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Guada L, Cabrero FR, Baldwin NL, Levi AD, Gultekin SH, Verma A. Acute Ascending Necrotizing Myelitis Following COVID-19 Infection: A Clinicopathological Report. Neurol Clin Pract 2022; 12:e28-e32. [DOI: 10.1212/cpj.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022]
Abstract
Abstract:Background and Objectives:Neurological manifestations of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2, COVID-19) infection are common and varied. The objective of this report is to describe clinicopathological findings of rare acute ascending necrotizing myelitis (ANM) and briefly summarize similar COVID-19-associated longitudinally extended transverse myelitis (LETM) cases.Methods:We describe the clinical presentation, disease course, diagnostic workup, therapeutic measures, and pathological findings of ANM associated with COVID-19 infection.Results:A 31-year-old previously healthy woman developed a longitudinally extensive lower thoracic myelopathy three weeks after COVID-19 infection. The thoracic spinal cord lesion extended to cervical level in one week and then to the lower medullary level in two more weeks. Thoracic laminectomy at T5 – T6 level and cord biopsy revealed necrobiotic changes without viral particles or microglial nodules. The clinical deficit stabilized following immunomodulatory and eculizumab therapy.Conclusion:COVID-19 infection can cause ascending necrotizing myelitis. It adds to the spectrum of reported cases of COVID-19-associated encephalitis and myelitis.
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Molazadeh N, Filippatou AG, Vasileiou ES, Levy M, Sotirchos ES. Evidence for and against subclinical disease activity and progressive disease in MOG antibody disease and neuromyelitis optica spectrum disorder. J Neuroimmunol 2021; 360:577702. [PMID: 34547512 DOI: 10.1016/j.jneuroim.2021.577702] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and aquaporin-4 IgG seropositive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD) are generally considered to be relapsing disorders, without clinical progression or subclinical disease activity outside of clinical relapses, in contrast to multiple sclerosis (MS). With advances in the diagnosis and treatment of these conditions, prolonged periods of remission without relapses can be achieved, and the question of whether progressive disease courses can occur has re-emerged. In this review, we focus on studies exploring evidence for and against relapse-independent clinical progression and/or subclinical disease activity in patients with MOGAD and AQP4-IgG+ NMOSD.
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Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Parissis D, Smyrni N, Ioannidis P, Grigoriadis N. Primary progression in NMOSD. Does it really exist? Mult Scler Relat Disord 2020; 48:102712. [PMID: 33450529 DOI: 10.1016/j.msard.2020.102712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Abstract
Acute myelitis, in conjunction with a longitudinally extensive MRI pattern, is a core feature of aquaporin 4 IgG-associated neuromyelitis optica spectrum disorders (NMOSD). According to current diagnostic criteria for transverse myelitis and NMOSD, clinical worsening should not exceed 3-4 weeks from attack onset. Recently, we were able to document, through frequent clinical examination and radiological follow-up, the unusual case of an ab initio progressive myelopathy, ultimately attributed to aquaporin-4 autoimmunity. Although this case might merely represent an overlooked cluster of individual clinical attacks, it could, however, draw attention to the controversial concept of disease progression in the context of NMOSD.
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Affiliation(s)
- Dimitrios Parissis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Nikoletta Smyrni
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Panos Ioannidis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Nikolaos Grigoriadis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
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Sotoca J, Rodríguez-Álvarez Y. COVID-19-associated acute necrotizing myelitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/5/e803. [PMID: 32522767 PMCID: PMC7309521 DOI: 10.1212/nxi.0000000000000803] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Javier Sotoca
- From the Neurology Department (J.S.) and Radiology Department (Y.R.-Á.), Hospital Universitari Mútua Terrassa, Spain.
| | - Yensa Rodríguez-Álvarez
- From the Neurology Department (J.S.) and Radiology Department (Y.R.-Á.), Hospital Universitari Mútua Terrassa, Spain
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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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Batra A, Periyavan S. Role of low plasma volume treatment on clinical efficacy of plasmapheresis in neuromyelitis optica. Asian J Transfus Sci 2017; 11:102-107. [PMID: 28970675 PMCID: PMC5613414 DOI: 10.4103/ajts.ajts_111_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND: Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Plasmapheresis (PP) is an effective adjunct therapy in severe NMO attacks. The recommended minimum plasma volume to be treated per session of PP is equivalent to total plasma volume (TPV) of the patient. AIM: To study the effect of lower plasma volume treated in patients with NMO on clinical efficacy of plasmapheresis in comparison to minimum recommended volume. METHODS: This retrospective study was done on acute NMO patients who were managed with PP at our center. Patients who had 5 sessions of PP, spread over 10 days, were included. Clinical outcome was defined as per predefined criteria. RESULTS: 24 patients who underwent PP for acute NMO met our inclusion criteria. Females (age; mean (SD) 33.7 (11.2) years) were more common (n = 18). The minimum recommended plasma volume (PV) that was supposed to be treated per patient during entire acute therapeutic period was 195.5 (14.6) mL per kilogram-body-weight (kg-bw). We treated lower plasma volume (mean (SD) 112.7 (17.0) mL per kg-bw); the difference was significant (P < 0.05). The volume treated was same across the gender (P > 0.05). Significant clinical improvement was observed in 79% of patients (n = 19) after 6 months. There were no significant differences in volume of plasma treated, between patients who had moderate and marked improvement; also, who did, and did not have significant clinical improvement (P > 0.05; for both). CONCLUSIONS: Plasmapheresis is a safe and efficient add-on therapy in NMO, especially in steroid-resistant cases. Although the volumes of plasma treated during acute plasmapheresis were less than recommended minimum volumes, majority of patients had significant clinical improvement.
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Affiliation(s)
- Akshay Batra
- Department of Transfusion Medicine and Hematology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sundar Periyavan
- Department of Transfusion Medicine and Hematology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Adawi M, Bisharat B, Bowirrat A. Systemic Lupus Erythematosus (SLE) Complicated by Neuromyelitis Optica (NMO - Devic's Disease): Clinic-Pathological Report and Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:41-7. [PMID: 24948869 PMCID: PMC4051802 DOI: 10.4137/ccrep.s15177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/01/2014] [Accepted: 04/13/2014] [Indexed: 11/05/2022]
Abstract
Neuromyelitis optica (NMO) is usually a relapsing demyelinating disease of the central nervous system associated with optic neuritis, transverse myelitis involving three or more contiguous spinal cord segments, and seropositivity for NMO-IgG antibody. NMO is often mistaken for multiple sclerosis and there are relatively sporadic publications about NMO and overlapping systemic or organ-specific autoimmune diseases, such as systemic lupus erythematosus (SLE). We described a unique case of a 25-year-old Arab young woman who was diagnosed with SLE, depending on clinical, laboratory investigations and after she had fulfilled the diagnostic criteria for SLE and had presented the following findings: constitutional findings (fatigue, fever, and arthralgia); dermatologic finding (photosensitivity and butterfly rash); chronic renal failure (proteinuria up to 400 mg in 24 hours); hematologic and antinuclear antibodies (positivity for antinuclear factor (ANF), anti-double-stranded DNA antibodies, direct Coombs, ANA and anti-DNA, low C4 and C3, aCL by IgG and IgM). Recently, she presented with several episodes of transverse myelitis and optic neuritis. Clinical, radiological, and laboratory findings especially seropositivity for NMO-IgG were compatible with NMO. Accurate diagnosis is critical to facilitate initiation of immunosuppressive therapy for attack prevention. This case illustrates that NMO may be associated with SLE.
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Affiliation(s)
- Mohammad Adawi
- Senior Physician Specialist in Rheumatology, Department of Rheumatology; North County Health Services (clalit), Faculty of Medicine in the Galilee, Bar Ilan University, Israel
| | - Bishara Bisharat
- Senior Physician Specialists in Family Medicine, Department of Family Medicine; Director of EMMS Nazareth Hospital, Faculty of Medicine in the Galilee, Bar Ilan University, Israel
| | - Abdalla Bowirrat
- Professor of Clinical Neuroscience and Population Genetics; Department of clinical Neuroscience - EMMS Nazareth Hospital, Faculty of Medicine in the Galilee, Bar Ilan University, Israel
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Khatri BO, Kramer J, Dukic M, Palencia M, Verre W. Maintenance plasma exchange therapy for steroid-refractory neuromyelitis optica. J Clin Apher 2012; 27:183-92. [DOI: 10.1002/jca.21215] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 02/12/2012] [Indexed: 12/18/2022]
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Matà S, Lolli F. Neuromyelitis optica: An update. J Neurol Sci 2011; 303:13-21. [DOI: 10.1016/j.jns.2011.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 12/01/2010] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
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Ratchford JN, Quigg ME, Conger A, Frohman T, Frohman E, Balcer LJ, Calabresi PA, Kerr DA. Optical coherence tomography helps differentiate neuromyelitis optica and MS optic neuropathies. Neurology 2009; 73:302-8. [PMID: 19636050 DOI: 10.1212/wnl.0b013e3181af78b8] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the retinal nerve fiber layer (RNFL) thickness and macular volume in neuromyelitis optica (NMO) spectrum patients using optical coherence tomography (OCT). BACKGROUND OCT can quantify damage to retinal ganglion cell axons and can identify abnormalities in multiple sclerosis and optic neuritis (ON) eyes. OCT may also be useful in the evaluation of patients with NMO. METHODS OCT and visual function testing were performed in 26 NMO spectrum patients with a history of ON, 17 patients with isolated longitudinally extensive transverse myelitis (LETM) without ON, 378 patients with relapsing-remitting multiple sclerosis (RRMS), and 77 healthy controls at 2 centers. RESULTS Substantial RNFL thinning was seen in NMO ON eyes (63.6 microm) relative to both RRMS ON eyes (88.3 microm, p < 0.0001) and control eyes (102.4 microm, p < 0.0001). A first episode of ON was estimated to cause 24 microm more loss of RNFL thickness in NMO than RRMS. Similar results were seen for macular volume. ON also was associated with more severe visual impairment in NMO spectrum patients than in RRMS patients. Eyes in the LETM group and unaffected NMO eyes were not significantly different from controls, though conclusions about these subgroups were limited by small sample sizes. CONCLUSIONS Optical coherence tomography (OCT) shows more severe retinal damage after optic neuritis (ON) episodes in neuromyelitis optica (NMO) than in relapsing-remitting multiple sclerosis. Identification of substantial retinal nerve fiber layer loss (>15 microm) after ON in a non-multiple sclerosis patient should prompt consideration of an NMO spectrum condition. OCT may be a useful tool for the evaluation of patients with NMO.
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Affiliation(s)
- J N Ratchford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Urai Y, Matsumoto K, Shimamura M, Ikeda K, Tsukaguchi M, Deguchi K, Touge T, Ueno M, Sakamoto H, Kuriyama S, Kinekawa F, Kurokohchi K, Uchida N, Masaki T. Paraneoplastic necrotizing myelopathy in a patient with advanced esophageal cancer: An autopsied case report. J Neurol Sci 2009; 280:113-7. [DOI: 10.1016/j.jns.2009.02.324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/31/2009] [Accepted: 02/03/2009] [Indexed: 10/21/2022]
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Bonnan M, Valentino R, Olindo S, Mehdaoui H, Smadja D, Cabre P. Plasma exchange in severe spinal attacks associated with neuromyelitis optica spectrum disorder. Mult Scler 2009; 15:487-92. [PMID: 19324982 DOI: 10.1177/1352458508100837] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Plasma exchange (PE) is increasingly undertaken in diseases involving humoral factors and is proven to be beneficial in acute demyelinating diseases. Spinal attacks in relapsing neuromyelitis optica (NMO) and in extensive transverse myelitis (ETM) – a truncated form of NMO with spinal involvement – are usually devastating. Objective We retrospectively studied the outcome of PE-treated versus steroid-only treated spinal attacks in relapsing NMO and ETM. Methods We included 96 severe spinal attacks in 43 Afro-Caribbean patients. PE was given as an add-on therapy in 29 attacks. Expanded disability status score (EDSS) was obtained before attack, during the acute and residual stage. We defined the ΔEDSS as the rise from basal to residual EDSS. Results The ΔEDSS was found to be lower in the PE-treated group (1.2 ± 1.6 vs 2.6 ± 2.3; P < 0.01). A low basal impairment is associated with a better outcome. Improvement was obtained in both NMO-IgG negative and positive NMO attacks. Minor adverse events manifested in seven PE sessions (24%). Conclusion PE appears to be a safe add-on therapy that may be employed early in severe spinal attacks in the NMO spectrum disorders in order to maximize improvement rate. PE efficiency is independent of NMO-IgG positivity.
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Affiliation(s)
- M Bonnan
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - R Valentino
- Réanimation médicale, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - S Olindo
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - H Mehdaoui
- Réanimation médicale, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - D Smadja
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - P Cabre
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
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Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG. The spectrum of neuromyelitis optica. Lancet Neurol 2007; 6:805-15. [PMID: 17706564 DOI: 10.1016/s1474-4422(07)70216-8] [Citation(s) in RCA: 1544] [Impact Index Per Article: 90.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuromyelitis optica (also known as Devic's disease) is an idiopathic, severe, demyelinating disease of the central nervous system that preferentially affects the optic nerve and spinal cord. Neuromyelitis optica has a worldwide distribution, poor prognosis, and has long been thought of as a variant of multiple sclerosis; however, clinical, laboratory, immunological, and pathological characteristics that distinguish it from multiple sclerosis are now recognised. The presence of a highly specific serum autoantibody marker (NMO-IgG) further differentiates neuromyelitis optica from multiple sclerosis and has helped to define a neuromyelitis optica spectrum of disorders. NMO-IgG reacts with the water channel aquaporin 4. Data suggest that autoantibodies to aquaporin 4 derived from peripheral B cells cause the activation of complement, inflammatory demyelination, and necrosis that is seen in neuromyelitis optica. The knowledge gained from further assessment of the exact role of NMO-IgG in the pathogenesis of neuromyelitis optica will provide a foundation for rational therapeutic trials for this rapidly disabling disease.
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Affiliation(s)
- Dean M Wingerchuk
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
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