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Kurtanović N, Gogić E, Tanović E, Čelik D, Mulić Hadžiavdić E. Rehabilitation of Rare Neurological Complications of COVID-19 Infection in Health Resort Settings. Cureus 2024; 16:e58221. [PMID: 38745792 PMCID: PMC11091940 DOI: 10.7759/cureus.58221] [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: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
There is increasing evidence of neurological involvement in patients with coronavirus disease. Reports of neurological manifestations include altered mental status, Guillain-Barré syndrome (GBS) and its forms, encephalopathy, psychosis, neurocognitive (dementia) syndrome, ischemic strokes, intracerebral hemorrhage, and acute transverse myelitis. We present three patients with rare neurological manifestations of the COVID-19 disease, with a special focus on rehabilitation in a health resort setting. Outcomes were evaluated based on neurological examination and the modified Barthel index. We highlight the importance of an interdisciplinary approach to reduce disability and improve functionality and quality of life.
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Affiliation(s)
- Nadina Kurtanović
- Department of Physical Medicine and Rehabilitation, Health Institution Spa Gata - Bihać, Bihać, BIH
| | - Ena Gogić
- Clinic for Physical Medicine and Rehabilitation, Clinical Center University of Sarajevo, Sarajevo, BIH
| | - Edina Tanović
- Clinic for Physical Medicine and Rehabilitation, Clinical Center University of Sarajevo, Sarajevo, BIH
| | - Damir Čelik
- Clinic for Physical Medicine and Rehabilitation, Clinical Center University of Sarajevo, Sarajevo, BIH
| | - Elmina Mulić Hadžiavdić
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center - Tuzla, Tuzla, BIH
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Sun YF, Liu LL, Jiang SS, Zhang XJ, Liu FJ, Zhang WM. Influence of ganglioside combined with methylprednisolone sodium succinate on efficacy and neurological function in patients with acute myelitis. World J Clin Cases 2023; 11:7972-7979. [DOI: 10.12998/wjcc.v11.i33.7972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Acute myelitis (AM) can lead to sudden sensory, motor and autonomic nervous dysfunction, which negatively affects their daily activities and quality of life, so it is necessary to explore optimization from a therapeutic perspective to curb the progression of the disease.
AIM To investigate the effect of ganglioside (GM) combined with methylprednisolone sodium succinate (MPSS) on the curative effect and neurological function of patients with AM.
METHODS First, we selected 108 AM patients visited between September 2019 and September 2022 and grouped them based on treatment modality, with 52 patients receiving gamma globulin (GG) + MPSS and 56 patients receiving GM + MPSS, assigned to the control group (Con) and observation group (Obs), respectively. The therapeutic effect, neurological function (sensory and motor function scores), adverse events (AEs), recovery (time to sphincter function recovery, time to limb muscle strength recovery above grade 2, and time to ambulation), inflammatory factors (IFs) [interleukin (IL)-6, C-reactive protein (CRP), and tumor necrosis factor (TNF)-α] and other data of the two groups were collected for evaluation and comparison.
RESULTS The Obs had: (1) A significantly higher response rate of treatment than the Con; (2) Higher scores of sensory and motor functions after treatment that were higher than the baseline (before treatment) and higher than the Con levels; (3) Lower incidence rates of skin rash, gastrointestinal discomfort, dyslipidemia, osteoporosis and other AEs; (4) Faster posttreatment recovery of sphincter function, limb muscle strength and ambulation; and (5) Markedly lower posttreatment IL-6, CRP and TNF-α levels than the baseline and the Con levels.
CONCLUSION From the above, it can be seen that GM + MPSS is highly effective in treating AM, with a favorable safety profile comparable to that of GG + MPSS. It can significantly improve patients’ neurological function, speed up their recovery and inhibit serum IFs.
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Affiliation(s)
- Yu-Fei Sun
- Department of Special Medicine, Basic Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
| | - Li-Li Liu
- Department of Medical Microbiology, Basic Medical College of Qingdao University, Qingdao 266075, Shandong Province, China
| | - Sha-Sha Jiang
- Department of Medical Microbiology, Basic Medical College of Qingdao University, Qingdao 266075, Shandong Province, China
| | - Xian-Juan Zhang
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Feng-Jun Liu
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wan-Ming Zhang
- Department of Special Medicine, Basic Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
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Fonseca JP, Coelho A, Lourenço AC, Pires C, Margalho P. Longitudinally extensive transverse myelitis (LETM) secondary to SARS‐CoV‐2 infection: A recent reality in spinal cord injury rehabilitation. Clin Case Rep 2022; 10:e05876. [PMID: 35592048 PMCID: PMC9097372 DOI: 10.1002/ccr3.5876] [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: 01/30/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022] Open
Abstract
Transverse myelitis can be a complication of SARS‐CoV‐2 infection. We report the case of a transverse myelitis related to SARS‐CoV‐2 infection. Beyond the disease itself, neurological involvement affects functionality. In this situation, physical and rehabilitation medicine plays a crucial role in managing patient rehabilitation.
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Affiliation(s)
- João P. Fonseca
- Department Physical and Rehabilitation Medicine Coimbra Hospital and University Center Coimbra Portugal
| | - Alexandra Coelho
- Department Physical and Rehabilitation Medicine Coimbra Hospital and University Center Coimbra Portugal
| | - Ana C. Lourenço
- Rovisco Pais Medical and Rehabilitation Center Tocha Portugal
| | - César Pires
- Rovisco Pais Medical and Rehabilitation Center Tocha Portugal
| | - Paulo Margalho
- Rovisco Pais Medical and Rehabilitation Center Tocha Portugal
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Barman A, Sahoo J, Viswanath A, Roy SS, Swarnakar R, Bhattacharjee S. Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection: A Narrative Review. Am J Phys Med Rehabil 2021; 100:919-939. [PMID: 34347629 PMCID: PMC8436817 DOI: 10.1097/phm.0000000000001857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT The objective of this review was to analyze the existing data on acute inflammatory myelopathies associated with coronavirus disease 2019 infection, which were reported globally in 2020. PubMed, CENTRAL, MEDLINE, and online publication databases were searched. Thirty-three acute inflammatory myelopathy cases (among them, seven cases had associated brain lesions) associated with coronavirus disease 2019 infection were reported. Demyelinating change was seen in cervical and thoracic regions (27.3% each, separately). Simultaneous involvement of both regions, cervical and thoracic, was seen in 45.4% of the patients. Most acute inflammatory myelopathy disorders reported sensory motor and bowel bladder dysfunctions. On cerebrospinal fluid analysis, pleocytosis and increased protein were reported in 56.7% and 76.7% of the patients, respectively. Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction was positive in five patients. On T2-weighted imaging, longitudinally extensive transverse myelitis and short-segment demyelinating lesions were reported in 76% and 21%, respectively. Among the patients with longitudinally extensive transverse myelitis, 61% reported "moderate to significant" improvement and 26% demonstrated "no improvement" in the motor function of lower limbs. Demyelinating changes in the entire spinal cord were observed in three patients. Most of the patients with acute inflammatory myelopathy (including brain lesions) were treated with methylprednisolone (81.8%) and plasma-exchange therapy (42.4%). An early treatment, especially with intravenous methylprednisolone with or without immunoglobulin and plasma-exchange therapy, helped improve motor recovery in the patients with acute inflammatory myelopathy associated with coronavirus disease 2019.
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Aloba JO, Muradia S, Monaghan A, Afolabi Z, Prasad RS. Idiopathic acute transverse myelitis in a middle-aged woman with progression to nadir in less than one hour. BMJ Case Rep 2021; 14:14/6/e240259. [PMID: 34088683 DOI: 10.1136/bcr-2020-240259] [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: 11/04/2022] Open
Abstract
We report a case of a middle-aged woman, normally fit and well, presenting with acute onset neurological deficit with progression to nadir in <1 hour. Initial MRI spine showed no significant abnormality, although second MRI spine showed abnormal signal in three to four segments with no compressive lesion. CT aortic angiography excluded vascular or ischaemic abnormality. We made a diagnosis of idiopathic acute transverse myelitis (ATM). She was treated with steroids and made significant progress improving from T11 ASIA A paraplegia to T11 ASIA C paraplegia by the time of discharge. Awareness of idiopathic ATM presenting hyperacutely with initial MRI spine being normal is important for prompt diagnosis and management.
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Affiliation(s)
- Jamiu Omotayo Aloba
- Emergency Medicine department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sagarika Muradia
- Neurology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Zainab Afolabi
- Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
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D’Amico S, Pavone P, Testa G, Greco F, Marino L, Smilari P, Pavone V. Secondary Scoliosis as a Complication of Acute Transverse Myelitis in a Child. J Funct Morphol Kinesiol 2020; 5:jfmk5020039. [PMID: 33467256 PMCID: PMC7739325 DOI: 10.3390/jfmk5020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022] Open
Abstract
Acute transverse myelitis (ATM) is a rare neurological condition that affects the spinal cord. Several events, including infections, autoimmune conditions, inflammatory, and drug-induced factors, may cause this disorder. Correct and rapid etiological diagnosis is necessary in order to start appropriate treatment that mainly consists of immunomodulating therapy, high dose intravenous corticosteroids, and in plasma exchange in noninfectious cases. The outcome is varied and depends on several factors. In children, the prognosis is usually good. We report a case of an 11-year-old boy who presented with interscapular pain, right leg steppage, homolateral hyposthenia of the upper limb, and signs of autonomic dysfunction. After performing specific and instrumental exams, a diagnosis of transverse myelitis was reached, and appropriate therapy was performed. A few days post-treatment, the child developed a secondary scoliosis, involving a thoracolumbar curve with loss of cervical and lumbar lordosis. After rehabilitative treatment was undertaken for 12 months, a complete recovery and normal restoration of spinal physiological curves was obtained. The pediatric cases of ATM have a good response to steroid therapy combined with physiotherapy. Collaboration among the various specialists is worthwhile, in order to lead to a correct and rapid diagnosis.
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Affiliation(s)
- Silvia D’Amico
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Gianluca Testa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Filippo Greco
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Lidia Marino
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Pierluigi Smilari
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Vito Pavone
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
- Correspondence: ; Tel.: +39-095-378-2273; Fax: +39-095-378-2320
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Bulut E, Shoemaker T, Karakaya J, Ray DM, Mealy MA, Levy M, Izbudak I. MRI Predictors of Recurrence and Outcome after Acute Transverse Myelitis of Unidentified Etiology. AJNR Am J Neuroradiol 2019; 40:1427-1432. [PMID: 31296526 DOI: 10.3174/ajnr.a6121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/06/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE The early prediction of recurrence after an initial event of transverse myelitis helps to guide preventive treatment and optimize outcomes. Our aim was to identify MR imaging findings predictive of relapse and poor outcome in patients with acute transverse myelitis of unidentified etiology. MATERIALS AND METHODS Spinal MRIs of 77 patients (mean age, 36.3 ± 20 years) diagnosed with acute transverse myelitis were evaluated retrospectively. Only the patients for whom an underlying cause of myelitis could not be identified within 3 months of symptom onset were included. Initial spinal MR images of patients were examined in terms of lesion extent, location and distribution, brain stem extension, cord expansion, T1 signal, contrast enhancement, and the presence of bright spotty lesions and the owl's eyes sign. The relapse rates and Kurtzke Expanded Disability Status Scale scores at least 1 year (range, 1-14 years) after a myelitis attack were also recorded. Associations of MR imaging findings with clinical variables were studied with univariate associations and binary log-linear regression. Differences were considered significant for P values < .05. RESULTS Twenty-seven patients (35.1%) eventually developed recurrent disease. Binary logistic regression revealed 3 main significant predictors of recurrence: cord expansion (OR, 5.30; 95% CI, 1.33-21.11), contrast enhancement (OR, 5.05; 95% CI, 1.25-20.34), and bright spotty lesions (OR, 3.63; 95% CI, 1.06-12.43). None of the imaging variables showed significant correlation with the disability scores. CONCLUSIONS Cord expansion, contrast enhancement, and the presence of bright spotty lesions could be used as early MR imaging predictors of relapse in patients with acute transverse myelitis of unidentified etiology. Collaborative studies with a larger number of patients are required to validate these findings.
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Affiliation(s)
- E Bulut
- From the Departments of Radiology (E.B.)
| | - T Shoemaker
- Department of Neurology (T.S., M.A.M., M.L.)
- Department of Neurological Sciences (T.S.), Rush University Medical Center, Chicago, Illinois
| | - J Karakaya
- Statistics (J.K.), Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - D M Ray
- Division of Neuroradiology (D.M.R., I.I.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M A Mealy
- Department of Neurology (T.S., M.A.M., M.L.)
| | - M Levy
- Department of Neurology (T.S., M.A.M., M.L.)
- Department of Neurology (M.L.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - I Izbudak
- Division of Neuroradiology (D.M.R., I.I.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Moore BJ, Batterson AM, Luetmer MT, Reeves RK. Fibrocartilaginous embolic myelopathy: demographics, clinical presentation, and functional outcomes. Spinal Cord 2018; 56:1144-1150. [PMID: 29802396 DOI: 10.1038/s41393-018-0159-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To describe the demographics, clinical presentation, and functional outcomes of fibrocartilaginous embolic myelopathy (FCEM). SETTING Academic inpatient rehabilitation unit in the midwestern United States. METHODS We retrospectively searched our database to identify patients admitted between January 1, 1995 and March 31, 2016, with a high probability of FCEM. Demographic, clinical, and functional outcome measures, including Functional Independence Measure (FIM) information was obtained by chart review. RESULTS We identified 31 patients with findings suggestive of FCEM (52% male), which was 2% of the nontraumatic spinal cord injury population admitted to inpatient rehabilitation. The age distribution was bimodal, with peaks in the second and sixth-to-seventh decades. The most common clinical presentation was acute pain and rapid progression of neurologic deficits consistent with a vascular myelopathy. Only three patients (10%) had FCEM documented as a diagnostic possibility. Most patients had paraplegia and neurologically incomplete injuries and were discharged to home. Nearly half of the patients required no assistive device for bladder management at discharge, but most were discharged with medications for bowel management. Median FIM walking locomotion score for all patients was 5, but most patients were discharged using a wheelchair for primary mobility. Median motor FIM subscale score was 36 at admission and 69 at discharge, with a median motor efficiency of 1.41. CONCLUSIONS FCEM may be underdiagnosed and should be considered in those with the appropriate clinical presentation, because their functional outcomes may be more favorable than those with other causes of spinal cord infarction.
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Affiliation(s)
- Brittany J Moore
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Anna M Batterson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Marianne T Luetmer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ronald K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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