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Singhi P, Sharma JP, Gautam R, Indra RM, Rafli A. Extensive Longitudinal Transverse Myelitis Associated With CSF Epstein-Barr Virus Infection: A Case Report. Child Neurol Open 2021; 8:2329048X211049958. [PMID: 34692894 PMCID: PMC8532220 DOI: 10.1177/2329048x211049958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 09/13/2021] [Indexed: 12/04/2022] Open
Abstract
Background. Acute transverse myelitis (ATM) in children can be secondary to central nervous system infections. Several reports have associated ATM with Epstein-Barr virus (EBV) infection. Case presentation. We report a previously healthy 10-year-old boy with paraparesis that started 7 days before admission. Spinal T2W MRI revealed extensive hyperintense lesions. Cerebrospinal fluid WBC was 268/µL and PCR examination was positive for EBV. High dose methylprednisolone (1 g/kg) was given for 5 days, the child was symptom free 3 months after presentation. Conclusion. Epstein-Barr infection should be considered in ATM, particularly when CSF WBC count is high.
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Affiliation(s)
| | | | | | - Raden M Indra
- Mohammad Hoesin General Hospital/Universitas Sriwijaya Medical School, Palembang, Indonesia
| | - Achmad Rafli
- Cipto Mangunkusumo General Hospital/Medical School, University of Indonesia, Jakarta, Indonesia
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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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Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
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Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
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Kim SM, Kim SJ, Lee HJ, Kuroda H, Palace J, Fujihara K. Differential diagnosis of neuromyelitis optica spectrum disorders. Ther Adv Neurol Disord 2017; 10:265-289. [PMID: 28670343 PMCID: PMC5476332 DOI: 10.1177/1756285617709723] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/31/2017] [Indexed: 12/31/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system (CNS) mostly manifesting as optic neuritis and/or myelitis, which are frequently recurrent/bilateral or longitudinally extensive, respectively. As the autoantibody to aquaporin-4 (AQP4-Ab) can mediate the pathogenesis of NMOSD, testing for the AQP4-Ab in serum of patients can play a crucial role in diagnosing NMOSD. Nevertheless, the differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease because: (1) diverse diseases with autoimmune, vascular, infectious, or neoplastic etiologies can mimic these phenotypes of NMOSD; (2) patients with NMOSD may only have limited clinical manifestations, especially in their early disease stages; (3) test results for AQP4-Ab can be affected by several factors such as assay methods, serologic status, disease stages, or types of treatment; (4) some patients with NMOSD do not have AQP4-Ab; and (5) test results for the AQP4-Ab may not be readily available for the acute management of patients. Despite some similarity in their phenotypes, these NMOSD and NMOSD-mimics are distinct from each other in their pathogenesis, prognosis, and most importantly treatment. Understanding the detailed clinical, serological, radiological, and prognostic differences of these diseases will improve the proper management as well as diagnosis of patients.
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Affiliation(s)
- Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University, College of Medicine, Seoul, Korea
| | - Haeng Jin Lee
- Department of Ophthalmology, Seoul National University, College of Medicine, Seoul, Korea
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, and MS & NMO Center, Southern TOHOKU Research Institute for Neuroscience (STRINS), Koriyama 963-8563, Japan
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