1
|
Drost EHGM, Chekrouni N, Brouwer MC, van de Beek D. Noncompressive myelopathy in acute community-acquired bacterial meningitis: Report of seven cases and review of literature. Eur J Neurol 2024:e16447. [PMID: 39222058 DOI: 10.1111/ene.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/24/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND PURPOSE Bacterial meningitis is a severe disease with high rates of complications and unfavorable outcome. Complications involving the spinal cord are rarely reported. METHODS Cases of noncompressive myelopathy were identified from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands. The American Spinal Injury Association Impairment Scale was used to classify the severity of spinal cord dysfunction. Subsequently, we reviewed the literature on noncompressive myelopathy as a complication of bacterial meningitis. RESULTS Noncompressive myelopathy was reported in seven of 3047 episodes of community-acquired bacterial meningitis (0.2%). The median age of these patients was 51 years (range = 17-77). Causative pathogens were Streptococcus pneumoniae in three, Streptococcus agalactiae in two, and Neisseria meningitidis and Haemophilus influenzae both in one. Paresis of legs (n = 6) or arms and legs (n = 1) was the presenting symptom, occurring after a median duration of 9 days after admission (range = 2-28). Spinal magnetic resonance imaging showed T2-weighted abnormalities of the spinal cord in six of seven patients. Improvement of spinal cord function during admission was noted in four of seven patients. The literature review yielded 15 additional cases. Among patients from our cohort and the literature, there was no significant association between immunosuppressive therapy and subsequent improvement of spinal cord function (5/8 patients with immunosuppressive therapy [63%] vs. 5/14 without immunosuppressive therapy [36%], p = 0.44). CONCLUSIONS Noncompressive myelopathy is an uncommon but severe complication of bacterial meningitis. Improvement after diagnosis is expected, but all patients had persistent neurological deficits.
Collapse
Affiliation(s)
- Evelien H G M Drost
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Nora Chekrouni
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Schmitz ZP, Hoffman RS. Magnetic resonance imaging in a patient with nitrous oxide-induced subacute combined degeneration of the spinal cord. Clin Toxicol (Phila) 2023; 61:1006-1008. [PMID: 38060330 DOI: 10.1080/15563650.2023.2286205] [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: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Chronic nitrous oxide use can lead to neurological findings that are clinically and radiographically identical to those found in patients with pernicious anemia, specifically subacute combined degeneration of the spinal cord and peripheral neuropathy. CASE SUMMARY A 22-year-old man presented with lower extremity weakness and ataxia in the setting of inhaling 250 nitrous oxide cartridges two to three times weekly for two years. IMAGES Magnetic resonance imaging showed T2 hyperenhancement of the dorsal columns of the cervical spine from the first to the sixth vertebrae, which helped to establish a diagnosis of nitrous oxide-induced subacute combined degeneration of the spinal cord. CONCLUSIONS Chronic nitrous oxide use should be included in the differential diagnosis of any patient with otherwise unexplained neurological complaints that localize to the dorsal columns and has the changes on magnetic resonance imaging described here.
Collapse
Affiliation(s)
| | - Robert S Hoffman
- Division of Medical Toxicology, Langone Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
3
|
Khoo M, Shah MA, Saifuddin A. Natural history of the cervical high-intensity intramedullary lesion in achondroplasia. Spinal Cord Ser Cases 2021; 7:46. [PMID: 34045437 DOI: 10.1038/s41394-021-00411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The cervical high-intensity intramedullary (CHII) lesion is a recognised finding in achondroplasia, manifesting as a focal area of increased T2W signal intensity in the upper cervical cord in the absence of cervical cord compression. The aim of this study is to determine the natural history of this abnormality. SETTING Tertiary referral spinal and orthopaedic hospital, UK. METHODS A retrospective review was undertaken of all patients with achondroplasia who had undergone at least one MRI study which included the cervical spine. Patient age at presentation was recorded and presence of the CHII lesion was determined on the sagittal T2W FSE sequence. For patients who had follow-up studies, presence of the CHII lesion was assessed for any change in morphology (resolution, partial resolution or enlargement). The development of new CHII lesions and presence of associated cord atrophy was also recorded. RESULTS The study group consisted of 40 patients (20 males, 20 females: mean age at first MRI of 32.6 years (range 7-66 years). The CHII lesion was identified in 19 (47.5%) cases and was associated with focal cord atrophy in 17 (85%) cases. There was no change or resolution of these lesions nor any associated cord compression. No new CHII lesions developed but progressive cord atrophy was evident. CONCLUSION The CHII lesion is seen in 47.5% of cases of achondroplasia. It appears to be a stable abnormality which does not progress or change its morphology. However, it does appear to be associated with progressive cord atrophy.
Collapse
Affiliation(s)
- Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.
| | | | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
4
|
Lee MJ, Aronberg R, Manganaro MS, Ibrahim M, Parmar HA. Diagnostic Approach to Intrinsic Abnormality of Spinal Cord Signal Intensity. Radiographics 2020; 39:1824-1839. [PMID: 31589577 DOI: 10.1148/rg.2019190021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intramedullary cord hyperintensity at T2-weighted MRI is a common imaging feature of disease in the spinal cord, but it is nonspecific. Radiologists play a valuable role in helping narrow the differential diagnosis by integrating patient history and laboratory test results with key imaging characteristics. The authors present an algorithmic approach to evaluating intrinsic abnormality of spinal cord signal intensity (SI), which incorporates clinical evaluation results, time of onset (acute vs nonacute), cord expansion, and pattern of T2 SI abnormality. This diagnostic approach provides a practical framework to aid both trainees and practicing radiologists in workup of myelopathy.©RSNA, 2019.
Collapse
Affiliation(s)
- Michael J Lee
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Ryan Aronberg
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Matthew S Manganaro
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Mohannad Ibrahim
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Hemant A Parmar
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| |
Collapse
|
5
|
Md Noh MSF, Bahari N, Abdul Rashid AM. Tuberculous Myelopathy Associated with Longitudinally Extensive Lesion: A Clinicoradiological Review of Reported Cases. J Clin Neurol 2020; 16:369-375. [PMID: 32657056 PMCID: PMC7354966 DOI: 10.3988/jcn.2020.16.3.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022] Open
Abstract
Acute transverse myelitis is an inflammatory disorder of the spinal cord in which there is no evidence of spinal cord compression. Longitudinally extensive transverse myelitis (LETM) is a specific subtype of acute transverse myelitis that usually affects three or more vertebral levels and produces marked neurological deficits. While the most-common cause of LETM is neuromyelitis optica or neuromyelitis optica spectrum disorder, there are rare cases of other causes mimicking this condition, including tuberculosis (TB). We sought to review the clinicoradiological features of TB myelopathy associated with longitudinally extensive lesion, which may mimic LETM, in the English literature. We searched the PubMed, Google Scholar, Web of Science, and Scopus databases for relevant articles using search terms including “longitudinally extensive transverse myelitis,” “tuberculosis,” “TB spinal cord,” and various combinations of these expressions. Full-text papers were selected without limiting the publication year. We also examined the reference lists of key papers to identify further articles that are potentially relevant. We found 10 cases in 7 papers describing TB myelopathy associated with longitudinally extensive lesion. The demographics, clinical features, relevant cerebrospinal fluid findings, and radiological findings were compiled and summarized. TB myelopathy associated with longitudinally extensive lesion is very rare, with no documented prevalence. Early and accurate diagnosis is important since the condition is potentially treatable.
Collapse
Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Senior Registrar and Interventional Neuroradiologist in-training, Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Norafida Bahari
- Consultant Radiologist, Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Anna Misyail Abdul Rashid
- Internal Medicine Physician, Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|
6
|
Tuberculous (TB) myelopathy associated with longitudinally extensive lesion: A case report. J Neuroradiol 2019; 48:453-455. [PMID: 31837378 DOI: 10.1016/j.neurad.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022]
|
7
|
Ko CC, Tu TH, Chen YT, Wu JC, Huang WC, Cheng H. Monkey Recovery from Spinal Cord Hemisection: Nerve Repair Strategies for Rhesus Macaques. World Neurosurg 2019; 129:e343-e351. [PMID: 31132502 DOI: 10.1016/j.wneu.2019.05.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Repair of spinal cord injury (SCI) using peripheral nerve graft (PNG) and acidic fibroblast growth factor (aFGF) has shown promising results in rats and a few human patients, but not in nonhuman primates. The aim of this study was to verify the effective use of PNG and aFGF for repairing incomplete SCI in nonhuman primates. METHODS Six adult rhesus macaques received spinal cord hemisection at T8 level and were grouped into repair and control groups (n = 3 in each). Animals in the repair group underwent nerve repair with autologous PNG plus aFGF immediately after lesioning. The control group received exactly the same operation for lesioning but no treatment. Postoperative behavioral evaluations, electrophysiologic tests (including motor and somatosensory evoked potentials), and magnetic resonance imaging were performed and compared between the 2 groups as well as histologic examination of the spinal cord cephalic to, at, and caudal to the lesion site after sacrifice. RESULTS Animals in the repair group had better motor function in the lower limbs at every observed time point and demonstrated more improvement on electrophysiologic examinations than the control group. The repair group had smaller areas of myelomalacia on magnetic resonance imaging around the lesion compared with the control group, suggesting diminished inflammatory responses with the repair strategy. CONCLUSIONS PNG plus aFGF for SCI in nonhuman primates yielded improvements in clinical behavior, electrophysiologic tests, and magnetic resonance imaging. This study suggests that the repair strategy is feasible and effective for nonhuman primate SCI. Further investigations are warranted to corroborate its effectiveness for clinical application.
Collapse
Affiliation(s)
- Chin-Chu Ko
- Jhong Jheng Spine & Orthopedic Hospital, Kaohsiung, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsung-Hsi Tu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Ya-Tzu Chen
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Wen-Cheng Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Henrich Cheng
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
8
|
Pearce MC, Choy G, Chen RC. Clinics in diagnostic imaging (190). Subacute combined degeneration of the spinal cord (SCD). Singapore Med J 2018; 59:460-464. [PMID: 30310922 DOI: 10.11622/smedj.2018109] [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] [Indexed: 11/18/2022]
Abstract
A 54-year-old man presented with progressive onset of lower limb paraesthesias, sensory ataxia, gait instability and lower limb weakness. Laboratory findings revealed low serum B12 levels. Magnetic resonance imaging showed long-segment symmetrically increased T2 signal within the dorsal columns of the spinal cord in the lower thoracic spine. The conglomeration of findings was consistent with a diagnosis of subacute combined degeneration of the spinal cord (SCD). Aside from mild residual paraesthesias, the patient's symptoms largely resolved after treatment with intramuscular injections of vitamin B12. The clinical presentation, pathophysiology, clinical and radiologic differential diagnosis, and management of SCD were described.
Collapse
Affiliation(s)
| | - Garry Choy
- Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Chun Chen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| |
Collapse
|
9
|
Nazari P, Tan LA, Kasliwal MK, Traynelis VC. Aortic Dissection: An Unusual Extraspinal Cause of Acute Paraplegia in the Emergency Department. J Emerg Med 2016; 52:e19-e21. [PMID: 27717591 DOI: 10.1016/j.jemermed.2016.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/15/2015] [Accepted: 01/17/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Pouya Nazari
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Lee A Tan
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Manish K Kasliwal
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Vincent C Traynelis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
10
|
Misdiagnosis of spinal subacute combined degeneration in a patient with elevated serum B12 concentration and sensory deficit level. Neurol Sci 2016; 37:1577-8. [DOI: 10.1007/s10072-016-2566-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
|
11
|
Spinal cord injuries without radiologic abnormality in children: a systematic review. Spinal Cord 2015; 53:842-8. [DOI: 10.1038/sc.2015.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 05/18/2015] [Accepted: 05/29/2015] [Indexed: 11/08/2022]
|
12
|
Smorgick Y, Tal S, Yassin A, Tamir E, Mirovsky Y, Anekstein Y. The relation between location of cervical cord compression and the location of myelomalacia. Skeletal Radiol 2015; 44:649-52. [PMID: 25528482 DOI: 10.1007/s00256-014-2074-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between the location of the cervical cord compression and the increased signal intensity within the cervical cord on T2-weighted imaging (T2WI) in patients with cervical myelopathy and myelomalacia. MATERIALS AND METHODS We reviewed 1,615 MRI reports from January 2011 to May 2013 from a single institution. Of the 1,615 reports reviewed, 168 patients were diagnosed with increased signal intensity within the cervical spine on T2WI. After applying the exclusion criteria 82 patients were included in the study. The MRIs of these 82 patients were then reviewed and the location of the increased signal intensity on T2WI in relation to the location of the pressure on the spinal cord was recorded. RESULTS In more than 50 % of the cases the lesions with increased signal intensity on T2WI either were located distal to the pressure on the spinal cord or started at the level of the pressure and extended to an area distal to the pressure. In 26 out of the 92 lesions with increased signal intensity on T2WI, the lesion started proximal to the pressure on the spinal cord and extended distal to it. In only 3 out of the 92 lesions, the lesion with increased signal intensity on T2WI was solely located proximal to the pressure on the spinal cord. In 5 other cases the lesion with increased signal intensity on T2WI started proximal to the level of pressure on the spinal cord and extended into the level of pressure on the spinal cord (p < 0.001; Table 1). CONCLUSION Cervical myelomalacia may appear proximal, distal or at the level of the compressed cord. It rarely appears solely proximal to the pressure area on the cord.
Collapse
Affiliation(s)
- Yossi Smorgick
- Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel,
| | | | | | | | | | | |
Collapse
|
13
|
Nakamoto BK, Siu AM, Hashiba KA, Sinclair BT, Baker BJ, Gerber MS, McMurtray AM, Pearce AM, Pearce JW. Surfer's myelopathy: a radiologic study of 23 cases. AJNR Am J Neuroradiol 2013; 34:2393-8. [PMID: 23828111 DOI: 10.3174/ajnr.a3599] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Surfing is an uncommon cause of an acute nontraumatic myelopathy. This study describes the MR imaging characteristics and clinical correlates in 23 subjects with surfer's myelopathy. MATERIALS AND METHODS This was a retrospective review of 23 cases of surfer's myelopathy from 2003-2012. Spinal cord MR imaging characteristics and neurologic examinations with the use of the American Spinal Injury Association scale were reviewed. Logistic regression was used to determine associations between MR imaging characteristics, American Spinal Injury Association scale, and clinical improvement. RESULTS All subjects (19 male, 4 female; mean age, 26.3 ± 7.4 years) demonstrated "pencil-like," central T2-hyperintense signal abnormalities in the spinal cord extending from the midthoracic region to the conus with associated cord expansion and varying degrees of conus enlargement on spinal cord MR imaging within 24 hours of symptom onset. T1 signal was normal. Faint gadolinium enhancement was present in a minority. Although there was a strong correlation between initial American Spinal Injury Association score and clinical improvement (P = .0032), MR imaging characteristics were not associated with American Spinal Injury Association score or clinical improvement. CONCLUSIONS Surfer's myelopathy should be considered in the radiographic differential diagnosis of a longitudinally extensive T2-hyperintense spinal cord lesion. MR imaging characteristics do not appear to be associated with severity on examination or clinical improvement.
Collapse
Affiliation(s)
- B K Nakamoto
- Department of Medicine, University of Hawaii, Honolulu, Hawaii
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Márquez JC, Granados AM, Castillo M. MRI of cervical spinal cord infarction in a patient with sickle cell disease. Clin Imaging 2012; 36:595-8. [PMID: 22920369 DOI: 10.1016/j.clinimag.2011.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022]
Abstract
We report a patient with sickle cell disease who developed spinal cord ischemia. Initial conventional magnetic resonance imaging (MRI) was unremarkable, but diffusion-weighted imaging showed restricted diffusion in the cervical spinal cord. Follow-up MRI performed 3 days later showed development of findings on conventional images that confirmed the infarction.
Collapse
Affiliation(s)
- Juan Camilo Márquez
- Division of Neuroradiology, Department of Radiology, University of North Carolina at Chapel Hill, NC, USA.
| | | | | |
Collapse
|
15
|
Abstract
Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that extends over three or more vertebrae, as seen on MRI of the spine. The clinical presentation of a patient with LETM is often dramatic and can consist of paraparesis or tetraparesis, sensory disturbances, and gait, bladder, bowel and/or sexual dysfunction. LETM is a characteristic feature of neuromyelitis optica, but such spinal lesions can also occur in various other autoimmune and inflammatory diseases that involve the CNS--such as multiple sclerosis, sarcoidosis or Sjögren syndrome--or in infectious diseases with CNS involvement. Patients with a neoplastic disorder or traumatic spinal cord injury can also present with longitudinal spinal lesions. In this Review, the signs and symptoms that suggest various etiologies and differential diagnoses of LETM are described, and illustrated by educational case studies. The best therapeutic options for patients with each diagnosis are also discussed.
Collapse
|
16
|
Rabhi S, Maaroufi M, Khibri H, Belahsen F, Tizniti S, Berrady R, Bono W. Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature. J Med Case Rep 2011; 5:166. [PMID: 21524288 PMCID: PMC3094295 DOI: 10.1186/1752-1947-5-166] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 04/27/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency. Subacute combined degeneration without anemia or macrocytosis is rare. CASE PRESENTATION We present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B12 supplements and showed improvement in her clinical symptoms. CONCLUSION Physicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.
Collapse
Affiliation(s)
- Samira Rabhi
- Department of Internal Medicine, Hassan II University Hospital, Fez, Morocco.
| | | | | | | | | | | | | |
Collapse
|
17
|
Counsel P, Khangure M. RE: differential diagnosis of T2 hyperintense spinal cord lesions. J Med Imaging Radiat Oncol 2009; 53:558. [PMID: 20002288 DOI: 10.1111/j.1754-9485.2009.02123.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|