1
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Wang M, Wang Z, Zhang L, Zhao J, Wu D, Li J, Wang Q, Su J, Xu D, Zhang S, Li M, Zeng X. Exploring the risk factors and prognosis of transverse myelitis in systemic lupus erythematosus. Ther Adv Chronic Dis 2022; 13:20406223221097330. [PMID: 35615445 PMCID: PMC9125597 DOI: 10.1177/20406223221097330] [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: 11/12/2021] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose: We aimed to describe the clinical characteristics and outcomes of patients
with transverse myelitis (TM) as a rare manifestation in systemic lupus
erythematosus (SLE) and explore the risk factors and prognosis of
SLE-related TM (SLE-TM). Methods: We conducted a retrospective case–control and cohort analysis. All patients
with SLE-TM (58 patients) and 232 with SLE without TM, as a control group,
were admitted to Peking Union Medical College Hospital between January 1993
and May 2021. Factors associated with the presence of SLE-TM and its
prognosis were assessed using logistic regression and Cox proportional
hazard models. Results: Multivariate analysis revealed that positive anti-Ro/Sjogren’s syndrome A
(anti-Ro/ SSA) (<0.01) and increased erythrocyte sedimentation rate (ESR)
(p < 0.01) were associated with SLE-TM. Regarding
prognosis, methylprednisolone (MP) pulse therapy within 2 weeks of onset
(adjusted hazard ratio (AHR), 2.12; 95% confidence interval (CI), 1.06–4.23;
p = 0.03) was associated with short-term neurological
improvement. An American Spinal Injury Association Impairment Scale (AIS)
grades of A, B, or C at onset (AHR, 0.12; 95% CI 0.05–0.28;
p < 0.001) and hypoglycorrhachia (AHR, 0.29; 95% CI,
0.13–0.65; p < 0.01) were associated with a short-term
non-improved outcome. Conclusions: The positive anti-Ro/SSA antibodies and increased ESR may be associated with
the presence of SLE-TM. An initial presentation with severe myelitis and
hypoglycorrhachia appear to be predictors of a poor neurological outcome.
Early steroid pulse therapy may improve the prognosis.
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Affiliation(s)
- Minhui Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Ziqian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Li Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Di Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jinmei Su
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shangzhu Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH)
- Key Laboratory of Rheumatology, and Clinical Immunology, Ministry of Education, Beijing, China
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2
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Ganelin-Cohen E, Konen O, Nevo Y, Cohen R, Halevy A, Shuper A, Aharoni S. Prognostic Parameters of Acute Transverse Myelitis in Children. J Child Neurol 2020; 35:999-1003. [PMID: 32808576 DOI: 10.1177/0883073820947512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute transverse myelitis is a rare and disabling disorder. Data on the imaging features in children are sparse. The aim of this study was to describe the clinical and magnetic resonance imaging findings characteristic of pediatric idiopathic acute transverse myelitis and to identify those with prognostic value. The database of a tertiary pediatric medical center was retrospectively reviewed for patients aged less than 18 years who were diagnosed in 2002-2017 with acute transverse myelitis that was not associated with recurrence of a demyelinating autoimmune event. Data were collected on clinical, laboratory, and imaging findings and outcome. A total of 23 children (11 male, 12 female) met the study criteria. Mean age at disease onset was 10 years, and mean duration of follow-up was 6 years 10 months. Spinal cord and brain magnetic resonance imaging scans were performed on admission or shortly thereafter. The most common finding was cross-sectional involvement, in 16 patients (70%). The mean number of involved spinal segments was 8. The most frequently involved region was the thoracic spine, in 17 patients (74%). Clinical factors predicting good prognosis were cerebrospinal fluid pleocytosis, absence of tetraparesis, and prolonged time to nadir. In conclusion, most children with acute transverse myelitis appear to have a good outcome. Prompt diagnosis and treatment are important. Further research is needed in a larger sample to evaluate the predictive value of imaging features.
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Affiliation(s)
- Esther Ganelin-Cohen
- Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Diagnostic Imaging, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Osnat Konen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Diagnostic Imaging, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yoram Nevo
- Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Cohen
- Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Halevy
- Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avinoam Shuper
- Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Aharoni
- Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Calloni SF, Huisman TA, Poretti A, Soares BP. Back pain and scoliosis in children: When to image, what to consider. Neuroradiol J 2017; 30:393-404. [PMID: 28786774 DOI: 10.1177/1971400917697503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Back pain and scoliosis in children most commonly present as benign and self-limited entities. However, persistent back pain and/or progressive scoliosis should always be taken seriously in children. Dedicated diagnostic work-up should exclude etiologies that may result in significant morbidity. Clinical evaluation and management require a comprehensive history and physical and neurological examination. A correct imaging approach is important to define a clear diagnosis and should be reserved for children with persistent symptoms or concerning clinical and laboratory findings. This article reviews the role of different imaging techniques in the diagnostic approach to back pain and scoliosis, and offers a comprehensive review of the main imaging findings associated with common and uncommon causes of back pain and scoliosis in the pediatric population.
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Affiliation(s)
- Sonia F Calloni
- 1 Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Italy.,2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Thierry Agm Huisman
- 2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Andrea Poretti
- 2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA.,3 Department of Neurogenetics, Kennedy Krieger Institute, USA
| | - Bruno P Soares
- 2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
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4
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Abstract
Inflammatory and infectious disorders of the spine in children are less common than in adults, and are usually categorized according to location into (1) those predominantly affecting the spinal cord; (2) those predominantly affecting the nerve roots and meninges; and (3) those predominantly affecting the vertebrae, discs, and epidural space. Disorders primitively involving the spinal cord may be grouped into 2 basic categories: (1) inflammatory (represented by acute transverse myelopathy) and (2) infectious (ie, bacterial, viral, fungal, or parasitic). Inflammatory spinal cord diseases are more common than primitive spinal cord infection.
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Affiliation(s)
- Andrea Rossi
- Department of Pediatric Neuroradiology, Istituto Giannina Gaslini, Via G. Gaslini 5, Genova I-16147, Italy.
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5
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Watts J, Box GA, Galvin A, Van Tonder F, Trost N, Sutherland T. Magnetic resonance imaging of intramedullary spinal cord lesions: A pictorial review. J Med Imaging Radiat Oncol 2014; 58:569-81. [DOI: 10.1111/1754-9485.12202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 05/31/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Jane Watts
- Department of Medical Imaging; St Vincent's Hospital; Melbourne Victoria Australia
| | | | - Angela Galvin
- Department of Medical Imaging; St Vincent's Hospital; Melbourne Victoria Australia
| | - Frans Van Tonder
- Department of Medical Imaging; St Vincent's Hospital; Melbourne Victoria Australia
| | - Nicholas Trost
- Department of Medical Imaging; St Vincent's Hospital; Melbourne Victoria Australia
| | - Thomas Sutherland
- Department of Medical Imaging; St Vincent's Hospital; Melbourne Victoria Australia
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6
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Bae YJ, Lee JW, Park KS, Yeom JS, Kim KJ, Lee GY, Kang HS. Compressive myelopathy: magnetic resonance imaging findings simulating idiopathic acute transverse myelopathy. Skeletal Radiol 2013; 42:793-802. [PMID: 23299512 DOI: 10.1007/s00256-012-1556-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/16/2012] [Accepted: 11/19/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide magnetic resonance imaging (MRI) findings of compressive myelopathy simulating idiopathic acute transverse myelopathy (ATM). MATERIALS AND METHODS From 19,416 patients who had spinal MRI from 1 September 2004 to 10 July 2011, the patients who met inclusion criteria were enrolled as follows: (1) definable cord compression, (2) long-segmental intramedullary T2-high signal intensity (HSI) extending more than 2 vertebral segments, and (3) no history of trauma, malignancy, or demyelinating disease. The characteristics of T2-HSI and contrast enhancement pattern were analyzed. The patients' clinical information was collected in the process. RESULTS Thirteen patients (10 men, 3 women; mean age, 52.8 years; age range, 43-77 years) were included in this study. Twelve patients had cervical cord compression and one had thoracic compression. Common findings of T2-HSI included fusiform shape (100 %) with cord swelling (92.3 %), cord compression in midline location (76.9 %), diffuse distribution occupying more than two-thirds of the cross-sectional dimension of the cord in axial image (84.6 %), and focal and peripheral enhancement (63.6 %). Intravenous corticosteroid was administered to four patients, including two patients following decompressive surgery, and interval decrease in T2-HSI was seen in three patients, but with residual lesions at cord compression level. CONCLUSIONS Spinal cord compression can induce long-segmental cord signal change, such as idiopathic ATM.
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Affiliation(s)
- Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
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7
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8
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Palace J. Acute disseminated encephalomyelitis and its place amongst other acute inflammatory demyelinating CNS disorders. J Neurol Sci 2011; 306:188-91. [PMID: 21664525 DOI: 10.1016/j.jns.2011.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 03/15/2011] [Accepted: 03/16/2011] [Indexed: 11/28/2022]
Abstract
The diagnosis of acute inflammatory demyelinating CNS conditions is complex and this is reflected in variations in how cohorts are defined across studies. For some conditions the diagnosis relies on whether it is monophasic or relapsing, in others the anatomical site of inflammation is used as a means of categorisation. Clinical features such as precipitants, gender and age may affect the probability of certain diagnoses, but are not highly accurate. Exclusive features for the pathology are identifiable for some but not all conditions, and are seldom available during life. Specific markers such as antibodies are informative and new developments in this area are likely in the near future. This review outlines the features and classification of acute disseminated encephalomyelitis and contrasts it with other related conditions before attempting to define a pragmatic organisation of these conditions based upon present evidence.
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9
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Alper G, Petropoulou KA, Fitz CR, Kim Y. Idiopathic acute transverse myelitis in children: an analysis and discussion of MRI findings. Mult Scler 2010; 17:74-80. [PMID: 20858691 DOI: 10.1177/1352458510381393] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is lack of reported magnetic resonance imaging (MRI) studies of idiopathic acute transverse myelitis (ATM) in children. OBJECTIVE To describe the imaging features of idiopathic ATM in children. METHODS We retrospectively analyzed the spinal MRI findings of children diagnosed with ATM. The anatomic regions, vertebral segmental length, gray or white matter involvement, cord expansion and gadolinium enhancement were examined. RESULTS A total of 27 children were diagnosed with isolated monophasic ATM with a mean follow-up of 5.2 years. Two children later diagnosed with neuromyelitis optica were excluded from the pediatric ATM cohort. None of the patients had a subsequent diagnosis of multiple sclerosis. The mean age of onset was 9.5 years (0.5-16.9 years). Spinal MRIs were abnormal in 21 (78%). The mean interval between symptom onset and the MRI was 1.7 days (0-19 days). Central cord hyperintensity involving gray matter was seen in all patients. A majority (67%) of the patients demonstrated long segment lesions with a mean segment length of 6.4. CONCLUSIONS We conclude that central cord inflammation extending over three or more segments is the most common finding of idiopathic monophasic transverse myelitis in children. The risk of multiple sclerosis in children who experience isolated transverse myelitis as a first demyelinating event is low.
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Affiliation(s)
- Gulay Alper
- Division of Child Neurology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA.
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10
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Govender R, Wieselthaler NA, Ndondo A, Wilmshurst JM. Acquired demyelinating disorders of childhood in the Western Cape, South Africa. J Child Neurol 2010; 25:48-56. [PMID: 19494357 DOI: 10.1177/0883073809336294] [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] [Indexed: 11/17/2022]
Abstract
In a retrospective review of patients with acquired demyelinating disorders of the central nervous system, 19 children (0.6%) were identified from the Paediatric Neurology database of 3159 patients; 7 had acute disseminated encephalomyelitis, 1 had Schilder's disease, 5 had multiple sclerosis, and 6 had acute transverse myelitis. The median age of presentation was 83 months, with increased incidence during the summer and winter months. The commonest presentation was hemiparesis. The commonest regions of magnetic resonance imaging (MRI) abnormalities were the deep white matter (68%) and cerebellum (48%).The patients with multiple sclerosis had more monosymptomatic presentations (P < .02), raised cerebrospinal fluid protein (P = .022), and contrast enhancement of lesions (P = .05) compared with the acute disseminated encephalomyelitis group. Neuroepidemiological published surveillances of African children provide no data about these disorders. The prevalence of acquired demyelinating disorders in resource-poor settings is under-estimated because of the large burden of infections and limited access to neuroimaging.
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Affiliation(s)
- Rajeshree Govender
- Department of Paediatric Neurology, School of Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
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11
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PARRY ANDREWT, PENNING VICTORIAA, SMITH KENC, KENNY PATRICKJ, LAMB CHRISTOPHERR. IMAGING DIAGNOSIS-NECROTIZING MENINGOMYELITIS AND POLYARTHRITIS. Vet Radiol Ultrasound 2009; 50:412-5. [DOI: 10.1111/j.1740-8261.2009.01558.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Cabrera-Gómez JA, Bonnan M, González-Quevedo A, Saiz-Hinarejos A, Marignier R, Olindo S, Graus F, Smadja D, Merle H, Thomas L, Gómez-García A, Cabre P. Neuromyelitis optica positive antibodies confer a worse course in relapsing-neuromyelitis optica in Cuba and French West Indies. Mult Scler 2009; 15:828-33. [PMID: 19498017 DOI: 10.1177/1352458509104585] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In Caucasian populations Neuromyelitis Optica (NMO-IgG) antibody has been detected in 27.1% / 78.2% of patients with relapsing-NMO (R-NMO). The prevalence reported for the disease in the Caribbean is 3.1/100,000 in the French West Indies (FWI) and 0.52 /100,000 in Cuba, but the NMO antibody status is unknown. Objective To assess the NMO-IgG antibody status of Cuban/FWI RNMO patients, comparing with European cases tested at the same laboratories. Methods Serum NMO-IgG antibodies were assayed in 48 R-NMO patients (Wingerchuck´s 1999 criteria): Cuba (24)/FWI (24), employing Lennon et al´s method. We compared the demographic, clinical, disability and laboratory data between NMO-IgG +/- patients. All the data were reviewed and collected blinded to the NMO-IgG status. Results Seropositivity of the NMO-IgG antibody demonstrated a lower rate in the Caribbean (33.3%), as compared with Caucasian patients from Spain/Italy (62.5%) and France (53.8%). Caribbean patients with NMO-IgG (+) displayed more attacks, more spinal attacks and a higher EDSS than NMO-IgG (-) cases, while brain and spinal cord MRI lesions were more frequent during remission, with more vertebral segments, more gray, white matter and holocord involvement. Conclusions NMO IgG positive antibodies in NMO patients had a lower rate in the Caribbean area – where the population has a predominant African ancestry – than in Caucasian Europeans, suggesting the influence of a possible ethnic factor in the pathogenesis of the disease, but they confer a worse course with more attacks, more disability and MRI lesions.
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Affiliation(s)
- JA Cabrera-Gómez
- Cuban Multiple Sclerosis Society and International Neurological Restoration Center, Havana, Cuba
| | - M Bonnan
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - A González-Quevedo
- Institute of Neurology and Neurosurgery, Havana, Cuba. Calle 29 y D, Vedado, La Habana, Cuba
| | - A Saiz-Hinarejos
- Service of Neurology Hospital Clinic and Institut d’Invesigación Biomèdica August Pi i Sanyer (IAIBAPS), University of Barcelona, Villarroel, Barcelona, Spain
| | - R Marignier
- Hôpital Neurologique Pierre Wertheimer, Lyon, France; U842 INSERM, Faculté Laënnec, Lyon Cedex
| | - S Olindo
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - F Graus
- Service of Neurology Hospital Clinic and Institut d’Invesigación Biomèdica August Pi i Sanyer (IAIBAPS), University of Barcelona, Villarroel, Barcelona, Spain
| | - D Smadja
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - H Merle
- Department of Ophthalmology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - L Thomas
- Emergency Department, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - A Gómez-García
- Sancti Spiritus Children Hospital, Sancti Spiritus, Cuba
| | - P Cabre
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
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13
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Bot JCJ, Barkhof F. Spinal-cord MRI in multiple sclerosis: conventional and nonconventional MR techniques. Neuroimaging Clin N Am 2009; 19:81-99. [PMID: 19064202 DOI: 10.1016/j.nic.2008.09.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple sclerosis is a diffuse disease of the central nervous system, and MRI of the spinal cord is highly recommended in the clinical evaluation of patients suspected of having multiple sclerosis. Within the new diagnostic criteria, spinal cord MRI increases sensitivity and possibly specificity for MS, but further work is needed to investigate other criteria that may give greater weight to the presence of cord lesions in patients with clinically isolated syndromes or suspected relapsing-remitting multiple sclerosis. Techniques should be further studied and validated in studies comparing these techniques with clinical status and histopathology, however.
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Affiliation(s)
- Joseph C J Bot
- Department of Radiology, MR Center for MS Research, VU Medical Center, 1007 MB Amsterdam, The Netherlands.
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14
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Yiu EM, Kornberg AJ, Ryan MM, Coleman LT, Mackay MT. Acute transverse myelitis and acute disseminated encephalomyelitis in childhood: spectrum or separate entities? J Child Neurol 2009; 24:287-96. [PMID: 19258287 DOI: 10.1177/0883073808323522] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical and radiological features of childhood acute transverse myelitis are compared to those of acute disseminated encephalomyelitis with spinal cord involvement in 22 children with acute transverse myelitis and 12 children with acute disseminated encephalomyelitis with spinal cord involvement. Children with acute transverse myelitis were more likely to have a sensory level (55%) and areflexia. Sixty-eight percent of the children with acute transverse myelitis, and 92% of children with acute disseminated encephalomyelitis had longitudinally extensive transverse myelitis. Demyelination was more extensive in acute disseminated encephalomyelitis (mean 15.6 vertebral segments) than in acute transverse myelitis (mean 8.0 vertebral segments). The outcome was normal to good in 82% with acute transverse myelitis and in 100% with acute disseminated encephalomyelitis. Persistent bladder dysfunction was uncommon in both. Poor prognostic factors in acute transverse myelitis are flaccid paraparesis, respiratory failure, and age less than 6 months. These clinical and radiological differences suggest acute transverse myelitis and acute disseminated encephalomyelitis are separate entities.
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Affiliation(s)
- Eppie M Yiu
- Children's Neuroscience Centre, Royal Children's Hospital, Melbourne, Australia
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15
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Cassinotto C, Deramond H, Olindo S, Aveillan M, Smadja D, Cabre P. MRI of the spinal cord in neuromyelitis optica and recurrent longitudinal extensive myelitis. J Neuroradiol 2009; 36:199-205. [PMID: 19223076 DOI: 10.1016/j.neurad.2008.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica (NMO) is a severe inflammatory and necrotizing disease that clinically affects the optic nerves and spinal cord in a relapsing course. We assessed the baseline and follow-up MRI characteristics of cord attacks in NMO and recurrent longitudinal extensive myelitis (RLEM). METHODS We retrospectively reviewed MRI data of 20 Afro-Caribbean patients diagnosed with either NMO or RLEM. MRI data from 51 cord or mixed attacks were evaluated, and 65 follow-up MRI studies were available for 30 baseline acute examinations. RESULTS The cervical cord was involved in 63% of cases. Four attacks were limited to the brainstem. MRI of the spinal cord revealed longitudinal extensive signal abnormalities extending over three vertebral segments, associated with cord swelling in 67% of the 51 relapses. Gadolinium enhancement was observed, preferentially surrounding edema, in 69% of attacks. In the axial plane, signal abnormalities typically involved central areas of the cord. Cavitation was observed in 16% of attacks. Cord attacks recurred in the same or contiguous areas in 67% of cases. Follow-up MRI revealed a gradual decrease in cord swelling and T2 signal hyperintensity, with fragmentation of signal abnormalities in some cases. Cord atrophy was evident in 57% of the follow-up MRI. CONCLUSION Given the poor prognosis of NMO and RLEM, radiologists need to be aware of the MRI pattern to prevent further attacks with the use of aggressive treatment.
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Affiliation(s)
- C Cassinotto
- Department of Radiology, Saint-André Hospital, Bordeaux, France.
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Kim MY, Suh ES. A case of acute transverse myelitis following chickenpox. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.3.380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Min Young Kim
- Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Eun Sook Suh
- Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea
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Kalanie H, Kholghie Y, Shamsai GR, Ghorbani M. Opticospinal multiple sclerosis in Iran. J Neurol Sci 2008; 276:130-2. [PMID: 18962726 DOI: 10.1016/j.jns.2008.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
Clinical course, magnetic resonance imaging (MRI) findings and cerebrospinal fluid data (CSF) on 20 patients among 520 with clinically definite multiple sclerosis (MS) according to the criteria of Poser et al., with opticospinal clinical presentation above 5 years and mean disease duration of 8+/-4.4 years were reviewed. The prevalence rate was 3.8%. The clinical course was relapsing-remitting (RR) for all patients. The mean age of onset was 24+/-8.2 years. The gender ratio was 2.3:1 female:male. First clinical presentation was spinal signs in 12 (60%), optic neuritis in 7 (35%) and simultaneous involvement of both eyes in 1 (5%) patient. No transverse myelitis (TM), sustained severe optic neuritis (SSON) or minor brain stem signs were recorded. No conversion to conventional MS (CMS) or secondary progressive MS (SPMS) was identified during the study period and no case had positive family history for the disease. The yearly number of attacks was 0.66+/-0.84, with mean Kurtzke expanded disability status scale (EDSS) of 2.5+/-1.2. All patients had 1 to 5 hemispheral T2 lesions in brain MRI, non-fulfilled Barkhof criteria for brain lesions. All had preventricular and 14 (70%) had juxtacortical lesions. None had gadolinium T1 enhanced lesions. No involvement of the brainstem or cerebellar structures was detected. Fifteen had 1 cervical lesion, five had 2 and four had 1 concomitant thoracic cord signal, all extending below three vertebral segments in sagittal planes with peripheral white matter location on the axial planes. Spinal fluid contained normal cell and protein with negative oligoclonal bands (OB).
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Affiliation(s)
- Hossein Kalanie
- Department of Neurology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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18
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Abstract
OBJECTIVE Our study was based on our hypotheses that in idiopathic acute transverse myelitis (ATM), fractional anisotropy (FA) values would be abnormal not only in the T2-hyperintense lesion but also in the surrounding normal-appearing spinal cord and that the abnormal FA values in the spinal cord could be related to clinical outcome. SUBJECTS AND METHODS Sagittal diffusion tensor imaging (DTI) was performed in 10 patients with idiopathic ATM (four men, six women; mean age, 45 years; age range, 20-66 years) and 10 sex- and age-matched normal volunteers. FA measurements were made in the spinal cord at three levels: lesion, proximal normal-appearing spinal cord, and distal normal-appearing spinal cord. The grade of FA decrease (mild, less than 10% decrease [(FA normal - FA pt) x 100 / FA normal]; moderate, 10-20%; severe, more than 20%) was related to the clinical outcome, which was determined by a neurologist using Paine's scale of normal, good, fair, or poor. RESULTS Mean FA values in patients were significantly lower than those in normal volunteers in lesions (0.5328 vs 0.7125, p = 0.002) and distal normal-appearing spinal cord (0.6676 vs 0.7720, p = 0.0137). All three patients with a mild FA decrease or increase in distal normal-appearing spinal cord showed a normal or good outcome, but all three patients with a severe FA decrease in distal normal-appearing spinal cord showed a fair outcome, among the eight patients to whom steroid treatment was given. CONCLUSION FA values in lesions and in distal normal-appearing spinal cord significantly decreased in patients with idiopathic ATM, and FA decrease in distal normal-appearing spinal cord might be related to clinical outcome.
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Heterogeneity and continuum of multiple sclerosis in Japanese according to magnetic resonance imaging findings. J Neurol Sci 2007; 266:115-25. [PMID: 17950755 DOI: 10.1016/j.jns.2007.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 08/03/2007] [Accepted: 09/10/2007] [Indexed: 11/23/2022]
Abstract
There are two distinct subtypes of multiple sclerosis (MS) in Asians: optic-spinal (OSMS) and conventional (CMS). Longitudinally extensive spinal cord lesions (LESCLs) extending over three or more vertebral segments are characteristic of patients with OSMS, yet in Asians, one-fourth of CMS patients also have LESCLs. To clarify the distinction between LESCLs in OSMS and CMS, and to characterize the relationship between the presence of LESCLs and brain magnetic resonance imaging (MRI) findings, we studied 142 patients with clinically definite MS of relapsing-remitting onset and 12 patients with primary progressive MS (PPMS) by MRI of the whole spinal cord and brain. The former was diagnosed by Poser criteria, including 57 with OSMS, 67 with CMS and 18 with brainstem-spinal form of MS, while the latter by McDonald criteria. The presence of LESCLs throughout the entire clinical course was significantly more common in OSMS patients than in CMS patients, while brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) were significantly more common in CMS patients than OSMS patients. LESCLs in OSMS patients most frequently affected the upper to middle thoracic cord, with either holocord or central gray matter involvement. By contrast, 70% of LESCLs in CMS patients predominantly affected the peripheral white matter of the mid-cervical cord. LESCLs in patients with PPMS also showed preferential involvement of the peripheral white matter of the mid-cervical cord. One-third of OSMS patients had neither LESCLs nor Barkhof brain lesions more than 10 years after disease onset, and showed significantly milder disability than OSMS patients with LESCLs. These findings suggest that LESCLs are heterogeneous between OSMS and CMS patients, and that there are distinct subtypes of MS in Japanese, according to clinical and MRI findings.
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Lanctin C, Wiertlewski S, Moreau C, Verny C, Derkinderen P, Damier P, Dubas F. Myélite aiguë transverse idiopathique : application des nouveaux critères diagnostiques à une cohorte de 17 patients. Rev Neurol (Paris) 2006; 162:980-9. [PMID: 17028566 DOI: 10.1016/s0035-3787(06)75108-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Idiopathic Acute Transverse Myelitis (ATM) is an inflammatory and immune-mediated disorder, distinct from infectious ATM, ATM of systemic lupus erythematosus or Sjögren's syndrome, and medullary manifestation of multiple sclerosis. Prognosis is not well-known. OBJECTIVE To evaluate clinical, paraclinical and pronognosis data in patients selected with new diagnosis criteria, classically described in idiopathic ATM. METHODS Seventeen patients with diagnosis criteria were retrospectively (1996-2005) studied. A telephone investigation was conducted in 2005 to obtained data on the clinical course. RESULTS Seven men and 10 women, ranging in age from 15 to 75 years (mean: 39.8 years) met these new criteria. Our study showed that epidemiological and clinical findings as well as laboratory results were in agreement with those presented in the literature. Conversely, prognosis was better since 76p.cent of the patients could walk without assistance. The clinical presentation of some of our patients and/or their progression towards other multifocal inflammatory disorders, suggests there might be links between ATM, neuromyelitis optica (NMO) and Acute Dissemined Encephalomyelitis (ADEM). CONCLUSION Patients with idiopathic ATM, selected with new criteria, have a rather good prognosis. ATM seems to be part of a continuum of neuroimmunologic disorders including NMO or ADEM although reasons explaining distinct focal disorders remain unclear.
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Affiliation(s)
- C Lanctin
- Pôle de Neurologie médicale et chirurgicale, Hôpital Laennec, CHU de Nantes, Saint-Herblain, France.
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Carter D, Olchovsky D, Yonath H, Langevitz P, Ezra D. Simultaneous deep vein thrombosis and transverse myelitis with negative serology as a first sign of antiphospholipid syndrome: a case report and review of the literature. Clin Rheumatol 2005; 25:756-8. [PMID: 16234992 DOI: 10.1007/s10067-005-0051-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 05/02/2005] [Indexed: 10/25/2022]
Abstract
Transverse myelitis is a rare manifestation of antiphospholipid syndrome, usually secondary to systemic lupus erythematosus (Rheum Dis Clin North Am 20:129-158, 1994). Only about 110 reports of this complication have been reported (Lupus 10:851-856, 2001). A connection has been demonstrated between positive serology for antiphospholipid and transverse myelitis (Lupus 8:109-115, 1999). Herein, we report of a young patient admitted with deep vein thrombosis and neurological manifestations of transverse myelitis with negative serology for systemic lupus erythematosus and antiphospholipid, who developed positive anticardiolipin antibody during pulse therapy with cyclophosphamide and methylprednisolone.
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Affiliation(s)
- Dan Carter
- Internal Medicine, Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.
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Starakis I, Marangos M, Giali S, Bassaris H. Acute transverse myelitis due to Coxsackie virus. J Clin Neurosci 2005; 12:296-8. [PMID: 15851085 DOI: 10.1016/j.jocn.2004.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Accepted: 03/24/2004] [Indexed: 11/24/2022]
Abstract
The case of a young adult male, who after a short upper respiratory illness presented with fever and alarming progressive neurological deficits, is reported. The diagnostic puzzle and the difficulty in establishing a diagnosis are reported. Acute transverse myelitis is a rare clinical manifestation of Coxsackie virus infection, and very few cases of transverse myelitis caused by serotype B have been reported in the English literature. This is a case report of an unusual acute transverse myelitis caused by Coxsackie B2 infection.
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Affiliation(s)
- Ioannis Starakis
- Internal Medicine, Infectious Diseases Section, University Hospital, Patras, Greece.
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Andronikou S, Albuquerque-Jonathan G, Wilmshurst J, Hewlett R. MRI findings in acute idiopathic transverse myelopathy in children. Pediatr Radiol 2003; 33:624-9. [PMID: 12879317 DOI: 10.1007/s00247-003-1004-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2003] [Revised: 05/06/2003] [Accepted: 05/25/2003] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the clinical and MRI findings in three children with acute idiopathic myelopathy (AIM). MATERIALS AND METHODS Retrospective review of the clinical presentation, MRI findings and outcome of three patients diagnosed with acute idiopathic transverse myelitis. RESULTS Of note was the swift onset of symptoms in all patients, without any preceding illness or history of vaccination in two of the patients, and the rapid resolution of symptoms on steroid therapy in all the patients. MRI showed T2-weighted hyperintensity and patchy enhancement with gadolinium, but the extensive cord involvement did not correlate with the severity of presentation or outcome. CONCLUSIONS Our findings do not support that MRI evidence alone of diffuse myelopathy is a predictor of poor outcome in childhood AIM.
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Affiliation(s)
- Savvas Andronikou
- Department of Paediatric Radiology, Red Cross Children's Hospital, University of Cape Town and School of Child and Adolescent Health, Klipfontein Road, Cape Town, South Africa.
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Defresne P, Hollenberg H, Husson B, Tabarki B, Landrieu P, Huault G, Tardieu M, Sébire G. Acute transverse myelitis in children: clinical course and prognostic factors. J Child Neurol 2003; 18:401-6. [PMID: 12886975 DOI: 10.1177/08830738030180060601] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to describe the clinical course of acute transverse myelitis in children, to identify prognostic factors, and to compare our findings with published data Twenty-four children, aged 2 to 14 years and admitted with a diagnosis of acute transverse myelitis, were studied. Clinical features and results of investigations were collected at admission and during the course of the disease. Motor, sphincter, and global outcomes were compared with those in the main adult and pediatric series. During the initial phase, the most common presenting symptoms were pain (88%) and fever (58%). Motor loss preceded sphincter dysfunction in two thirds of patients and became bilateral in half of the patients. When maximal deficit was achieved (plateau), the patients presented a combination of sensory, motor, and sphincter dysfunctions without radicular involvement The motor loss consistently involved the lower limbs but was inconsistent and moderate in the upper limbs. The mean duration of the plateau was 1 week. The recovery phase was characterized by a progressive improvement of all deficits. Sphincter dysfunction improved more slowly than did the other deficits. A full recovery was achieved by 31% of the patients; minimal sequelae were present in 25% and mild to severe sequelae in 44%. An unfavorable outcome was associated with complete paraplegia (P = .03) and/or a time to maximal deficit shorter than 24 hours (P = .005). A favorable outcome was associated with a plateau shorter than 8 days (P = .03), the presence of supraspinal symptoms (P = .01), and a time to independent walking shorter than 1 month (P = .01). The course of acute transverse myelitis in children proceeds through three stages, an initial phase, a plateau, and a recovery phase, each characterized by specific clinical features. The global outcome was favorable in 56% of patients. Several prognostic factors were identified.
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Affiliation(s)
- Pierre Defresne
- Service de Neurologie, Département de Pédiatrie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium.
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Fortuño JR, Menor F, Gómez-Gosálvez F, Pamies J, Jover J, Jesús Esteban M. Imagen en RM de encefalomielitis aguda diseminada, cerebelitis y mielitis en la infancia: probables variantes topográficas de un mismo proceso. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Finsterer J, Voigtländer T. Elevated 14-3-3 protein and axonal loss in immunoglobulin-responsive, idiopathic acute transverse myelitis. Clin Neurol Neurosurg 2002; 105:18-22. [PMID: 12445918 DOI: 10.1016/s0303-8467(02)00086-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To report the elevation of the 14-3-3 protein and the complete denervation of hand muscles in idiopathic acute transverse myelitis (IATM) of the cervical cord. CASE DESCRIPTION In a 29-year-old woman with a 2-week history of neck pain and repeated attenuated flus, subacute quadriplegia, hypaesthesia of both arms, a T3 sensory level, and urinary dysfunction occurred. Based upon the clinical findings, the cervical MRIs, and an elevated 14-3-3 protein in the CSF, IATM C4-C7 was diagnosed. Ten, 17, 28 and 61 days after onset, nerve conduction studies revealed complete denervation of the right abductor pollicis brevis and abductor digiti minimi muscles but gradual improvement of the compound muscle action potential of the left abductor pollicis brevis muscle. F-waves of the right median nerve were absent. Tibial somatosensory evoked potentials showed a prolonged central conduction time. Transcranial magnetic stimulation evoked a response in the left but not the right abductor digiti minimi muscle. CONCLUSION IATM may cause elevation of the 14-3-3 protein and loss of motor axons originating from affected anterior horn cells.
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Affiliation(s)
- J Finsterer
- Neurological Hospital, Rosenhügel, Vienna, Austria.
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27
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Bajaj NP, Rose P, Clifford-Jones R, Hughes PJ. Acute transverse myelitis and Guillain-Barré overlap syndrome with serological evidence for mumps viraemia. Acta Neurol Scand 2001; 104:239-42. [PMID: 11589654 DOI: 10.1034/j.1600-0404.2001.00340.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Both acute transverse myelitis (ATM) and Guillain-Barré syndrome (GBS) occur as rare associations with mumps viraemia but to our knowledge, concurrent ATM and GBS related to mumps has only been reported once previously. We describe the case of a young woman presenting with confusion and collapse 2 weeks after a flu-like illness. An initial diagnosis of transverse myelitis was made on the basis of the clinical findings and radiological evidence of a swollen spinal cord with uniform high signal change on T2 weighted MRI. The patient was treated with intravenous methylprednisolone without significant recovery. The diagnosis was later revised to include GBS on the basis of worsening facial diplegia in the setting of a flaccid tetraparesis, and neurophysiological evidence of a sensorimotor axonal polyradiculoneuropathy. Acute mumps viraemia was confirmed on serological grounds. The patient made an improvement in ventilatory capacity with intravenous immunoglobulin treatment.
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Affiliation(s)
- N P Bajaj
- Department of Neurology, Hurstwood Park Neurology Centre, Hurstwood Lane, West Sussex, United Kingdom.
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28
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McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis 2001; 32:236-42. [PMID: 11170913 DOI: 10.1086/318454] [Citation(s) in RCA: 331] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2000] [Revised: 06/12/2000] [Indexed: 12/17/2022] Open
Abstract
Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71-associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture-proven, EV71-induced neurological disease were identified. Nine patients (64%) developed severe neurological disease; 4 of these patients developed long-term neurological sequelae. Neurological syndromes included aseptic meningitis, Guillain-Barré syndrome, acute transverse myelitis, acute cerebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension, and a febrile convulsion. Clinical and magnetic resonance imaging data indicated that immunopathology was a major factor in the pathogenesis of neurological disease in this outbreak. This finding is in contrast to reports of previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.
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Affiliation(s)
- P McMinn
- Department of Microbiology, Princess Margaret Hospital for Children, Perth, WA, Australia.
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Kovacs B, Lafferty TL, Brent LH, DeHoratius RJ. Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature. Ann Rheum Dis 2000; 59:120-4. [PMID: 10666167 PMCID: PMC1753077 DOI: 10.1136/ard.59.2.120] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To give a comprehensive review of transverse myelopathy (TM), a rare but serious condition reported in 1-2% of patients with systemic lupus erythematosus (SLE). METHODS 14 patients with SLE and TM were evaluated and 91 additional cases published in the English and German literature reviewed. RESULTS TM presented either as the initial manifestation or within five years of the diagnosis of SLE. Most patients presented with a detectable sensory deficit at the thoracic level. In our 14 patients, 22% of the patients showed complete neurological recovery, whereas in the total patient population of 105 (our cases plus those reviewed in the literature), complete recovery was observed in 50%, partial recovery in 29% and no improvement or deterioration in 21%. Treatment with intravenous methylprednisolone followed by cyclophosphamide seemed to be most effective. Seventy per cent of the total patient population had abnormal magnetic resonance imaging findings. In our group of 14 patients, those with higher disease activity (measured by the SLAM) at onset of TM were treated more aggressively (for example, with plasmapheresis and intravenous pulse cyclophosphamide). TM in our patients was associated with antiphospholipid antibodies in 43% of the cases as compared with 64% of the total patient population. Optic neuritis occurred in 48% of the total patient population with SLE and TM, suggesting an association. CONCLUSIONS TM in SLE is a poorly understood entity. Outcome might be more favourable than previously suggested. There is an association of TM with antiphospholipid antibodies in SLE patients. Treatment including intravenous cyclophosphamide may improve the final outcome. This report emphasises the need for multicentre trials to establish guidelines for optimal treatment.
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Affiliation(s)
- B Kovacs
- Department of Medicine, Albert Einstein Medical Center, Philadelphia 19141, USA
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Simon JH. The contribution of spinal cord MRI to the diagnosis and differential diagnosis of multiple sclerosis. J Neurol Sci 2000; 172 Suppl 1:S32-5. [PMID: 10606803 DOI: 10.1016/s0022-510x(99)00275-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imaging considerations for the diagnosis and differential diagnosis of MS are based primarily on results of MR studies of the brain. Recent studies suggest that with current technology, MR imaging of the spinal cord can make important contributions, particularly in cases with equivocal or negative brain MRI studies. Spinal cord MRI may also assume an important role in early diagnosis.
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Affiliation(s)
- J H Simon
- Department of Radiology/MRI, University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Campus Box A-034, Denver, CO, USA.
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Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF. Neurologic complications in children with enterovirus 71 infection. N Engl J Med 1999; 341:936-42. [PMID: 10498488 DOI: 10.1056/nejm199909233411302] [Citation(s) in RCA: 489] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enterovirus 71 infection causes hand-foot-and-mouth disease in young children, which is characterized by several days of fever and vomiting, ulcerative lesions in the oral mucosa, and vesicles on the backs of the hands and feet. The initial illness resolves but is sometimes followed by aseptic meningitis, encephalomyelitis, or even acute flaccid paralysis similar to paralytic poliomyelitis. METHODS We describe the neurologic complications associated with the enterovirus 71 epidemic that occurred in Taiwan in 1998. At three major hospitals we identified 41 children with culture-confirmed enterovirus 71 infection and acute neurologic manifestations. Magnetic resonance imaging (MRI) was performed in 4 patients with acute flaccid paralysis and 24 with rhombencephalitis. RESULTS The mean age of the patients was 2.5 years (range, 3 months to 8.2 years). Twenty-eight patients had hand-foot-and-mouth disease (68 percent), and 6 had herpangina (15 percent). The other seven patients had no skin or mucosal lesions. Three neurologic syndromes were identified: aseptic meningitis (in 3 patients); brain-stem encephalitis, or rhombencephalitis (in 37); and acute flaccid paralysis (in 4), which followed rhombencephalitis in 3 patients. In 20 patients with rhombencephalitis, the syndrome was characterized by myoclonic jerks and tremor, ataxia, or both (grade I disease). Ten patients had myoclonus and cranial-nerve involvement (grade II disease). In seven patients the brain-stem infection produced transient myoclonus followed by the rapid onset of respiratory distress, cyanosis, poor peripheral perfusion, shock, coma, loss of the doll's eye reflex, and apnea (grade III disease); five of these patients died within 12 hours after admission. In 17 of the 24 patients with rhombencephalitis who underwent MRI, T2-weighted scans showed high-intensity lesions in the brain stem, most commonly in the pontine tegmentum. At follow-up, two of the patients with acute flaccid paralysis had residual limb weakness, and five of the patients with rhombencephalitis had persistent neurologic deficits, including myoclonus (in one child), cranial-nerve deficits (in two), and ventilator-dependent apnea (in two). CONCLUSIONS In the 1998 enterovirus 71 epidemic in Taiwan, the chief neurologic complication was rhombencephalitis, which had a fatality rate of 14 percent. The most common initial symptoms were myoclonic jerks, and MRI usually showed evidence of brainstem involvement.
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Affiliation(s)
- C C Huang
- Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Laffey JG, Murphy D, Regan J, O'Keeffe D. Efficacy of spinal cord stimulation for neuropathic pain following idiopathic acute transverse myelitis: a case report. Clin Neurol Neurosurg 1999; 101:125-7. [PMID: 10467910 DOI: 10.1016/s0303-8467(99)00012-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Spinal cord stimulation (SCS) involves the electrical stimulation of dorsal structures within the spinal cord, and is the most widespread application of neurostimulation for the relief of chronic pain. Idiopathic acute transverse myelitis (IATM) is an acute monophasic lesion of the spinal cord that presents with symptoms associated with loss of cord function. The incidence of chronic pain secondary to this condition is unknown, but is considered rare. We report the efficacy of SCS for relief of severe neuropathic pain in both lower limbs secondary to IATM, which had failed to respond to conventional pain therapies.
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Affiliation(s)
- J G Laffey
- Department of Anaesthesia, St. Vincent's Hospital, Dublin, Ireland
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Wilmshurst JM, Walker MC, Pohl KR. Rapid onset transverse myelitis in adolescence: implications for pathogenesis and prognosis. Arch Dis Child 1999; 80:137-42. [PMID: 10325728 PMCID: PMC1717819 DOI: 10.1136/adc.80.2.137] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Five adolescents with transverse myelitis were reviewed. All presented with a rapid onset paralysis of the lower limbs and impairment of bladder control. The maximum disability developed between 10 minutes and six hours. There was no history of trauma, asthma, or prodromal illness. Investigations failed to demonstrate a vascular cause. Extensive spinal cord abnormalities were observed on magnetic resonance imaging. Electrophysiological investigations, performed in four cases, were all consistent with anterior horn cell damage. In all five adolescents there was poor recovery. The underlying pathogenesis of this rapid onset condition remains a subject of debate. Similarities with both transverse myelitis and fibrocartilaginous emboli are evident, widening the spectrum of conditions within the transverse myelitis umbrella. These observations suggest that in rapid onset "transverse myelitis" the combination of extensive hyperintensity on spinal cord neuroimaging with electrophysiological evidence of anterior horn cell involvement might have adverse prognostic significance.
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Affiliation(s)
- J M Wilmshurst
- Department of Paediatric Neurology, Newcomen Centre, Guy's Hospital, London, UK
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Abstract
We describe electroclinical and imaging features of a peculiar type of parainfectious myelitis that selectively involves the conus/epiconus region of the spinal cord. Twelve patients of parainfectious myelitis with MRI evidence of inflammatory lesions in the conus/epiconus region of the spinal cord were studied. All patients underwent full clinical and electrophysiological evaluation along with MRI of the spine. MRI included axial images at the site of lesion. All patients had a unique clinical presentation with urinary symptoms. Careful clinical examination revealed minimal sensorimotor dysfunction in the lower lumbar and sacral segments, which remained unnoticed by most of the patients; three female patients had no sensorimotor deficit. The motor paralysis recorded in four patients was flaccid and areflexic. The sensory level was inconspicuous as it was in the leg area corresponding to the lumbar and sacral spinal segments. Sensory loss was significantly more in the perineal region in those seven patients who had MRI evidence of inflammatory lesion in conus medullaris; two patients had maximum sensory loss in lumbar dermatomal distribution, which corresponded with the focal segmental myelitis involving 'epiconus'. MRI done in the sagittal plane was either normal or only 'suggestive' of myelitis in most of the patients and the inflammatory lesions were much more visible in the axial plane. The lesions predominantly involved central gray matter with spread to adjoining white matter in nine patients; in three patients with pure bladder involvement, lesions were confined to lateral gray matter of the conus medullaris. Our findings indicate that parainfectious myelitis (PIM) selectively involving conus medullaris is an important cause of unexplained acute or sub-acute urinary symptoms in adolescent and adult patients. In suspected cases, MRI must include axial images of the conus-epiconus region, as sagittal images may not always reveal the lesion. Due to initial presentation with urinary symptoms, absent or minimal sensory-motor signs, no transverse level over the trunk and unique MRI features, this condition may be called parainfectious conus myelitis (PICM).
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Affiliation(s)
- S Pradhan
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Abstract
Transverse myelitis is a rare neurologic disorder. It is an interruption of spinal cord function not caused by macrotrauma. Symptoms develop rapidly and consist of ascending paralysis, diminished or absent sensation below the cervical or thoracic region, and often urinary retention. Etiologies include parainfectious events, multiple sclerosis, autoimmune disorders, vascular insufficiency, paraneoplastic myelopathy, postvaccinial events, idiopathic occurrence, and minimal trauma. Treatment generally consists of supportive measures. The use of steroids to hasten recovery remains controversial but is routine in most cases. The time period and degree of recovery is variable. We present a case of rapid onset of neurologic symptoms in a college football player right before a game. No other sports related cases have been reported in the sports medicine literature. Diagnostic, therapeutic, and historical aspects of this rare but important disorder are discussed.
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Affiliation(s)
- D S Ross
- Department of Family and Sports Medicine, Methodist Hospital of Dallas, UT Southwestern Medical Center at Dallas, USA.
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