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Shrimpton M, Shaw C. Concurrent transverse myelitis and acute inflammatory demyelinating polyneuropathy. BMJ Case Rep 2024; 17:e259732. [PMID: 38806395 DOI: 10.1136/bcr-2024-259732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
A woman in her 40s presented with thoracic banding dysaesthesia and lower motor neuron weakness. Spinal imaging revealed a short segment of transverse myelitis and neurophysiology was suggestive of concurrent acute inflammatory demyelinating polyneuropathy. The patient improved with consecutive intravenous immunoglobulin and methylprednisolone treatment. Acute inflammatory demyelinating polyneuropathy is a progressive immune-mediated peripheral neuropathy which responds to intravenous immunoglobulin or plasmapheresis, whereas transverse myelitis is a central inflammatory syndrome usually treated with corticosteroid. We highlight differentiating features of the clinical presentation and the utility of investigations such as neurophysiology and MRI along with a review of treatment and the role for corticosteroid therapy.
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Affiliation(s)
| | - Cameron Shaw
- Neurology Department, Barwon Health, Geelong, Victoria, Australia
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Andersen EW, Ryan MM, Leventer RJ. Guillain-Barré syndrome with optic neuritis. J Paediatr Child Health 2022; 58:887-890. [PMID: 34331483 DOI: 10.1111/jpc.15656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Erik W Andersen
- Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Monique M Ryan
- Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Neuroscience, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J Leventer
- Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Neuroscience, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Alrubaye R, Bondugula V, Baleguli V, Chofor R. A possible Guillain-Barré syndrome/transverse myelitis overlap syndrome after recent COVID-19. BMJ Case Rep 2022; 15:15/2/e246967. [PMID: 35140089 PMCID: PMC8830199 DOI: 10.1136/bcr-2021-246967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Neurological manifestations are common in SARS-CoV-2 infection, including life-threatening acute muscle weakness, due to neuromuscular disorders such as acute transverse myelitis (TM) and Guillain-Barré syndrome (GBS). These syndromes can rarely coexist and present as an overlap syndrome. Here, we report a patient who developed acute symmetrical proximal lower limb weakness 5 days after diagnosis of COVID-19. GBS was diagnosed due to the presence of motor signs, albumin-cytological dissociation in cerebrospinal fluid examination and axonal damage according to nerve condition tests. However, abnormal areas on MRI of the thoracic spine and lack of improvement with intravenous immunoglobulin supported a diagnosis of TM. Therefore, a possible overlap between GBS and TM was established. To our knowledge, this is the third case report of GBS/TM overlap syndrome after COVID-19. The patient’s full and rapid recovery with intravenous corticosteroids and plasmapheresis supports our diagnosis.
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Affiliation(s)
- Riyadh Alrubaye
- Department of Hospital Medicine/Internal Medicine Residency Program, Northeast Georgia Health System Inc, Gainesville, Georgia, USA
| | - Vijayamala Bondugula
- Department of Neurology, Northeast Georgia Health System Inc, Gainesville, Georgia, USA
| | - Vidya Baleguli
- Department of GME/Internal Medicine, Northeast Georgia Health System Inc, Gainesville, Georgia, USA
| | - Rosemary Chofor
- Department of GME/Internal Medicine Residency Program, Northeast Georgia Health System Inc, Gainesville, Georgia, USA
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Guillain-Barré and transverse myelitis overlap syndrome: two case reports. Med Clin (Barc) 2020; 157:214-216. [PMID: 32958265 DOI: 10.1016/j.medcli.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022]
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Agarwal A, Fernandez Bowman A. Synchronous Occurrence of Guillain-Barre Syndrome and Transverse Myelitis of Unknown Etiology in an Adolescent. Cureus 2020; 12:e9645. [PMID: 32923245 PMCID: PMC7480888 DOI: 10.7759/cureus.9645] [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] [Indexed: 11/05/2022] Open
Abstract
Synchronous occurrence of Guillain-Barre syndrome (GBS) and acute transverse myelitis (ATM) happens very rarely in childhood. Only a few cases of these conditions occurring simultaneously have been reported and represent a diagnostic challenge. We describe a case of a 17-year-old male presenting with acute onset of bilateral symmetrical numbness and tingling starting in the feet that rapidly ascended to the legs with associated motor weakness, associated with a sensory level and urinary retention. Albuminocytologic dissociation on cerebrospinal fluid (CSF) analysis was consistent with GBS. MRI spine revealed an area of increased T2 signal involving the dorsal aspect of the left side of the cord at the C7 level. The patient was treated with IV methylprednisolone and IV immunoglobulin with significant improvement. This report emphasizes the rarity of this synchronous occurrence in children and the need for further reports to understand the mechanism and better treatment approaches.
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Rissardo JP, Caprara ALF. Transverse Myelitis and Guillain-Barré Syndrome Overlap Secondary to Bartonella henselae: Case Report. Prague Med Rep 2020; 120:131-137. [PMID: 31935348 DOI: 10.14712/23362936.2019.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The GBS/ATM overlap is characterized by the simultaneous occurrence of Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM), which are two neurological autoimmune disorders. In this context, cat scratch disease (CSD) was rarely reported combined with this overlap. An adult female presenting fever, back pain, inferior limb weakness, and anuria was admitted to our hospital. On the physical exam, a distended bladder and bilateral lymphadenopathy were observed. The neurological assessment revealed muscle weakness, plantar flexion, and hyporeflexia in right with absence in left. Also, she reported hyperalgesia in inferior limbs. Her blood pressure was fluctuating being in the majority of the time hypertensive. A spinal cord MRI (magnetic resonance imaging) was suggestive of transverse myelitis. Methylprednisolone was started. The cerebrospinal fluid showed 37.0 cells/mm3 of white blood cell count, 49 mg/dl of glucose, and 50.7 mg/dl of protein. Ceftriaxone and vancomycin were started. On further questioning, the subject stated that her finger was bitten by a cat about two weeks before the beginning of the symptoms. Serological tests were positive for Bartonella henselae. Doxycycline and rifampin were started. After one-month, her symptoms improve but she continued with a radicular pain and weakness. An EMG (electroneuromyography) was suggestive of demyelination. IVIG (intravenous immunoglobulin) was started. After IVIG 4-day, the patient had recovery of her strength. To the authors' knowledge, there are two case reports of pediatric individuals linking CSD and GBS/ATM. Still, this association in an adult patient has not been reported until the present moment.
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Affiliation(s)
- Jamir Pitton Rissardo
- Department of Medicine and Department of Neurology, Federal University of Santa Maria, Santa Maria, Brasil.
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Guo F, Zhang YB. Clinical features and prognosis of patients with Guillain-Barré and acute transverse myelitis overlap syndrome. Clin Neurol Neurosurg 2019; 181:127-132. [PMID: 31039494 DOI: 10.1016/j.clineuro.2019.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Patients who present with Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM), either simultaneously or consecutively, are defined as having GBS/ATM overlap syndrome. As this syndrome has been underinvestigated, we performed a literature review to evaluate case reports of GBS/ATM overlap syndrome to facilitate its early diagnosis. PATIENTS AND METHODS We searched four scientific literature databases (PUBMED, EMBASE, ELSEVIER and WEB OF SCIENCE) for cases that presented as GBS/ATM overlap syndrome. Eighteen articles that described 23 cases were included, and the clinical and prognostic data were analyzed. RESULTS Initially, only five (29.4%) patients were diagnosed with GBS/ATM overlap syndrome. Patients with GBS/ATM overlap syndrome presented as four clinical features. First, some of the patients displayed abnormal pyramidal signs, including 29.4% of patients who had positive pyramidal signs or a negative plantar reflex and 17.6% of patients who had signs of areflexia or hyporeflexia combined with positive pyramidal signs. Second, patients suffered pain and respiratory failure at a high rate (43.5% with pain at the onset of the disease, 43.5% with ventilator support, and 47.8% shown with respiratory failure). Third, patients had a partial clinical recovery of immunomodulators, 56.5% of patients had a favorable outcome, 46.2% of patients who received intravenous immunoglobulin (IVIG) combined steroids responded well to the treatment. Four, acute axonal polyneuropathy seemed to be associated with poor outcomes (odds ratio = 3.00, 95% CI = 1.35-6.68, P = 0.01). Abnormalities in spinal cord magnetic resonance imaging (MRI) were detected in all patients, and the most frequently involved segments were the cervical cord (69.6%) and the thoracic cord (69.6%). In addition to spinal cord lesions, in three patients lesions in the medulla and cerebral hemisphere were also observed. The most common prescriptions included a high dose of methylprednisolone at 1 g/day for 3-5 days that was followed by a 6-week course of oral prednisone and IVIG at 0.4 g/kg/day for 5 days. CONCLUSION While it is difficult to make an early diagnosis of GBS/ATM overlap syndrome, electrophysiology is helpful in the diagnosis of GBS and spinal cord MRIs are key to identifying ATM. Brain MRIs are also recommended to detect subclinical lesions. The combined use of IVIG and steroids was the most frequent treatment. However, less than half of the patients responded positively to treatment. Acute axonal neuropathy may be a risk factor for a poor prognosis.
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Affiliation(s)
- Fang Guo
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yong-Bo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Wang YQ, Chen H, Zhuang WP, Li HL. The clinical features of combined central and peripheral demyelination in Chinese patients. J Neuroimmunol 2018; 317:32-36. [PMID: 29501083 DOI: 10.1016/j.jneuroim.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/30/2017] [Accepted: 02/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Combined central and peripheral demyelination (CCPD) is rare and has never been reported as a spectrum disease in Han Chinese population. OBJECTIVES To study the clinical features of CCPD in Han Chinese patients. METHODS Twenty-two CCPD patients were selected from 788 demyelination cases. We reviewed and compared the clinical manifestation, laboratory data, electrophysiological examination, MRI and the prognosis. RESULTS CCPD patients presented with sensory disturbance (86.4%), plegia (77.3%), cranial nerve involvement (77.3%), abnormal deep tendon reflexes (72.7%). CSF data showed increased CSF protein in 81% patients. Oligoclonal IgG bands (OB) were negative. Cortical or juxtacortical, periventricular, infratentorial lesions, thoracic and cervical spinal cord were mostly affected. Visual evoked potentials indicated optic nerves demyelinating in 50% cases. 21 CCPD patients were treated with intravenous immunoglobulin or steroids or both of them, and the efficacy was 33.3%, 54.5%, 71.4%, respectively. One case that showed no response to steroids plus intravenous immunoglobulin treatment was improved significantly after using cyclophosphamide. CONCLUSIONS CCPD is a spectrum disease that can't be regarded as a simple combination of MS and CIDP. A suspected CCPD should receive brain and spinal MRI as well as electrophysiological examination to obtain a precise diagnosis.
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Affiliation(s)
- Yan-Qin Wang
- Fuqing Hospital of Fujian Province, The Affiliated Fuqing Hospital to Fujian Health College, China
| | - Han Chen
- Fuqing Hospital of Fujian Province, The Affiliated Fuqing Hospital to Fujian Health College, China
| | - Wu-Ping Zhuang
- Fuqing Hospital of Fujian Province, The Affiliated Fuqing Hospital to Fujian Health College, China
| | - Hong-Lei Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Medical Neurobiology, Zhejiang Province, Hangzhou, China.
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Concomitant Transverse Myelitis and Acute Axonal Sensory-Motor Neuropathy in an Elderly Patient. Case Reports Immunol 2017; 2017:7289474. [PMID: 28785494 PMCID: PMC5530449 DOI: 10.1155/2017/7289474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
Diagnosing concomitant transverse myelitis (TM) and Guillain-Barré syndrome (GBS) can be challenging. We report a case of an elderly patient presenting with acute sensory and motor disturbances in the four limbs, associated with urinary retention, ophthalmoparesis, facial weakness, and dysarthria. Electrodiagnostic studies were consistent with acute motor sensory axonal neuropathy (AMSAN), and imaging showed a longitudinally extensive tumefactive contrast-enhancing hyperintense spinal cord lesion extending from T6 to the cone. Concomitant AMSAN and TM have not been previously reported in the elderly. Comorbid TM and other GBS variants have been previously reported. Intravenous methylprednisolone, plasma exchange, cyclophosphamide, or combination therapies are usually used, although there are no randomized controlled studies regarding treatment choices.
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Đorđević G, Stamenović J. DEMYELINATION OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM: A CASE REPORT. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Samuelsen SV, Maity A, Nybo M, Macaubas C, Lønstrup L, Balboni IM, Mellins ED, Astakhova K. Novel Phospholipid-Protein Conjugates Allow Improved Detection of Antibodies in Patients with Autoimmune Diseases. PLoS One 2016; 11:e0156125. [PMID: 27257889 PMCID: PMC4892602 DOI: 10.1371/journal.pone.0156125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/10/2016] [Indexed: 01/08/2023] Open
Abstract
Reliable measurement of clinically relevant autoimmune antibodies toward phospholipid-protein conjugates is highly desirable in research and clinical assays. To date, the development in this field has been limited to the use of natural heterogeneous antigens. However, this approach does not take structural features of biologically active antigens into account and leads to low reliability and poor scientific test value. Here we describe novel phospholipid-protein conjugates for specific detection of human autoimmune antibodies. Our synthetic approach includes mild oxidation of synthetic phospholipid cardiolipin, and as the last step, coupling of the product with azide-containing linker and copper-catalyzed click chemistry with β2-glycoprotein I and prothrombin. To prove utility of the product antigens, we used enzyme-linked immunosorbent assay and three cohorts of samples obtained from patients in Denmark (n = 34) and the USA (n = 27 and n = 14). Afterwards we analyzed correlation of the obtained autoantibody titers with clinical parameters for each patient. Our results prove that using novel antigens clinically relevant autoantibodies can be detected with high repeatability, sensitivity and specificity. Unlike previously used antigens the obtained autoantibody titers strongly correlate with high disease activity and in particular, with arthritis, renal involvement, anti-Smith antibodies and high lymphocyte count. Importantly, chemical composition of antigens has a strong influence on the correlation of detected autoantibodies with disease activity and manifestations. This confirms the crucial importance of antigens’ composition on research and diagnostic assays, and opens up exciting perspectives for synthetic antigens in future studies of autoimmunity.
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Affiliation(s)
- Simone V. Samuelsen
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Arindam Maity
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Claudia Macaubas
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, California, United States of America
| | - Lars Lønstrup
- Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Imelda M. Balboni
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, California, United States of America
| | - Elizabeth D. Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, California, United States of America
| | - Kira Astakhova
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, Denmark
- * E-mail:
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