 months, versus 1 and 0 patients, respectively, in the untreated group. We found a disproportionately large number of post vaccination cases, especially after OPV. The association of ADEM with hyponatremia needs further study. MRI is central to diagnosis. Outcome is much better with treatment with steroids being far superior to IVIG. Excess use of IVIG should be discouraged.
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Affiliation(s)
| | | | - Iman Ali Elagouza
- Faculty of Medicine, Paediatrics Department, Ain Shams University, Cairo, Egypt.
| | - Raghda Zaitoun
- Faculty of Medicine, Paediatrics Department, Ain Shams University, Cairo, Egypt
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21
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Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol 2020; 267:2799-2802. [PMID: 32474657 PMCID: PMC7260459 DOI: 10.1007/s00415-020-09951-9] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/24/2022]
Abstract
A 51-year-old woman with COVID-19 infection developed coma and an impaired oculocephalic response to one side. MRI of the brain demonstrated acute multifocal demyelinating lesions, and CSF testing did not identify a direct cerebral infection. High-dose steroids followed by a course of IVIG was administered, and the patient regained consciousness over the course of several weeks. As more patients reach the weeks after initial infection with COVID-19, acute disseminated encephalomyelitis should be considered a potentially treatable cause of profound encephalopathy or multifocal neurological deficits.
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Affiliation(s)
- Timothy Parsons
- The Hospital of Central Connecticut, Hartford Healthcare, 100 Grand St., New Britain, CT, 06052, USA. .,University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Sarah Banks
- The Hospital of Central Connecticut, Hartford Healthcare, 100 Grand St., New Britain, CT, 06052, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Chay Bae
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joel Gelber
- The Hospital of Central Connecticut, Hartford Healthcare, 100 Grand St., New Britain, CT, 06052, USA
| | - Hussein Alahmadi
- The Hospital of Central Connecticut, Hartford Healthcare, 100 Grand St., New Britain, CT, 06052, USA
| | - Matthew Tichauer
- The Hospital of Central Connecticut, Hartford Healthcare, 100 Grand St., New Britain, CT, 06052, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
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22
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The Spectrum of Acute Disseminated Encephalomyelitis and Mild Encephalopathy with Reversible Splenial Lesion. Case Rep Neurol Med 2019; 2019:9272074. [PMID: 31781440 PMCID: PMC6855051 DOI: 10.1155/2019/9272074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acute disseminated encephalomyelitis and mild encephalopathy with reversible splenial lesion are autoimmune demyelinating disorders of central nervous system. Diagnosis remains clinical, aided by neuroimaging confirmation and excluding other causes. In the absence of a biological marker, the diagnosis of these entities based on clinical and imaging criteria could overlap. Methods We describe a 22-year-old woman developing mild neurological signs after an upper tract infection, a brain magnetic resonance image revealed confluent, symmetrical white matter lesions with corpus callosum involvement; after extensive ancillary testing that ruled out secondary causes we concluded that this subject had a post infectious encephalitis sharing clinical and imaging criteria for acute disseminated encephalomyelitis. However, mild encephalopathy with reversible splenial lesion could be an alternate diagnosis for this subject. Treatment with methylprednisolone completely solved both the clinical and image abnormalities without relapsing for more than 3 years of follow-up. Conclusion Both acute disseminated encephalomyelitis and mild encephalopathy with reversible splenial lesion share clinical and radiological features. A biological marker is needed to differentiate among these entities, since overlap is seen according to current criteria.
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23
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Wang Q, Cai LN, Wang XQ. Acute disseminated encephalomyelitis following varicella-zoster virus infection: Case report of effective treated both in clinical symptom and neuroimaging. Brain Behav 2019; 9:e01374. [PMID: 31342665 PMCID: PMC6749488 DOI: 10.1002/brb3.1374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Acute disseminated encephalomyelitis (ADEM) is an idiopathic inflammatory demyelinating disorder of the central nervous system (CNS). Early treatment is the key for neurological recovery. METHODS A case of ADEM associated with varicella-zoster virus infection was presented, in which magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) examinations were included. RESULTS Magnetic resonance imaging of the brain revealed multiple hyperintense lesions at the subcortical level on fluid-attenuated inversion recovery (FLAIR), and MRI of the spinal cord revealed longitudinally segmented hyperintense lesions at the spinal cord on T2-weighted images. The patient was treated with methylprednisolone and gancyclovir, and had a favorable recovery. Subsequent MRI of the brain and cervical cord showed the previous abnormal hyperintensities had markedly disappeared. CONCLUSION A rare case of ADEM with longitudinal segmented hyperintense lesions at the spinal cord on T2-weighted images was presented. Excellent response to ADEM treatment with high-dose steroids was reported resulting in a remarkable neurological recovery. A long-term follow-up is needed for prognosis.
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Affiliation(s)
- Qi Wang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Li-Na Cai
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Xiang-Qing Wang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China
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24
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Golub D, Williams F, Wong T, Iyengar N, Jolley H, Sabadiah S, Rhee D, Gold-von Simson G. A Longitudinally Extensive Spinal Cord Lesion Restricted to Gray Matter in an Adolescent Male. Front Neurol 2019; 10:270. [PMID: 30949125 PMCID: PMC6435483 DOI: 10.3389/fneur.2019.00270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/28/2019] [Indexed: 01/19/2023] Open
Abstract
Longitudinally extensive spinal cord lesions (LECL) restricted to gray matter are poorly understood as are their neurodevelopmental repercussions in children. We herein report the critical case of a 13-year-old male presenting with progressive quadriparesis found to have cervical LECL restricted to the anterior horns. Challenged with a rare diagnostic dilemma, the clinical team systematically worked through potential vascular, genetic, infectious, rheumatologic, and paraneoplastic diagnoses before assigning a working diagnosis of acute inflammatory myelopathy. Nuanced consideration of and workup for both potential ischemic causes (arterial dissection, fibrocartilaginous embolism, vascular malformation) and specific inflammatory conditions including Transverse Myelitis, Neuromyelitis Optica Spectrum Disorders (NMOSD), Multiple Sclerosis (MS), Acute Disseminated Encephalomyelitis (ADEM), and Acute Flaccid Myelitis (AFM) is explained in the context of a comprehensive systematic review of the literature on previous reports of gray matter-restricted longitudinally extensive cord lesions in children. Treatment strategy was ultimately based on additional literature review of treatment-refractory acute inflammatory neurological syndromes in children. A combination of high-dose steroids and plasmapheresis was employed with significant improvement in functional outcome, suggesting a potential benefit of combination immune-modulatory treatment in these patients. This case furthermore highlights quality clinical reasoning with respect to the elusive nature of diagnosis, nuances in neuroimaging, and multifocal treatment strategies in pediatric LECL.
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Affiliation(s)
- Danielle Golub
- New York University School of Medicine, New York, NY, United States
| | - Faith Williams
- School of Medicine, Washington University School of Medicine, Saint Louis, MO, United States
| | - Taylor Wong
- New York University School of Medicine, New York, NY, United States
| | - Nishanth Iyengar
- New York University School of Medicine, New York, NY, United States
| | - Hannah Jolley
- Department of Pediatrics, New York University School of Medicine, New York, NY, United States
| | - Sakinah Sabadiah
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - David Rhee
- Department of Pediatrics, New York University School of Medicine, New York, NY, United States
| | - Gabrielle Gold-von Simson
- Department of Pediatrics, New York University School of Medicine, New York, NY, United States.,Health and Hospitals, Clinical Translational Science Institute, New York University, New York, NY, United States
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25
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Bulut E, Karakaya J, Salama S, Levy M, Huisman TAGM, Izbudak I. Brain MRI Findings in Pediatric-Onset Neuromyelitis Optica Spectrum Disorder: Challenges in Differentiation from Acute Disseminated Encephalomyelitis. AJNR Am J Neuroradiol 2019; 40:726-731. [PMID: 30846436 DOI: 10.3174/ajnr.a6003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis could be challenging, especially in cases presenting with only brain manifestations. Our purpose was to investigate brain MR imaging features that may help distinguish these 2 entities. MATERIALS AND METHODS We retrospectively examined initial brain MR imaging studies of 10 patients with pediatric-onset neuromyelitis optica spectrum disorder (female/male ratio, 7:3) and 10 patients with acute disseminated encephalomyelitis (female/male ratio, 2:8). The mean age of the patients was 10.3 ± 5.6 and 8.7 ± 5.3 years, respectively. Brain lesions were evaluated with respect to location, extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. The χ2 test (Yates or Fisher exact χ2tests) was used to compare differences between groups. RESULTS Cerebral subcortical ± juxtacortical and pons ± middle cerebellar peduncle were the most frequent locations involved in both neuromyelitis optica spectrum disorder (n = 5 and 4, respectively) and acute disseminated encephalomyelitis (n = 9 and 7, respectively). Thalamic lesions were more frequent in acute disseminated encephalomyelitis (P = .020) and were detected only in 1 patient with neuromyelitis optica spectrum disorder. None of the patients with neuromyelitis optica spectrum disorder had hypothalamic, internal capsule, or cortical lesions. The internal capsule involvement was found to be significantly different between groups (P = .033). There was no significant difference in terms of extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. CONCLUSIONS Although there is a considerable overlap in brain MR imaging findings, thalamic and internal capsule involvement could be used to differentiate pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis.
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Affiliation(s)
- E Bulut
- From the Departments of Radiology (E.B.)
| | - J Karakaya
- Statistics (J.K.), Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Salama
- Department of Neurology and Psychiatry (S.S.), University of Alexandria, Alexandria, Egypt
| | - M Levy
- Department of Neurology (M.L.), Johns Hopkins School of Medicine, Baltimore, Maryland
| | - T A G M Huisman
- Edward B. Singleton Chair of Radiology (T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - I Izbudak
- Section of Pediatric Neuroradiology (I.I.), Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
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26
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Delayed appearance of transient hyperintensity foci on T1-weighted magnetic resonance imaging in acute disseminated encephalomyelitis. Jpn J Radiol 2019; 37:277-282. [PMID: 30671706 DOI: 10.1007/s11604-018-00808-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/26/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM). MATERIALS AND METHODS Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated. RESULTS Five ADEM patients were included in this study. Linear (n = 2) or nodular (n = 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (n = 1), subcortical region alone (n = 1), and internal capsule (n = 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14-43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients. CONCLUSION T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.
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27
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Bathla G, Policeni B. Acute Disseminated Encephalomyelitis. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Chen Y, Ma F, Xu Y, Chu X, Zhang J. Vaccines and the risk of acute disseminated encephalomyelitis. Vaccine 2018; 36:3733-3739. [PMID: 29784468 DOI: 10.1016/j.vaccine.2018.05.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is important to examine the risk of Acute disseminated encephalomyelitis (ADEM) after vaccination. METHODS We conducted a nested case-control study between January 2011 and December 2015. Four controls per case were matched for age, gender, address. An independent expert committee validated the diagnoses of cases and controls. Data on vaccinations were obtained from computerized vaccination records. The analyses were conducted with the use of conditional logistic regression. RESULTS The analyses include 272 cases of ADEM and 1096 controls. No increase in the risk of ADEM was observed for vaccination against hepatitis B, influenza, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, meningitis, hepatitis A, varicella and rabies vaccines. Vaccine was associated with a statistically significant increase in risk in the 31-60-day exposure interval (OR, 4.04 [95% CI, 1.07-12.69]), but not the 0-30 and 61-180-day interval. There was no association between vaccine received and the recurrence of ADEM. CONCLUSIONS Findings from the present study do not demonstrate an association of vaccines with an increased risk of ADEM and its recurrence among either paediatric (≤18 years) or adult (>18 years) individuals within the 180 days after vaccinations. The finding in children in the 31-60 day risk interval is likely coincidental and was not confirmed in separate self-control analyses.
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Affiliation(s)
- Yong Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China.
| | - Fubao Ma
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Yuanling Xu
- Department of Neurology, Nanjing Brain Hospital, China.
| | - Xuhua Chu
- Department of Neurology, Jiangsu Provincial People's Hospital, China.
| | - Jinlin Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China.
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29
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Sandi D, Bereg E, Biernacki T, Vörös E, Klivényi P, Bereczki C, Vécsei L, Bencsik K. Pediatric multiple sclerosis and fulminant disease course: Features and approaches to treatment - A case report and review of the literature. J Clin Neurosci 2018; 53:13-19. [PMID: 29731272 DOI: 10.1016/j.jocn.2018.04.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
Multiple sclerosis (MS) is the autoimmune, neurodegenerative disease of the central nervous system (CNS). Typically, it affects the young adult population, however, up to 10% of the cases, it can develop in childhood. Atypical manifestations, such as the tumefactive variant (tMS) or acute disseminated encephalomyelitis (ADEM), especially coupled with fulminant disease course, are even more rare and pose a considerable differential diagnostic and therapeutic challenge. Recently, the therapeutic strategy on the use of disease modifying therapies (DMTs) in MS has shifted to the direction of a more individualized approach, that takes the personal differences heavily into account, in particular regard to the activity and prognosis of the disease. Despite this change has only been applied to adults yet, it is plausible to predict, that it will soon be applied to pediatric patients as well, particularly, as several randomized studies are under way concerning DMTs in pediatric populations. To our best knowledge, we are the first to report a successful natalizumab treatment of pediatric fulminant tMS, in case of a 13.5 years old girl. We feel that this report demonstrates the need of early and adequate treatment in such an aggressive case, because it can reverse the course of a possibly fatal disease.
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Affiliation(s)
- Dániel Sandi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Edit Bereg
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Erika Vörös
- Department of Radiology, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Csaba Bereczki
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, University of Szeged, Szeged, Hungary; MTA-SZTE Neuroscience Research Group, University of Szeged, Szeged, Hungary
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30
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Takasawa K, Nakagawa R, Takishima S, Moriyama K, Watanabe K, Kiyohara K, Hasegawa T, Shimohira M, Kashimada K, Shimizu N, Morio T. Cause of acute encephalitis/encephalopathy in Japanese children diagnosed by a rapid and comprehensive virological detection system and differences in their clinical presentations. Brain Dev 2018; 40:107-115. [PMID: 28801087 DOI: 10.1016/j.braindev.2017.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acute encephalitis/encephalopathy (AE/E) is a rare and severe complication of common childhood infections; however, a treatment strategy based on clinical and pathological evidence has not been established. METHODS The clinical data and aetiological results using a rapid and comprehensive virological detection system of 62 Japanese children diagnosed with AE/E from 2010 to 2014 were collected. We assessed clinical differences between causes and effectiveness of our multiplex PCR system to establish a pathogen-based treatment strategy for AE/E. RESULTS Suspected causes were detected in 84% of patients, and our multiplex PCR system contributed to diagnosing 38% of the patients. Furthermore, a negative virus PCR might be important for inferring underlying disease. Most cases were triggered by human herpes virus (HHV) 6/7 (32%) and influenza virus (24%). The causes of AE/E depended on age (p=0.00089) but not on sex (p=0.94). The median age of HHV6/7-associated AE/E was 2.3years, which is lower than the median ages of AE/E associated with other viruses. Major initial treatments were pulse steroid therapy (83.9%) and acyclovir (71%). Most of the patients in this study had good prognoses: 77% recovered without neurological sequalae. CONCLUSIONS Our virological detection system was useful for detecting the cause of AE/E, and may also contribute to construction of pathogen-based treatment strategies for AE/E. Our data indicated the possibility that early intervention with pulse steroid therapy could be effective for treating AE/E. Further investigation for selection of antiepileptic drugs and additional therapies might be required to prevent progression of AE/E.
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Affiliation(s)
- Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan.
| | - Ryuichi Nakagawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Tokyo-Kita Medical Center, Tokyo, Japan
| | | | - Kengo Moriyama
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken Watanabe
- Frontier Science Laboratory Virus Research Unit, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Kiyohara
- Department of Pediatrics, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Takeshi Hasegawa
- Department of Pediatrics, Soka Municipal Hospital, Saitama, Japan
| | - Masahiro Shimohira
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Shimizu
- Frontier Science Laboratory Virus Research Unit, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
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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.
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Kamr WH, El-Tantawy AM, Moustafa M, Abd-Elsalam OA. Acute disseminated encephalomyelitis: MR Diffusion weighted imaging: Potential diagnostic value and outcome predilection. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sudhakar SV, Muthusamy K, Mani S, Gibikote S, Shroff M. Imaging in Pediatric Demyelinating and Inflammatory Diseases of Brain- Part 2. Indian J Pediatr 2016; 83:965-82. [PMID: 27130513 DOI: 10.1007/s12098-016-2052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 01/28/2016] [Indexed: 01/18/2023]
Abstract
Imaging plays an important role in diagnosis, management, prognostication and follow up of pediatric demyelinating and inflammatory diseases of brain and forms an integral part of the diagnostic criteria. This article reviews the spectrum of aquaporinopathies with an in-depth discussion on present criteria and differentiation from other demyelinating diseases with clinical vignettes for illustration; the latter part of article deals with the spectrum of CNS vasculitis.
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Affiliation(s)
- Sniya Valsa Sudhakar
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India.
| | - Karthik Muthusamy
- Department of Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Sridhar Gibikote
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Manohar Shroff
- Department of Pediatric Neuroimaging, Hospital for Sick Children, Toronto, Canada
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34
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Sudhakar SV, Muthusamy K, Mani S, Gibikote S, Shroff M. Imaging in Pediatric Demyelinating and Inflammatory Diseases of the Brain- Part 1. Indian J Pediatr 2016; 83:952-64. [PMID: 26634264 DOI: 10.1007/s12098-015-1916-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
Imaging plays an important role in the diagnosis, management, prognostication and follow up of pediatric demyelinating and inflammatory diseases of the brain and forms an integral part of the diagnostic criteria. Conventional and advanced MR imaging is the first and only reliable imaging modality. This article reviews the typical and atypical imaging features of common and some uncommon demyelinating and inflammatory diseases with emphasis on the criteria for categorization. Imaging protocols and the role of advanced imaging techniques are also covered appropriately.
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Affiliation(s)
- Sniya Valsa Sudhakar
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India.
| | - Karthik Muthusamy
- Department of Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Sridhar Gibikote
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Manohar Shroff
- Department of Pediatric Neuroimaging, Hospital for Sick Children, Toronto, Canada
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35
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Chen J, Carletti F, Young V, Mckean D, Quaghebeur G. MRI differential diagnosis of suspected multiple sclerosis. Clin Radiol 2016; 71:815-27. [DOI: 10.1016/j.crad.2016.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 04/08/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
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Hardy TA, Reddel SW, Barnett MH, Palace J, Lucchinetti CF, Weinshenker BG. Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol 2016; 15:967-981. [DOI: 10.1016/s1474-4422(16)30043-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/02/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023]
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Chang PT, Yang E, Swenson DW, Lee EY. Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. Magn Reson Imaging Clin N Am 2016; 24:449-80. [PMID: 27150329 DOI: 10.1016/j.mric.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.
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Affiliation(s)
- Patricia T Chang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Montalván V, Gallo M, Rojas E. A 25 years-old woman with a postvaccine thalamic pseudotumoral lesion. Rev Clin Esp 2015; 215:468-72. [PMID: 26298546 DOI: 10.1016/j.rce.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/25/2022]
Affiliation(s)
- V Montalván
- Departamento de Neurología, Hospital Guillermo Almenara, Lima, Perú.
| | - M Gallo
- Departamento de Neurología, Hospital Guillermo Almenara, Lima, Perú
| | - E Rojas
- Departamento de Neurología, Hospital Guillermo Almenara, Lima, Perú
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Arabi YM, Harthi A, Hussein J, Bouchama A, Johani S, Hajeer AH, Saeed BT, Wahbi A, Saedy A, AlDabbagh T, Okaili R, Sadat M, Balkhy H. Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV). Infection 2015; 43:495-501. [PMID: 25600929 PMCID: PMC4521086 DOI: 10.1007/s15010-015-0720-y] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/04/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since the identification of the first case of infection with the Middle East respiratory syndrome corona virus (MERS-CoV) in Saudi Arabia in June 2012, the number of laboratory-confirmed cases has exceeded 941 cases globally, of which 347 died. The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. These are so far the first reported cases of neurologic injury associated with MERS-CoV infection. METHODS Data was retrospectively collected from three patients admitted with MERS-CoV infection to Intensive Care unit (ICU) at King Abdulaziz Medical City, Riyadh. They were managed separately in three different wards prior to their admission to ICU. FINDING The three patients presented with severe neurologic syndrome which included altered level of consciousness ranging from confusion to coma, ataxia, and focal motor deficit. Brain MRI revealed striking changes characterized by widespread, bilateral hyperintense lesions on T2-weighted imaging within the white matter and subcortical areas of the frontal, temporal, and parietal lobes, the basal ganglia, and corpus callosum. None of the lesions showed gadolinium enhancement. INTERPRETATION CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed.
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Affiliation(s)
- Y. M. Arabi
- Intensive Care Department, MC-1425, Respiratory Services, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia
| | - A. Harthi
- Neuro Physiology Services, Neurology Division, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - J. Hussein
- Neuro Radiology Section, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - A. Bouchama
- Intensive Care Unit, Experimental Medicine Department, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - S. Johani
- Microbiology, Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - A. H. Hajeer
- Basic Medical Sciences, Microbiology, Pathology and Laboratory Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - B. T. Saeed
- Cardiac Sciences Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - A. Wahbi
- Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - A. Saedy
- Infectious Disease Section, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - T. AlDabbagh
- Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - R. Okaili
- Neuro Radiology, Nuero Interventionalist, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - M. Sadat
- Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
| | - H. Balkhy
- Infection Prevention and Control Program, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia
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A Case of Acute Disseminated Encephalomyelitis in a Middle-Aged Adult. Case Rep Neurol Med 2015; 2015:601706. [PMID: 26180647 PMCID: PMC4477182 DOI: 10.1155/2015/601706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/02/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that is often preceded by infection or recent vaccination. Encephalopathy and focal neurological deficits are usually manifest several weeks after a prodromal illness with rapidly progressive neurologic decline. ADEM is most commonly seen in children and young adults, in which prognosis is favorable, but very few cases have been reported of older adults with ADEM and thus their clinical course is unknown. Methods. Here we present a case of ADEM in a middle-aged adult that recovered well after treatment. Results. A 62-year-old man presented with encephalopathy and rapid neurological decline following a gastrointestinal illness. A brain MRI revealed extensive supratentorial white matter hyperintensities consistent with ADEM and thus he was started on high dose intravenous methylprednisolone. He underwent a brain biopsy showing widespread white matter inflammation secondary to demyelination. At discharge, his neurological exam had significantly improved with continued steroid treatment and four months later, he was able to perform his ADLs. Conclusions. This case of ADEM in a middle-aged adult represents an excellent response to high dose steroid treatment with a remarkable neurological recovery. Thus it behooves one to treat suspected cases of ADEM in an adult patient aggressively, as outcome can be favorable.
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41
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Chen Y, Ma F, Xu Y, Chu X, Zhang J. Incidence of acute disseminated encephalomyelitis in the Jiangsu province of China, 2008-2011. Mult Scler J Exp Transl Clin 2015; 1:2055217315594831. [PMID: 28607697 PMCID: PMC5433407 DOI: 10.1177/2055217315594831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022] Open
Abstract
Background It is important to have an estimate of the incidence of acute disseminated encephalomyelitis (ADEM) because the incidence of ADEM is unknown and the outcomes undefined in China. Objectives This study attempts to describe ADEM incidence in large Chinese populations located in four geographically different and moderately distant areas of the same province. Methods A retrospective investigation was conducted with ADEM patients in Nanjing, Nantong, Yancheng and Xuzhou. The survey was carried out in regions that might have received patients meeting the case definition of ADEM provided by the International Pediatric MS Study Group from 2008 to 2011. A total of 125 hospitals were included and 412 patients were identified through the hospital information systems (HIS). Results The incidence of ADEM was 0.32/100,000/year. There are two peaks on the age-specific ADEM rates curve. One is 0.77/100,000/year among 0- to 9-year-olds, the other is 0.45/100,000/year in those aged 50–59 years. The incidence rate found for ADEM in males was 0.34/100,000/year, and in females was 0.29/100,000/year. The highest incidence rate was in Nanjing (0.40/100,000/year). Conclusions The average annual incidence of ADEM was 0.32/100,000/year. The peak age of onset was 50–59 years old and 0–9 years old. The incidence among males was insignificantly higher than that among females. There was no significant difference in incidence by seasonal variation.
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Affiliation(s)
- Yong Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Fubao Ma
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Yuanling Xu
- Department of Neurology, Nanjing Brain Hospital, China
| | - Xuhua Chu
- Department of Neurology, Jiangsu Provincial People's Hospital, China
| | - Jinlin Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
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Differential Diagnosis of Acute Myelopathies: An Update. Clin Neuroradiol 2015; 25 Suppl 2:183-7. [PMID: 26031429 DOI: 10.1007/s00062-015-0401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
Appropriate description may lead to adequate diagnostic and therapeutic measures, and therefore, a simple scheme to categorize and term the imaging findings of acute myelopathy is suggested based on current literature. Assigning imaging findings to five groups, that is (a) "segmental with rash," (b) "poliolike," (c) "granulomatous-nodular," (d) "longitudinally extensive transverse myelitis," (e) "short-segment ovoid or peripherally located," provides a rationale to lessen differential diagnoses. The key for understanding, proper description and differential diagnosis is the correlation of two time points: When did the first symptoms appear and when did imaging take place? Early infarction within the first 24 h will show neither swelling nor enhancement.
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Okumura A, Nakazawa M, Igarashi A, Abe S, Ikeno M, Nakahara E, Yamashiro Y, Shimizu T, Takahashi T. Anti-aquaporin 4 antibody-positive acute disseminated encephalomyelitis. Brain Dev 2015; 37:339-43. [PMID: 24837901 DOI: 10.1016/j.braindev.2014.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical and neuroimaging features of a young female patient with acute disseminated encephalomyelitis associated with anti-aquaporin-4 antibodies. METHODS The patient had mild encephalopathy 14 days after influenza vaccination. Cerebrospinal fluid analysis revealed an increased cell count and a marked increase in myelin basic protein. Magnetic resonance imaging (MRI) demonstrated multiple lesions in the juxtacortical white matter. The patient was diagnosed with acute disseminated encephalomyelitis and treated with methylprednisolone pulse therapy. She recovered in 1 month. However, right retrobulbar optic neuritis appeared 2 months after discharge, and serum anti-aquaporin 4 antibodies were measured with a cell-based assay. RESULTS Anti-aquaporin 4 antibodies were present in the patient's serum. She was treated with a prolonged course of oral prednisolone. The patient was negative for serum anti-aquaporin 4 antibodies 8 months after the second clinical event, and prednisolone was discontinued 13 months after the second clinical event. Serum anti-aquaporin 4 antibodies remained negative 4 months after the discontinuation of prednisolone. There was no evidence of relapse at 9 months after discontinuation of steroids. CONCLUSIONS This case will expand the spectrum of anti-aquaporin-4 antibody-related central nervous system disorders. The measurement of anti-aquaporin 4 antibody may be considered in patients with a clinical diagnosis of acute disseminated encephalomyelitis and a second clinical event within a short interval.
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Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan; Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Mika Nakazawa
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ayuko Igarashi
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shinpei Abe
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mitsuru Ikeno
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Eri Nakahara
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuichiro Yamashiro
- Probiotics Research Laboratory, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Sorte DE, Poretti A, Newsome SD, Boltshauser E, Huisman TAGM, Izbudak I. Longitudinally extensive myelopathy in children. Pediatr Radiol 2015; 45:244-57; quiz 241-3. [PMID: 25636706 DOI: 10.1007/s00247-014-3225-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/09/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022]
Abstract
When children present with acute myelopathy manifested by sensory, motor, or bowel and bladder symptoms, MRI of the neuraxis with contrast agent is the most important imaging study to obtain. Although occasionally normal, MRI often demonstrates signal abnormality within the spinal cord. Classically, longitudinally extensive transverse myelitis (≥3 vertebral bodies in length) has been described with neuromyelitis optica (NMO), but alternative diagnoses should be considered. This pictorial essay reviews the differential diagnoses that may present with longitudinally extensive spinal cord signal abnormalities. Multiple inflammatory, infectious, vascular, metabolic and neurodegenerative etiologies can present with a myelopathy. Thus, radiologists can assist in the diagnosis by familiarizing themselves with the spectrum of diseases in childhood that result in longitudinally extensive signal abnormalities in the absence of trauma.
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Affiliation(s)
- Danielle Eckart Sorte
- Division of Interventional Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Baruah D, Chandra T, Bajaj M, Sonowal P, Klein A, Maheshwari M, Guleria S. A simplified algorithm for diagnosis of spinal cord lesions. Curr Probl Diagn Radiol 2015; 44:256-66. [PMID: 25801464 DOI: 10.1067/j.cpradiol.2014.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/07/2014] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
Neuroimaging is indispensable for evaluation of Myelopathy not only for localization but also for etiologic determination. MRI is the preferred examination for further characterization of the majority of these conditions. These include traumatic, inflammatory, infections, compressive and neoplastic conditions. This article provides an overview of a variety of pathologies that afflict the spinal cord in an easy to understand format. Their respective imaging manifestations on MRI and differential diagnoses are focused in this review. Early diagnosis and treatment of Myelopathy is critical in preventing or arresting neurological morbidity.
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Affiliation(s)
- Dhiraj Baruah
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI.
| | - Tushar Chandra
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Manish Bajaj
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Purabi Sonowal
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Andrew Klein
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Mohit Maheshwari
- Department of Radiology, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Saurabh Guleria
- Department of Pediatric Radiology, University of Alabama, Birmingham, AL
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Takano Y, Takegawa M, Anzai K, Fujino H, Sumimoto SI. Influenza A(H1N1)pdm09 Infection With Simultaneous Comorbidity of Severe Pneumonia and Acute Disseminated Encephalomyelitis. Glob Pediatr Health 2015; 2:2333794X15574090. [PMID: 27335946 PMCID: PMC4784629 DOI: 10.1177/2333794x15574090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sacheli A, Bauer R. Influenza vaccine-induced CNS demyelination in a 50-year-old male. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:368-73. [PMID: 25175754 PMCID: PMC4159247 DOI: 10.12659/ajcr.891416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Male, 50 Final Diagnosis: Acute post-vaccination CNS demyelinating disorder Symptoms: Blurred vision • hemiparesis • hemiplegia • hypertonia • itching • paresthesia Medication: — Clinical Procedure: MRI Specialty: Neurology
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Affiliation(s)
- Aaron Sacheli
- Cracchiolo Inpatient Rehabilitation Center, St. John Hospital & Medical Center, Detroit, USA
| | - Raymond Bauer
- Cracchiolo Inpatient Rehabilitation Center, St. John Hospital & Medical Center, Detroit, USA
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Verma R, Patil TB, Lalla R, Kumar M. Extensive acute disseminated encephalomyelitis in a young girl responding to intravenous methylprednisolone. BMJ Case Rep 2013; 2013:bcr-2013-009222. [PMID: 24092604 DOI: 10.1136/bcr-2013-009222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a monophasic clinical syndrome, characterised by immune-mediated demyelination of the central nervous system. Differentiating ADEM from acute viral encephalomyelitis may pose a difficult clinical challenge. We describe a 3-year-old girl who presented with fever, weakness in all four limbs, urinary retention, respiratory distress and altered sensorium. MRI of the brain showed multiple cerebral T2-hyperintense signals with bilateral thalamic and basal ganglia involvement. MRI of the spine showed extensive T2-hyperintensities from cervical to lumbar spinal cord. Cerebrospinal fluid examination was normal. The patient was diagnosed as ADEM and treated with intravenous methylprednisolone. She showed complete clinical and radiological improvement at the end of 1-month follow-up.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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