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Tsagkas C, Wendebourg MJ, Mehling M, Lorscheider J, Lyrer P, Décard BF. Acute Polyradiculomyelitis With Spinal Cord Gray Matter Lesions: A Report of Two Cases. Front Neurol 2021; 12:721669. [PMID: 34489856 PMCID: PMC8416670 DOI: 10.3389/fneur.2021.721669] [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: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: Inflammatory polyradiculomyelitis belongs to a rare group of immune-mediated diseases affecting both the central and peripheral nervous system. We aimed to describe an unusual presentation of acute polyradiculomyelitis with marked spinal cord lesions restricted to the gray matter. Methods: Thorough examination of two case reports including clinical, MRI, serologic, electrophysiologic and CSF examinations as well as short-term follow-up. Results: We present two adult patients with acute polyradiculomyelitis and unusual spinal cord lesions restricted to the gray matter on MRI. The clinical presentation, serologic, electrophysiologic and CSF features of the two patients varied, whereas both patients demonstrated severe, asymmetrical, predominantly distal, motor deficits of the lower extremities as well as bladder and bowel dysfunction. Both patients only partially responded to anti-inflammatory treatment. Severe motor impairment and bladder dysfunction persisted even months after symptom onset. Conclusions: To our best of knowledge, these are the first reports of acute polyradiculomyelitis with distinct involvement of the lower thoracic spinal cord gray matter. Currently, it remains unclear whether gray matter lesions reflect a separate pathophysiologic mechanism or an exceedingly rare presentation of spinal cord involvement in acute polyradiculomyelitis.
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Affiliation(s)
- Charidimos Tsagkas
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Maria Janina Wendebourg
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Mehling
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Bernhard Friedrich Décard
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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2
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Langerak T, van Rooij I, Doornekamp L, Chandler F, Baptista M, Yang H, Koopmans MPG, GeurtsvanKessel CH, Jacobs BC, Rockx B, Adriani K, van Gorp ECM. Guillain-Barré Syndrome in Suriname; Clinical Presentation and Identification of Preceding Infections. Front Neurol 2021; 12:635753. [PMID: 33643209 PMCID: PMC7902883 DOI: 10.3389/fneur.2021.635753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/20/2021] [Indexed: 01/08/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is associated with various types of preceding infections including Campylobacter jejuni and cytomegalovirus, but there is also an association with arthropod borne viruses (arboviruses), such as Zika virus, that are endemic in tropical regions. Here we present the clinical characteristics of 12 GBS patients from Suriname that were hospitalized between the beginning of 2016 and half 2018. Extensive diagnostic testing was performed for pathogens that are commonly associated with GBS, but also for arboviruses, in order to identify the preceding infection that might have led to GBS. With this extensive testing algorithm, we could identify a recent infection in six patients of which four of them had evidence of a recent Zika virus or dengue virus infection. These results suggest that arboviruses, specifically Zika virus but possibly also dengue virus, might be important causative agents of GBS in Suriname. Furthermore, we found that more accessibility of intravenous immunoglobulins or plasma exchange could improve the treatment of GBS in Suriname.
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Affiliation(s)
- Thomas Langerak
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
| | - Irene van Rooij
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
| | - Laura Doornekamp
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
| | - Felicity Chandler
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mark Baptista
- Department of Neurology, St. Vincentius Hospital, Paramaribo, Suriname
| | - Harvey Yang
- Department of Neurology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | | | - Bart C Jacobs
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Immunology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Barry Rockx
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kirsten Adriani
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Neurology, Zaans Medisch Centrum, Zaandam, Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
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3
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Agarwal A, Fernandez Bowman A. Synchronous Occurrence of Guillain-Barre Syndrome and Transverse Myelitis of Unknown Etiology in an Adolescent. Cureus 2020; 12:e9645. [PMID: 32923245 PMCID: PMC7480888 DOI: 10.7759/cureus.9645] [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] [Indexed: 11/05/2022] Open
Abstract
Synchronous occurrence of Guillain-Barre syndrome (GBS) and acute transverse myelitis (ATM) happens very rarely in childhood. Only a few cases of these conditions occurring simultaneously have been reported and represent a diagnostic challenge. We describe a case of a 17-year-old male presenting with acute onset of bilateral symmetrical numbness and tingling starting in the feet that rapidly ascended to the legs with associated motor weakness, associated with a sensory level and urinary retention. Albuminocytologic dissociation on cerebrospinal fluid (CSF) analysis was consistent with GBS. MRI spine revealed an area of increased T2 signal involving the dorsal aspect of the left side of the cord at the C7 level. The patient was treated with IV methylprednisolone and IV immunoglobulin with significant improvement. This report emphasizes the rarity of this synchronous occurrence in children and the need for further reports to understand the mechanism and better treatment approaches.
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Gharzeddine J, Renner B, Wassall N, Tran K, Liu A. Young woman with Guillain-Barré syndrome and cervical transverse myelitis-A new GBS variant, not coincidence. Clin Case Rep 2020; 8:1048-1052. [PMID: 32577262 PMCID: PMC7303867 DOI: 10.1002/ccr3.2818] [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: 11/04/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 11/07/2022] Open
Abstract
A case of antibody proven Guillain Barré Syndrome in a previously healthy young female with extra clinical features, scans, and physical exam findings consistent with cervical spine and cervical medullary junction myelitis, together a new variant to consider.
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Affiliation(s)
- Jenna Gharzeddine
- Department of NeurologyWhite Memorial Medical CenterLos AngelesCAUSA
| | - Brian Renner
- Department of NeurologyCalifornia Hospital Medical CenterLos AngelesCAUSA
- Department of NeurologyCedars‐Sinai Health SystemLos AngelesCAUSA
| | - Natalie Wassall
- Department of NeurologyWhite Memorial Medical CenterLos AngelesCAUSA
| | - Kristen Tran
- Department of NeurologyWhite Memorial Medical CenterLos AngelesCAUSA
| | - Antonio Liu
- Department of NeurologyWhite Memorial Medical CenterLos AngelesCAUSA
- Department of NeurologyCalifornia Hospital Medical CenterLos AngelesCAUSA
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5
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Stoian A, Motataianu A, Bajko Z, Balasa A. Guillain-Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery. J Crit Care Med (Targu Mures) 2020; 6:74-79. [PMID: 32104735 PMCID: PMC7029401 DOI: 10.2478/jccm-2020-0008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION There are rare reports of the occurrence of acute transverse myelitis and Guillain-Barré syndrome after various surgical procedures and general/epidural anaesthesia. The concomitant occurrence of these pathologies is very rare and is called Guillain-Barré and acute transverse myelitis overlap syndrome. In this article, we present the case of a second trimester pregnant patient who developed Guillain-Barré and acute transverse myelitis overlap syndrome. CASE PRESENTATION We report the case of a 16-year-old female patient who underwent a therapeutic termination of pregnancy two weeks prior to the onset of the disease with gradual development of a motor deficit with walking and sensitivity disorders, fecal incontinence. The diagnosis was based on clinical exam, electroneurography and spinal magnetic resonance imaging. Endocrinopathies, infectious diseases, autoimmune and inflammatory diseases, neoplastic diseases and vitamin deficiencies were ruled out. Our patient attended five sessions of therapeutic plasma exchange, followed by steroid treatment, intravenous immunoglobulin with minimum recovery of the motor deficit in the upper limbs, but without significant evolution of the motor deficit in the lower limbs. The patient was discharged on maintenance corticotherapy and immunosuppressive treatment with azathioprine. CONCLUSIONS We report a very rare association between Guillain-Barré syndrome and acute transverse myelitis triggered by a surgical intervention with general anaesthesia. The overlap of Guillain-Barré syndrome and acute transverse myelitis makes the prognosis for recovery worse, and further studies are needed to establish the first-line therapy in these cases.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu MuresRomania
- Neurology 1 Clinic, Emergency Clinical County Hospital of Targu Mures, Targu MuresRomania
| | - Anca Motataianu
- Neurology 1 Clinic, Emergency Clinical County Hospital of Targu Mures, Targu MuresRomania
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu MuresRomania
| | - Zoltan Bajko
- Neurology 1 Clinic, Emergency Clinical County Hospital of Targu Mures, Targu MuresRomania
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu MuresRomania
| | - Adrian Balasa
- Neurosurgery Clinic, Emergency Clinical County Hospital of Targu Mures, Targu MuresRomania
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu MuresRomania
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Guo F, Zhang YB. Clinical features and prognosis of patients with Guillain-Barré and acute transverse myelitis overlap syndrome. Clin Neurol Neurosurg 2019; 181:127-132. [PMID: 31039494 DOI: 10.1016/j.clineuro.2019.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Patients who present with Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM), either simultaneously or consecutively, are defined as having GBS/ATM overlap syndrome. As this syndrome has been underinvestigated, we performed a literature review to evaluate case reports of GBS/ATM overlap syndrome to facilitate its early diagnosis. PATIENTS AND METHODS We searched four scientific literature databases (PUBMED, EMBASE, ELSEVIER and WEB OF SCIENCE) for cases that presented as GBS/ATM overlap syndrome. Eighteen articles that described 23 cases were included, and the clinical and prognostic data were analyzed. RESULTS Initially, only five (29.4%) patients were diagnosed with GBS/ATM overlap syndrome. Patients with GBS/ATM overlap syndrome presented as four clinical features. First, some of the patients displayed abnormal pyramidal signs, including 29.4% of patients who had positive pyramidal signs or a negative plantar reflex and 17.6% of patients who had signs of areflexia or hyporeflexia combined with positive pyramidal signs. Second, patients suffered pain and respiratory failure at a high rate (43.5% with pain at the onset of the disease, 43.5% with ventilator support, and 47.8% shown with respiratory failure). Third, patients had a partial clinical recovery of immunomodulators, 56.5% of patients had a favorable outcome, 46.2% of patients who received intravenous immunoglobulin (IVIG) combined steroids responded well to the treatment. Four, acute axonal polyneuropathy seemed to be associated with poor outcomes (odds ratio = 3.00, 95% CI = 1.35-6.68, P = 0.01). Abnormalities in spinal cord magnetic resonance imaging (MRI) were detected in all patients, and the most frequently involved segments were the cervical cord (69.6%) and the thoracic cord (69.6%). In addition to spinal cord lesions, in three patients lesions in the medulla and cerebral hemisphere were also observed. The most common prescriptions included a high dose of methylprednisolone at 1 g/day for 3-5 days that was followed by a 6-week course of oral prednisone and IVIG at 0.4 g/kg/day for 5 days. CONCLUSION While it is difficult to make an early diagnosis of GBS/ATM overlap syndrome, electrophysiology is helpful in the diagnosis of GBS and spinal cord MRIs are key to identifying ATM. Brain MRIs are also recommended to detect subclinical lesions. The combined use of IVIG and steroids was the most frequent treatment. However, less than half of the patients responded positively to treatment. Acute axonal neuropathy may be a risk factor for a poor prognosis.
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Affiliation(s)
- Fang Guo
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yong-Bo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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7
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Degan D, Tiseo C, Ornello R, Notturno F. Acute motor axonal neuropathy and transverse myelitis overlap: the importance of history taking. Intern Emerg Med 2018; 13:445-447. [PMID: 29143293 DOI: 10.1007/s11739-017-1771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/10/2017] [Indexed: 11/29/2022]
Abstract
In young adults, acute motor axonal neuropathy and transverse myelitis rarely occur as associated conditions. Clinical reasoning, symptoms, laboratory and ancillary investigations (electroneurographic and radiological findings), should properly address the physician to the correct diagnosis.
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Affiliation(s)
- Diana Degan
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy.
| | - Cindy Tiseo
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, via Vetoio, 67100, L'Aquila, Italy
| | - Francesca Notturno
- Department of Neurology and Stroke Unit, Avezzano Hospital, 67051, Avezzano, Italy
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8
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Ceccanti M, Sbardella E, Letteri F, De Michele M, Falcou A, Romanzi F, Onesti E, Inghilleri M. Acute Flaccid Paralysis by Enterovirus D68 Infection: First Italian Description in Adult Patient and Role of Electrophysiology. Front Neurol 2017; 8:638. [PMID: 29230194 PMCID: PMC5711819 DOI: 10.3389/fneur.2017.00638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022] Open
Abstract
A Peruvian woman was admitted to the Emergency Department, due to an acute flaccid paralysis (AFP) of the upper limbs that progressively involved also lower limbs and respiratory muscles. She previously suffered from non-Hodgkin’s lymphoma and had to undergo hematopoietic stem cell transplantation. A magnetic resonance imaging showed a T2 hyperintensity in the anterior and central region of the cervical segment with an elective involvement of gray matter. This finding, combined with other clinical, laboratory, and electrophysiological data, led to a diagnosis of AFP. Enterovirus D68 was isolated in the patient’s cerebrospinal fluid, plasma, and throat swab. To our knowledge, this is the first Italian case of AFP by Enterovirus D68 infection in an adult. The diagnostic assessment and management of AFP by Enterovirus D68 are discussed.
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Affiliation(s)
- Marco Ceccanti
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Emilia Sbardella
- Emergency Department, Stroke Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federica Letteri
- Emergency Department, Stroke Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Manuela De Michele
- Emergency Department, Stroke Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Anne Falcou
- Emergency Department, Stroke Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federica Romanzi
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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9
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Yang J, Lee YB, Lee KW, Park HM. Atypical Acute Motor Axonal Neuropathy with Cerebrospinal Pleocytosis Mimicking Myelitis. J Clin Neurol 2017; 13:205-206. [PMID: 28176505 PMCID: PMC5392467 DOI: 10.3988/jcn.2017.13.2.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jiwon Yang
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Yeong Bae Lee
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang Woo Lee
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeon Mi Park
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea.
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10
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Tolunay O, Çelik T, Çelik Ü, Kömür M, Tanyeli Z, Sönmezler A. Concurrency of Guillain-Barre syndrome and acute transverse myelitis: a case report and review of literature. KOREAN JOURNAL OF PEDIATRICS 2016; 59:S161-S164. [PMID: 28018472 PMCID: PMC5177703 DOI: 10.3345/kjp.2016.59.11.s161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/03/2015] [Accepted: 01/27/2015] [Indexed: 12/14/2022]
Abstract
Guillain-Barré syndrome and acute transverse myelitis manifest as demyelinating diseases of the peripheral and central nervous system. Concurrency of these two disorders is rarely documented in literature. A 4-year-old girl presenting with cough, fever, and an impaired walking ability was admitted to hospital. She had no previous complaints in her medical history. A physical examination revealed lack of muscle strength of the lower extremities and deep tendon reflexes. MRI could not be carried out due to technical problems; therefore, both Guillain-Barré syndrome and acute transverse myelitis were considered for the diagnosis. Intravenous immunoglobulin treatment was started as first line therapy. Because this treatment did not relieve the patient's symptoms, spinal MRI was carried out on the fourth day of admission and demyelinating areas were identified. Based on the new findings, the patient was diagnosed with acute transverse myelitis, and high dose intravenous methylprednisolone therapy was started. Electromyography findings were consistent with acute polyneuropathy affecting both motor and sensory fibers. Therefore, the patient was diagnosed with concurrency of Guillain-Barré syndrome and acute transverse myelitis. Interestingly, while concurrency of these 2 disorders is rare, this association has been demonstrated in various recent publications. Progress in diagnostic tests (magnetic resonance imaging and electrophysiological examination studies) has enabled clinicians to establish the right diagnosis. The possibility of concurrent Guillain-Barré syndrome and acute transverse myelitis should be considered if recovery takes longer than anticipated.
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Affiliation(s)
- Orkun Tolunay
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Tamer Çelik
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Çelik
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mustafa Kömür
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Zeynep Tanyeli
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Abdurrahman Sönmezler
- Department of Neurology, Adana Numune Training and Research Hospital, Turkey and Research Hospital, Adana, Turkey
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11
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Chung H, Joa KL, Kim HS, Kim CH, Jung HY, Kim MO. Concomitant acute transverse myelitis and sensory motor axonal polyneuropathy in two children: two case reports. Ann Rehabil Med 2015; 39:142-5. [PMID: 25750885 PMCID: PMC4351487 DOI: 10.5535/arm.2015.39.1.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/29/2014] [Indexed: 11/05/2022] Open
Abstract
Acute transverse myelitis (ATM) is an upper motor neuron disease of the spinal cord, and concomitant association of peripheral polyneuropathy, particularly the axonal type, is rarely reported in children. Our cases presented with ATM complicated with axonal type polyneuropathy. Axonal type polyneuropathy may be caused by acute motor-sensory axonal neuropathy (AMSAN) or critical illness polyneuropathy and myopathy (CIPNM). These cases emphasize the need for nerve and muscle biopsies to make the differential diagnosis between AMSAN and CIPNM in patients with ATM complicated with axonal polyneuropathy.
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Affiliation(s)
- Hyung Chung
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyung-Lim Joa
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyo-Sang Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Chang-Hwan Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Han-Young Jung
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Myeong Ok Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
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12
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Mao Z, Hu X. Clinical characteristics and outcomes of patients with Guillain–Barré and acquired CNS demyelinating overlap syndrome: a cohort study based on a literature review. Neurol Res 2014; 36:1106-13. [DOI: 10.1179/1743132814y.0000000400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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14
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Canpolat M, Kumandas S, Yikilmaz A, Gumus H, Koseoglu E, Poyrazoğlu HG, Kose M, Per H. Transverse myelitis and acute motor sensory axonal neuropathy due to Legionella pneumophila: a case report. Pediatr Int 2013; 55:778-82. [PMID: 24330286 DOI: 10.1111/ped.12126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 11/07/2012] [Accepted: 04/10/2013] [Indexed: 11/29/2022]
Abstract
Guillain-Barré syndrome is a rapidly progressive symmetrical muscle weakness associated with acute inflammatory disease. Transverse myelitis (TM) is the inflammation of the spinal cord characterized by rapidly evolving muscle weakness in the lower extremities, defects in sensory level and sphincter dysfunction. Guillain-Barré syndrome, and TM association occurs very rarely in childhood. A 7-year-old girl presented with complaints of neck pain, spout-style vomiting, cough, shortness of breath, and acute paraparesis with sensory and sphincter disturbance. The patient was intubated because of increased respiratory distress. A positive direct fluorescein antigen test in bronchoalveolar lavage confirmed Legionella pneumophila infection. Imaging and neurophysiologic studies were diagnostic for TM with acute motor and sensory axonal neuropathy. She was treated with a combination of high-dose methylprednisolone and intravenous immunoglobulins, and we observed incomplete recovery. The presented case is the first child with concomitant TM and acute motor and sensory axonal neuropathy related to L. pneumophila infection.
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Affiliation(s)
- Mehmet Canpolat
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Kayseri, Turkey
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15
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Topcu Y, Bayram E, Karaoglu P, Yis U, Guleryuz H, Kurul SH. Coexistence of myositis, transverse myelitis, and Guillain Barré syndrome following Mycoplasma pneumoniae infection in an adolescent. J Pediatr Neurosci 2013; 8:59-63. [PMID: 23772249 PMCID: PMC3680901 DOI: 10.4103/1817-1745.111428] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Guillain-Barré syndrome (GBS) and transverse myelitis may occur coexistently in the pediatric population. This may be explained by a shared epitope between peripheral and central nervous system myelin. Coexistent transverse myelitis, myositis, and acute motor neuropathy in childhood have not been previously described. We describe a 14-year-old female patient with transverse myelitis, myositis, and GBS following Mycoplasma pneumoniae infection. She presented with weakness and walking disability. Weakness progressed to involve all extremities and ultimately, she was unable to stand and sit. Based on the clinical findings, a presumptive diagnosis of myositis was made at an outside institution because of high serum creatine kinase level. The patient was referred to our institution for further investigation. Magnetic resonance imaging of spine revealed enhancing hyperintense lesions in the anterior cervicothoracic spinal cord. The electromyography revealed acute motor polyneuropathy. Serum M. pneumoniae IgM and IgG were positive indicating an acute infection. Repeated M. pneumoniae serology showed a significant increase in Mycoplasma IgG titer. The patient was given intravenous immunoglobulin for 2 days and clarithromycin for 2 weeks. She was able to walk without support after 2 weeks of hospitalization. This paper emphasizes the rarity of concomitant myositis, transverse myelitis, and GBS in children.
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Affiliation(s)
- Yasemin Topcu
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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16
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Lin JJ, Hsia SH, Wu CT, Wang HS, Lin KL, Lyu RK. Risk factors and outcomes of Guillain-Barré syndrome with acute myelitis. Pediatr Neurol 2011; 44:110-6. [PMID: 21215910 DOI: 10.1016/j.pediatrneurol.2010.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/07/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
Guillain-Barré syndrome and acute myelitis represent common and very rare etiologies of acute limb weakness in children, respectively. Typically, demyelination is most common, limited to either the central or peripheral nervous system. Concurrent acute myelitis and Guillain-Barré syndrome are seldom reported. We retrospectively reviewed cases of Guillain-Barré syndrome in Chang Gung Children's Hospital from 2000-2008. The risk factors of Guillain-Barré syndrome with or without acute myelitis were analyzed. Thirty-six children with Guillain-Barré syndrome were enrolled. Five children manifested coexisting acute myelitis. In the disease's earliest stage, differentiating concurrent acute myelitis and Guillain-Barré syndrome from Guillain-Barré syndrome only was difficult. Four of 5 children were aged more than 8 years. All patients developed a sharply defined sensory level, and manifested severe bladder dysfunction. Autonomic dysfunction was evident in three patients. All children with sufficient follow-up continued to demonstrate residual paresis, and two demonstrated significant long-term motor deficits. Detection of a sharply defined sensory level, severe bladder dysfunction, and autonomic dysfunction can be helpful in recognizing concurrent acute myelitis. Therefore, recognition of this combination of peripheral and central nervous inflammation early is important for determining prognoses and perhaps initial treatment.
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Affiliation(s)
- Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Sato N, Watanabe K, Ohta K, Tanaka H. Acute transverse myelitis and acute motor axonal neuropathy developed after vaccinations against seasonal and 2009 A/H1N1 influenza. Intern Med 2011; 50:503-7. [PMID: 21372468 DOI: 10.2169/internalmedicine.50.4340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute transverse myelitis (ATM) has been described as an uncommon complication of vaccinations and is rarely accompanied by inflammatory peripheral neuropathy. We report a case of a 77-year-old woman who developed ATM and acute motor axonal neuropathy (AMAN) following vaccinations against seasonal and 2009 A/H1N1 influenza. She manifested ophthalmoplegia, quadriparesis and sensory impairment. MR imaging showed a longitudinally-extensive spinal cord lesion, and nerve conduction study revealed motor axonal polyneuropathy. Despite prompt treatment, her symptoms poorly recovered. While concurrent ATM and AMAN may suggest the presence of a common antigen, their scarcity indicates the importance of other factors causing immunologic disruptions.
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Affiliation(s)
- Nozomu Sato
- Department of Neurology, Yokohama City Minato Red Cross Hospital, Japan.
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