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Zhou Y, Chen Q, Gan W, Lin X, Wang B, Zhou M, Wu X, Hong D, Chen H. Comparison between MRI-negative and positive results and the predictors for a poor prognosis in patients with idiopathic acute transverse myelitis. BMC Neurol 2024; 24:226. [PMID: 38951761 PMCID: PMC11218061 DOI: 10.1186/s12883-024-03738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Idiopathic acute transverse myelitis (IATM) is a focal inflammatory disorder of the spinal cord that results in motor, sensory, and autonomic dysfunction. However, the comparative analysis of MRI-negative and MRI-positive in IATM patients were rarely reported. OBJECTIVES The purpose of this study was to compare MRI-negative with MRI-positive groups in IATM patients, analyze the predictors for a poor prognosis, thus explore the relationship between MRI-negative and prognosis. METHODS We selected 132 patients with first-attack IATM at the First Affiliated Hospital of Nanchang University from May 2018 to May 2022. Patients were divided into MRI-positive and MRI-negative group according to whether there were responsible spinal MRI lesions, and good prognosis and poor prognosis based on whether the EDSS score ≥ 4 at follow-up. The predictive factors of poor prognosis in IATM patients was analyzed by logistic regression models. RESULTS Of the 132 patients, 107 first-attack patients who fulfilled the criteria for IATM were included in the study. We showed that 43 (40%) patients had a negative spinal cord MRI, while 27 (25%) patients were identified as having a poor prognosis (EDSS score at follow-up ≥ 4). Compared with MRI-negative patients, the MRI-positive group was more likely to have back/neck pain, spinal cord shock and poor prognosis, and the EDSS score at follow-up was higher. We also identified three risk factors for a poor outcome: absence of second-line therapies, high EDSS score at nadir and a positive MRI result. CONCLUSIONS Compared with MRI-negative group, MRI-positive patients were more likely to have back/neck pain, spinal cord shock and poor prognosis, with a higher EDSS score at follow-up. The absence of second-line therapies, high EDSS score at nadir, and a positive MRI were risk factors for poor outcomes in patients with first-attack IATM. MRI-negative patients may have better prognosis, an active second-line immunotherapy for IATM patients may improve clinical outcome.
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Affiliation(s)
- Yu Zhou
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Qianxi Chen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Weiming Gan
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Xiuwen Lin
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Bo Wang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Meihong Zhou
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Xiaomu Wu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China.
| | - Hao Chen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China.
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Spillman AM. An atypical case of acute transverse myelitis following COVID-19 infection. JAAPA 2024; 37:1-3. [PMID: 38128141 DOI: 10.1097/01.jaa.0000991344.28023.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Acute transverse myelitis is a rare condition that can follow a viral infection. At least 43 cases of COVID-19 associated with acute transverse myelitis have been presented in the literature. This case review highlights one such case in a young man. Although rare, acute transverse myelitis following COVID-19 can cause significant disability for patients. Clinicians must be equipped and encouraged to report and study cases of neurologic complications following COVID-19 infection to develop further treatment and cure.
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Affiliation(s)
- Amanda Mallory Spillman
- Amanda Mallory Spillman practices at OrthoCincy in Edgewood, Ky., and is the director of clinical education at the A.T. Still University Central Coast PA Program. The author has disclosed no potential conflicts of interest, financial or otherwise
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Disease characteristics of idiopathic transverse myelitis with serum neuronal and astroglial damage biomarkers. Sci Rep 2023; 13:3988. [PMID: 36894677 PMCID: PMC9998854 DOI: 10.1038/s41598-023-30755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
Despite its close association with CNS inflammatory demyelinating disorders (CIDDs), pathogenic characteristics of idiopathic transverse myelitis (ITM) remain largely unknown. Here, we investigated serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) in patients with ITM to unravel the disease characteristics of ITM. We prospectively recruited 70 patients with ITM, 62 with AQP4 + NMOSD and 85 with RRMS-including 31 patients with acute TM attacks-along with 30 HCs. We measured sNfL and sGFAP levels using single-molecular arrays and compared these levels per lesion volume between the disease groups during attacks. Compared to HCs, ITM patients showed higher sNfL and sGFAP during acute attacks (sNfL: p < 0.001, sGFAP: p = 0.024), while those in remission (sNfL: p = 0.944, sGFAP: p > 0.999) did not, regardless of lesion extents and presence of multiple attacks. ITM patients demonstrated lower sGFAP/volume (p = 0.011) during acute attacks and lower sGFAP (p < 0.001) in remission compared to AQP4 + NMOSD patients. These findings suggest that both neuronal and astroglial damages occur in patients with acute ITM attacks at a similar level to those with RRMS, distinct from AQP4 + NMOSD. However, active neuroinflammatory process was not remarkable during remission in this cohort.
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Doubrovinskaia S, Mooshage CM, Seliger C, Lorenz H, Nagel S, Lehnert P, Purrucker J, Wildemann B, Bendszus M, Wick W, Schönenberger S, Kaulen LD. Neurological autoimmune diseases following vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A follow-up study. Eur J Neurol 2023; 30:463-473. [PMID: 36259114 PMCID: PMC9874608 DOI: 10.1111/ene.15602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Population-based studies suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger neurological autoimmunity including immune-mediated thrombotic thrombocytopenia. Long-term characterization of cases is warranted to facilitate patient care and inform vaccine-hesitant individuals. METHODS In this single-center prospective case study with a median follow-up of 387 days long-term clinical, laboratory and imaging characteristics of patients with neurological autoimmunity diagnosed in temporal association (≤6 weeks) with SARS-CoV-2 vaccinations are reported. RESULTS Follow-up data were available for 20 cases (central nervous system demyelinating diseases n = 8, inflammatory peripheral neuropathies n = 4, vaccine-induced immune thrombotic thrombocytopenia n = 3, myositis n = 2, myasthenia n = 1, limbic encephalitis n = 1, giant cell arteritis n = 1). Following therapy, the overall disability level improved (median modified Rankin Scale at diagnosis 3 vs. 1 at follow-up). The condition of two patients worsened despite immunosuppressants possibly related to their autoimmune diagnoses (limbic encephalitis n = 1, giant cell arteritis n = 1). At 12 months' follow-up, 12 patients achieved complete clinical remissions with partial responses in five and stable disease in one case. Correspondingly, autoimmune antibodies were non-detectable or titers had significantly lowered in all, and repeat imaging revealed radiological responses in most cases. Under vigilant monitoring 15 patients from our cohort underwent additional SARS-CoV-2 vaccinations (BNT162b2 n = 12, mRNA-1273 n = 3). Most patients (n = 11) received different vaccines than prior to diagnosis of neurological autoimmunity. Except for one short-lasting relapse, which responded well to steroids, re-vaccinations were well tolerated. CONCLUSIONS In this study long-term characteristics of neurological autoimmunity encountered after SARS-CoV-2 vaccinations are defined. Outcome was favorable in most cases. Re-vaccinations were well tolerated and should be considered on an individual risk/benefit analysis.
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Affiliation(s)
- Sofia Doubrovinskaia
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Christoph M. Mooshage
- Department of NeuroradiologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Corinna Seliger
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Hanns‐Martin Lorenz
- Division of RheumatologyDepartment of Internal Medicine V, University Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Simon Nagel
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
- Department of NeurologyHospital LudwigshafenLudwigshafenGermany
| | - Pascal Lehnert
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Jan Purrucker
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Brigitte Wildemann
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Martin Bendszus
- Department of NeuroradiologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Wolfgang Wick
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Silvia Schönenberger
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Leon D. Kaulen
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
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Erdoğan T, Koçer B, Şen S, Balcı BP, Terzi M. Newly Diagnosed Tumefactive Demyelinating Lesion and Multiple Sclerosis After COVID-19 Infection. Noro Psikiyatr Ars 2023; 60:223-230. [PMID: 37645083 PMCID: PMC10461761 DOI: 10.29399/npa.28142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/18/2022] [Indexed: 08/31/2023] Open
Abstract
Introduction To describe the parainfectious or postinfectious effects of COVID-19 infection on the first demyelinating presentation of Multiple Sclerosis and tumefactive demyelinating lesion (TDL) developing with Longitudinally Extensive Transverse Myelitis (LETM). Methods We present six patients who presented with a first CNS demyelination event or whose demyelinating lesions had aggravated after COVID-19 infection between May and December 2020. Nasopharyngeal swab SARS-CoV-2 PCR positivity was detected in five cases and cerebrospinal fluid (CSF) PCR was positive in one. The symptoms, neurological signs, radiological and CSF findings of the cases were examined. Results A 24-year-old woman presented with LETM aggravated by COVID-19, accompanied by a newly developed open-ring enhanced TDL. Four patients were diagnosed with the first presentation of MS, and one presented with clinically isolated syndrome according to the McDonald 2017 criteria. The interval between SARS-CoV-2 infection and the onset of clinical symptoms ranged from 4-93 days. All of the cases present with pyramidal or brain stem findings and have high brain and/or spinal MRI load. This suggests the moderate activity of CNS demyelinating disease after COVID-19 infection. Conclusions Based on this case series, all these first demyelinating events suggested that COVID-19 infection might trigger or exacerbate CNS demyelinating disease. SARS-CoV-2 plays a role in the clinical onset of Multiple Sclerosis. Active delayed demyelination developed within the first three months. This can be explained by COVID-triggered neuroimmune response that had been latent, and the initiation of the active disease process began with triggering or aggravation of the lesions in MRI. Multiple Sclerosis should be maintained during the COVID-19 pandemic.
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Affiliation(s)
- Tuğba Erdoğan
- Gazi University School of Medicine, Department of Neurology, Ankara, Turkey
| | - Belgin Koçer
- Gazi University School of Medicine, Department of Neurology, Ankara, Turkey
| | - Sedat Şen
- Ondokuz Mayıs University School of Medicine, Department of Neurology, Samsun, Turkey
| | - Belgin Petek Balcı
- İstanbul Hamidiye Faculty of Medicine, University of Health Sciences, Department of Neurology, İstanbul, Turkey
| | - Murat Terzi
- Ondokuz Mayıs University School of Medicine, Department of Neurology, Samsun, Turkey
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Ostovan VR, Sahraian MA, Karazhian N, Rostamihosseinkhani M, Salimi M, Marbooti H. Clinical characteristics, radiological features and prognostic factors of transverse myelitis following COVID-19 vaccination: A systematic review. Mult Scler Relat Disord 2022; 66:104032. [PMID: 35858499 PMCID: PMC9258415 DOI: 10.1016/j.msard.2022.104032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/24/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
Background Since introducing COVID-19 vaccines, many neurological complications such as acute transverse myelitis have been reported in the literature. This study aims to identify the clinical characteristics, radiological findings, and prognostic factors in patients with COVID-19 vaccine-associated transverse myelitis (TM). Methods We systematically reviewed Scopus, Pubmed, Cochrane library, Google Scholar, and preprint databases using appropriate keywords from inception till 8th April 2022. Besides, we manually searched the reference lists of the included studies and relevant previous reviews. Results We included 28 studies identifying 31 post-COVID-19 vaccination myelitis patients (17 female and 14 male). The mean age of the included patients was 52±19 years. ChAdOx1 nCoV-19 vaccine (Oxford-AstraZeneca) was the most common type of vaccine in association with myelitis (12 out of 31), followed by Pfizer (8 out of 31), Moderna (7 out of 31), Sinopharm (3 out of 31), and Janssen vaccine (1 out of 31). The myelitis occurred in 24 and 7 patients after administering the first and second dose of the vaccine, respectively. 21 and 10 patients had good recovery (Modified Rankin Score (MRS) <3 at the follow-up) and poor recovery (MRS≥3 at the follow-up) from myelitis, respectively. Age (OR 1.09, 95%CI 1.01–1.18, pvalue 0.02), and MRS at admission (OR 17.67, 95%CI 1.46–213.76, pvalue 0.024) were two independent risk factors for poor recovery from myelitis. Conclusion The patients with higher age and MRS at admission had a worse prognosis and needed timely and more aggressive therapeutic strategies.
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Affiliation(s)
- Vahid Reza Ostovan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Karazhian
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Marzieh Salimi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hoda Marbooti
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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Miyaue N, Yoshida A, Yamanishi Y, Tada S, Ando R, Hosokawa Y, Yabe H, Nagai M. Refractory Longitudinally Extensive Transverse Myelitis after Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in a Japanese Man. Intern Med 2022; 61:739-742. [PMID: 34897155 PMCID: PMC8943383 DOI: 10.2169/internalmedicine.8747-21] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed and administered worldwide. There have been reports of neurological adverse events following immunization (AEFIs). We herein report a case of refractory longitudinally extensive transverse myelitis in a 75-year-old Japanese man following the first dose of the BNT162b2 vaccine. The patient developed total sensory loss below the umbilicus and complete paralysis in both legs. Although he was treated with steroid therapy and plasma exchange, his recovery was limited, and severe sequelae remained. Further studies, including large epidemiological studies, are required to understand the association between SARS-CoV-2 vaccines and neurological AEFI.
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Affiliation(s)
- Noriyuki Miyaue
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Japan
| | - Akira Yoshida
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Japan
| | - Yuki Yamanishi
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Japan
| | - Satoshi Tada
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Japan
| | - Rina Ando
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Japan
| | - Yuko Hosokawa
- Department of Neurology, Saiseikai Matsuyama Hospital, Japan
| | - Hayato Yabe
- Department of Neurology, Saiseikai Matsuyama Hospital, Japan
| | - Masahiro Nagai
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Japan
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8
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Abbatemarco JR, Galli JR, Sweeney ML, Carlson NG, Samara VC, Davis H, Rodenbeck S, Wong KH, Paz Soldan MM, Greenlee JE, Rose JW, Delic A, Clardy SL. Modern Look at Transverse Myelitis and Inflammatory Myelopathy: Epidemiology of the National Veterans Health Administration Population. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1071. [PMID: 34465615 PMCID: PMC8409131 DOI: 10.1212/nxi.0000000000001071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA). METHODS This retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria. RESULTS We identified 4,084 patients with an International Classification of Diseases (ICD) code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2-4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes (p = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57-2.40) and tobacco use (OR 1.87, 95% CI, 1.17-2.99). DISCUSSION This national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.
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Affiliation(s)
- Justin R Abbatemarco
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Jonathan R Galli
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Michael L Sweeney
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Noel G Carlson
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Verena C Samara
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Haley Davis
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Stefanie Rodenbeck
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Ka-Ho Wong
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - M Mateo Paz Soldan
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - John E Greenlee
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - John W Rose
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Alen Delic
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Stacey L Clardy
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC.
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9
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Adil M, Jensen‐Fangel S, Gammelgaard L, Petersen T. Longitudinally extensive transverse myelitis and Hepatitis C-a case report and literature review. Clin Case Rep 2021; 9:e04631. [PMID: 34430004 PMCID: PMC8364999 DOI: 10.1002/ccr3.4631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022] Open
Abstract
Tractopathy lesions in the spinal cord associated with HCV infection, which normalized on MRI after antiviral treatment, are described. These specific MRI findings can be used in the diagnosis and treatment of secondary causes of transverse myelitis.
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Affiliation(s)
- Mohammad Adil
- Department of NeurologyUniversity Hospital of Southern DenmarkSonderborgDenmark
| | | | | | - Thor Petersen
- Department of NeurologyUniversity Hospital of Southern DenmarkSonderborgDenmark
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10
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Hemram SK, Ghosh A, Annigeri S. Rare and Atypical Presentations of Acute Disseminated Encephalomyelitis in Children: A Case Series. J Trop Pediatr 2021; 67:6294509. [PMID: 34100092 DOI: 10.1093/tropej/fmab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disorder of central nervous system occurring in children with a wide range of clinical manifestations after infection or vaccination. There are few case reports in literature, describing atypical presentations of ADEM with fever of unknown origin, autonomic dysfunction, complex movement disorders such as myoclonus, dystonia and chorea, acute psychosis and myocarditis. Here, we report four cases of ADEM with atypical features like uniocular blindness, myelin oligodendrocyte glycoprotein antibodies negative multiphasic disseminated encephalomyelitis, ADEM mimicking Guillain-Barre syndrome at presentation and isolated spinal ADEM. Treatment with high-dose steroids elicited an excellent neurological outcome in all patients. A high index of clinical suspicion along-with awareness of atypical features, magnetic resonance imaging and cerebrospinal fluid studies are of paramount importance in establishing ADEM diagnosis and initiation of early treatment for better outcome.
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Affiliation(s)
- Sunil Kumar Hemram
- Department of Pediatrics, Midnapore Medical College, West Bengal 721101, India
| | - Arindam Ghosh
- Department of Pediatrics, Midnapore Medical College, West Bengal 721101, India
| | - Saba Annigeri
- Department of Pediatrics, Midnapore Medical College, West Bengal 721101, India
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11
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Murphy OC, Mukharesh L, Salazar-Camelo A, Pardo CA, Newsome SD. Early factors associated with later conversion to multiple sclerosis in patients presenting with isolated myelitis. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325274. [PMID: 33687973 DOI: 10.1136/jnnp-2020-325274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify early clinical and paraclinical factors that may help predict later conversion to multiple sclerosis (MS) in patients presenting with isolated myelitis (ie, 'transverse myelitis' without clinical or radiological evidence of inflammation/demyelination elsewhere in the central nervous system). METHODS In this retrospective cohort study, we included patients with isolated myelitis who were followed clinically and radiologically at our specialised myelopathy clinic. We excluded patients with MS at the onset, aquaporin-4-IgG seropositivity, myelin oligodendrocyte glycoprotein-IgG seropositivity or other identified aetiology. Logistic regression was used to identify factors predictive of conversion to MS (defined by the 2017 McDonald criteria). RESULTS We included 100 patients, followed for a median of 4.3 years. Conversion to MS occurred in 25 of 77 patients (32%) with short-segment myelitis (longest lesion spanning <3 vertebral segments on MRI) as compared with 0 of 23 patients (0%) with longitudinally extensive myelitis (p=0.002). Among patients with short-segment myelitis, factors identified as highly predictive of conversion to MS using multivariate logistic regression included cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCB) (OR (OR) 9.2, 95% CI 2.1 to 41.0, p=0.004), younger age (OR 1.1 for each year younger, 95% CI 1.0 to 1.1, p=0.04) and longer follow-up (OR 1.3 for each year longer, 95% CI 1.0 to 1.6, p=0.04). Conversion to MS occurred at a median of 2.8 years after myelitis onset. CONCLUSIONS Short-segment MRI cord lesion(s), CSF-restricted OCB, younger age and longer follow-up are all factors predictive of conversion to MS in patients presenting with isolated myelitis.
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Affiliation(s)
- Olwen C Murphy
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Loulwah Mukharesh
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrea Salazar-Camelo
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carlos A Pardo
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Scott D Newsome
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
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12
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Gupta A, Kumar SN, Taly AB. Urodynamic profile in acute transverse myelitis patients: Its correlation with neurological outcome. J Neurosci Rural Pract 2019; 8:44-48. [PMID: 28149080 PMCID: PMC5225720 DOI: 10.4103/0976-3147.193547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The objective of this study was to observe urodynamic profile of acute transverse myelitis (ATM) patients and its correlation with neurological outcome. Patients and Methods: This prospective study was conducted in the neurorehabilitation unit of a tertiary university research hospital from July 2012 to June 2014. Forty-three patients (19 men) with ATM with bladder dysfunction, admitted in the rehabilitation unit, were included in this study. Urodynamic study (UDS) was performed in all the patients. Their neurological status was assessed using ASIA impairment scale and functional status was assessed using spinal cord independence measure. Bladder management was based on UDS findings. Results: In total, 17 patients had tetraplegia and 26 had paraplegia. Thirty-six patients (83.7%) had complaints of increased frequency and urgency of urine with 26 patients reported at least one episode of urge incontinence. Seven patients reported obstructive urinary complaints in the form of straining to void with 13 patients reported both urgency and straining to void and 3 also had stress incontinence. Thirty-seven (86.1%) patients had neurogenic overactive detrusor with or without sphincter dyssynergia and five patients had acontractile detrusor on UDS. No definitive pattern was observed between neurological status and bladder characteristics. All patients showed significant neurological and functional recovery with inpatient rehabilitation (P < 0.05 and P < 0.001, respectively). Conclusions: The problem of neurogenic bladder dysfunction is integral to ATM. Bladder management in these patients should be based on UDS findings. Bladder characteristics have no definitive pattern consistent with the neurological status.
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Affiliation(s)
- Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sushruth Nagesh Kumar
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun B Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India; Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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13
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Maj E, Wójtowicz K, Aleksandra, Podlecka-Piȩtowska, Prokopienko M, Marchel A, Rowiński O, Bekiesińska-Figatowska M. Intramedullary spinal tumor-like lesions. Acta Radiol 2019; 60:994-1010. [PMID: 30537844 DOI: 10.1177/0284185118809540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of magnetic resonance imaging (MRI) has led to an increasingly frequent detection of changes in the spinal cord. The most common intramedullary lesions are: demyelinating; vascular; inflammatory; infectious; and congenital, largely called tumor-like lesions. Spinal cord tumors are relatively rare, as compared with brain tumors. The hardest task is to conclude whether the spinal cord lesion is a tumor or a tumor-like lesion. This review is intended to help evaluate the spinal cord and gives an overview of the tumor-like lesions occurring in the spinal cord along with their characteristic.
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Affiliation(s)
- Edyta Maj
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Marek Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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14
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Sechi E, Shosha E, Williams JP, Pittock SJ, Weinshenker BG, Keegan BM, Zalewski NL, Lopez-Chiriboga AS, Jitprapaikulsan J, Flanagan EP. Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology. Neurology 2019; 93:e414-e420. [PMID: 31235660 DOI: 10.1212/wnl.0000000000007828] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Diagnostic criteria from 2002 classify transverse myelitis (TM) as idiopathic or disease associated but predate the discovery of aquaporin-4 (AQP4)-immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which associate with TM. Prior incidence estimates of idiopathic TM (ITM) range from 1 to 6.2 per 1 million. We sought to determine whether the population-based incidence and prevalence of ITM were reduced by testing patients with ITM for AQP4/MOG-IgG and reclassifying seropositive cases as having disease-associated TM. METHODS For this observational study, we retrospectively identified all cases of incident (January 1, 2003-December 31, 2016) and prevalent (December 31, 2016) ITM in Olmsted County (85% white) by using the Rochester Epidemiology Project medical records linkage system. ITM was defined by the 2002 Transverse MyelitisConsortium Working Group diagnostic criteria. Available sera were tested for AQP4-IgG and MOG-IgG. RESULTS Twenty-four patients (incident 22, prevalent 17) initially met 2002 ITM criteria (longitudinally extensive TM [LETM] 6). Sera were tested for AQP4-IgG in 22 of 24 (92%) and MOG-IgG in 21 of 24 (88%). Three seropositive cases (AQP4-IgG 2, MOG-IgG 1) were identified and reclassified as having disease-associated TM, accounting for 14% of total incident and 12% of total prevalent cases. AQP4-IgG and MOG-IgG seropositive cases represented 50% (3 of 6) of idiopathic LETM. After reclassification of seropositive patients, the final ITM incidence was 8.6 per 1,000,000 and prevalence was 7.9 per 100,000. Three cases of ITM (14%) subsequently fulfilled multiple sclerosis criteria within the study period. CONCLUSIONS The availability of AQP4-IgG and MOG-IgG modestly reduced ITM incidence and prevalence, which remained higher than previously reported in this predominantly white population. Incorporation of these biomarkers into future revisions of TM diagnostic criteria should be considered.
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Affiliation(s)
- Elia Sechi
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Eslam Shosha
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jonathan P Williams
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Sean J Pittock
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Brian G Weinshenker
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - B Mark Keegan
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Nicholas L Zalewski
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Alfonso Sebastian Lopez-Chiriboga
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jiraporn Jitprapaikulsan
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN
| | - Eoin P Flanagan
- From the Departments of Neurology (E.S., E.S., S.J.P., B.G.W., B.M.K., N.L.Z., A.S.L.-C., E.P.F.), Health Sciences Research (J.P.W.), and Laboratory Medicine and Pathology (S.J.P., J.J., E.P.F.), Mayo Clinic College of Medicine, Rochester, MN.
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15
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Ciron J, Cobo-Calvo A, Audoin B, Bourre B, Brassat D, Cohen M, Collongues N, Deschamps R, Durand-Dubief F, Laplaud D, Maillart E, Papeix C, Zephir H, Bereau M, Brochet B, Carra-Dallière C, Derache N, Gagou-Scherer C, Henry C, Kerschen P, Mathey G, Maubeuge N, Maurousset A, Montcuquet A, Moreau T, Prat C, Taithe F, Thouvenot E, Tourbah A, Rollot F, Vukusic S, Marignier R. Frequency and characteristics of short versus longitudinally extensive myelitis in adults with MOG antibodies: A retrospective multicentric study. Mult Scler 2019; 26:936-944. [PMID: 31148523 DOI: 10.1177/1352458519849511] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aim to (1) determine the frequency and distinctive features of short myelitis (SM) and longitudinally extensive transverse myelitis (LETM) in a cohort of adults with myelin oligodendrocyte glycoprotein (MOG)-antibody (Ab)-associated myelitis and (2) determine baseline prognostic factors among MOG-Ab-positive patients whose disease started with myelitis. MATERIAL AND METHODS We retrospectively analyzed clinical and paraclinical variables from a multicentric French cohort of adults with MOG-Ab-associated myelitis. At last follow-up, patients were classified into two groups according to the severity of the Expanded Disability Status Scale (EDSS) as ⩽2.5 or ⩾3.0. RESULTS Seventy-three patients with at least one episode of myelitis over disease course were included; among them, 28 (38.4%) presented with SM at the time of the first myelitis. Motor and sphincter involvement was less frequently observed in SM (51.9% and 48.2%, respectively) than in LETM patients (83.3% and 78.6%, respectively), p = 0.007 and p = 0.017; 61% of LETM patients displayed brain lesions compared to 28.6% in the SM group, p = 0.008, and the thoracic segment was more frequently involved in the LETM (82.2%) than in the SM group (39.3%), p < 0.001. EDSS at last follow-up was higher in LETM (median 3.0 (interquartile range: 2.0-4.0)) compared to SM patients (2.0, (1.0-3.0)), p = 0.042. Finally, a higher EDSS at onset was identified as the only independent risk factor for EDSS ⩾3.0 (odds ratio, 1.40, 95% confidence interval (CI): 1.01-1.95, p = 0.046). CONCLUSION SM in MOG-Ab-associated disease is not rare. The severity at onset was the only independent factor related to the final prognosis in MOG-Ab-associated myelitis.
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Affiliation(s)
- Jonathan Ciron
- Department of Neurology, Centre de Ressources et Compétences Sclérose en Plaques, Toulouse University Hospital, Toulouse, France
| | - Alvaro Cobo-Calvo
- Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle and INSERM U1028, CNRS UMR 5292, Lyon 1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Bertrand Audoin
- Department of Neurology, Hôpital de La Timone, APHM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Bertrand Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | - David Brassat
- Department of Neurology, Centre de Ressources et Compétences Sclérose en Plaques, Toulouse University Hospital, Toulouse, France
| | - Mikael Cohen
- Centre de Ressources et Compétences SEP, Neurologie, Université Nice Côte d'Azur, CHU Pasteur 2, Nice, France
| | - Nicolas Collongues
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Romain Deschamps
- Department of Neurology, Fondation A. De Rothschild, Paris, France
| | - Françoise Durand-Dubief
- Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - David Laplaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Caroline Papeix
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Hélène Zephir
- Department of Neurology, Lille University Hospital, Lille, France; LIRIC UMR 995, Lille, France
| | - Matthieu Bereau
- Department of Neurology, Besançon University Hospital, Besançon, France
| | - Bruno Brochet
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | - Carole Henry
- Department of Neurology, Paris Saint-Denis Hospital, Paris, France
| | | | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Nicolas Maubeuge
- Department of Neurology, Poitiers University Hospital, Poitiers, France
| | - Aude Maurousset
- Department of Neurology, Tours University Hospital, Tours, France
| | - Alexis Montcuquet
- Department of Neurology, Limoges University Hospital, Limoges, France
| | - Thibault Moreau
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - Christophe Prat
- Department of Neurology, Angoulême Hospital, Angoulême, France
| | - Frédéric Taithe
- Department of Neurology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France
| | - Ayman Tourbah
- CHU de Reims and Université Reims Champagne Ardenne, LPN, EA 2027 Université Paris 8, Saint-Denis, France
| | - Fabien Rollot
- Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Sandra Vukusic
- Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Bron, France; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle and INSERM U1028, CNRS UMR 5292, Lyon 1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Bron, France; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle and INSERM U1028, CNRS UMR 5292, Lyon 1 University, Center for Research in Neuroscience of Lyon, Lyon, France
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16
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Ali A, Bareeqa SB, Riaz A, Ahmed SI, Shaikh MH, Ghauri MI. Assessment of Clinical Outcomes in Patients Presenting with Transverse Myelitis: A Tertiary Care Experience from a Developing Country. Cureus 2019; 11:e4342. [PMID: 31187007 PMCID: PMC6541160 DOI: 10.7759/cureus.4342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM. Methods: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department of Neurology at Jinnah Medical College Hospital (JMCH), Karachi. In total 131 patients of TM were enrolled and treated as per standard protocol, and re-evaluated after eight weeks for assessment of clinical outcomes. Results: The average age of patients was 51.15 ± 6.56 years. Out of 131 cases, 36.6% of patients had full recovery and 63.4% had poor recovery while recurrence occurred in 66.7% cases. Urinary frequency was observed in 12.2% cases and incontinence in 6.9% cases. Conclusion: Acute TM has become transformed with recent developments, especially the advent of the MRI and the discovery of biomarkers.
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Affiliation(s)
- Aijaz Ali
- Neurology, Jinnah Medical College Hospital, Karachi, PAK
| | | | - Amir Riaz
- Rheumatology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Syed Ijlal Ahmed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
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17
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Annunziata P, Masi G, Cioni C, Gastaldi M, Marchioni E, D'amico E, Patti F, Laroni A, Mancardi G, Vitetta F, Sola P. Clinical, laboratory features, and prognostic factors in adult acute transverse myelitis: an Italian multicenter study. Neurol Sci 2019; 40:1383-1391. [PMID: 30903415 DOI: 10.1007/s10072-019-03830-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We compared the clinical, laboratory, and radiological features of different subgroups of acute transverse myelitis (ATM) diagnosed according to the criteria established by the Transverse Myelitis Consortium Working Group (TMCWG) as well as of non-inflammatory acute transverse myelopathies (NIATM) to identify possible short- and long-term prognostic factors. METHODS A multicenter and retrospective study comprising 110 patients with ATM and 15 NIATM admitted to five Italian neurological units between January 2010 and December 2014 was carried out. RESULTS A significantly higher frequency of isolated sensory disturbances at onset in ATM than in NIATM patients (chi-square = 14. 7; P = 0.005) and a significantly higher frequency of motor symptoms in NIATM than ATM (chi-square = 12.4; P = 0.014) was found. ATM patients with high disability at discharge had more motor-sensory symptoms without (OR = 3.87; P = 0.04) and with sphincter dysfunction at onset (OR = 7.4; P = 0.0009) compared to those with low disability. Higher age (OR = 1.08; P = 0.001) and motor-sensory-sphincter involvement at onset (OR = 9.52; P = 0.002) were significantly associated with a high disability score at discharge and after a median 1-year follow-up. CONCLUSIONS The diagnosis of ATM may prevail respect to that of NIATM when a sensory symptomatology at onset occurs. In ATM, patients older and with motor-sensory involvement with or without sphincter impairment at admission could experience a major risk of poor prognosis both at discharge and at longer time requiring a timely and more appropriate treatment.
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Affiliation(s)
- Pasquale Annunziata
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy. .,Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università di Siena, Unità di Neuroimmunologia clinica, Viale Bracci, 2, 53100, Siena, Italy.
| | - Gianni Masi
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Chiara Cioni
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Matteo Gastaldi
- Department of General Neurology, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Enrico Marchioni
- Department of Neuro-Oncology, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Emanuele D'amico
- Department of Medical, Surgical Science and Advanced Technology "GF Ingrassia", University of Catania, Catania, Italy
| | - Francesco Patti
- Department of Medical, Surgical Science and Advanced Technology "GF Ingrassia", University of Catania, Catania, Italy
| | - Alice Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Vitetta
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Sola
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
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18
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Moore BJ, Batterson AM, Luetmer MT, Reeves RK. Fibrocartilaginous embolic myelopathy: demographics, clinical presentation, and functional outcomes. Spinal Cord 2018; 56:1144-1150. [PMID: 29802396 DOI: 10.1038/s41393-018-0159-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To describe the demographics, clinical presentation, and functional outcomes of fibrocartilaginous embolic myelopathy (FCEM). SETTING Academic inpatient rehabilitation unit in the midwestern United States. METHODS We retrospectively searched our database to identify patients admitted between January 1, 1995 and March 31, 2016, with a high probability of FCEM. Demographic, clinical, and functional outcome measures, including Functional Independence Measure (FIM) information was obtained by chart review. RESULTS We identified 31 patients with findings suggestive of FCEM (52% male), which was 2% of the nontraumatic spinal cord injury population admitted to inpatient rehabilitation. The age distribution was bimodal, with peaks in the second and sixth-to-seventh decades. The most common clinical presentation was acute pain and rapid progression of neurologic deficits consistent with a vascular myelopathy. Only three patients (10%) had FCEM documented as a diagnostic possibility. Most patients had paraplegia and neurologically incomplete injuries and were discharged to home. Nearly half of the patients required no assistive device for bladder management at discharge, but most were discharged with medications for bowel management. Median FIM walking locomotion score for all patients was 5, but most patients were discharged using a wheelchair for primary mobility. Median motor FIM subscale score was 36 at admission and 69 at discharge, with a median motor efficiency of 1.41. CONCLUSIONS FCEM may be underdiagnosed and should be considered in those with the appropriate clinical presentation, because their functional outcomes may be more favorable than those with other causes of spinal cord infarction.
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Affiliation(s)
- Brittany J Moore
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Anna M Batterson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Marianne T Luetmer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ronald K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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19
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Yeh EA, Hintzen RQ. Specific myelopathy diagnoses using advancing diagnostics: Idiopathic no more. Neurology 2018; 90:51-52. [PMID: 29247075 DOI: 10.1212/wnl.0000000000004812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Ann Yeh
- From the Department of Pediatrics (Neurology) (E.A.Y.), SickKids Research Institute, Division of Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, Canada; and Departments of Neurology and Immunology (R.Q.H.), Erasmus MC, Rotterdam, the Netherlands.
| | - Rogier Q Hintzen
- From the Department of Pediatrics (Neurology) (E.A.Y.), SickKids Research Institute, Division of Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, Canada; and Departments of Neurology and Immunology (R.Q.H.), Erasmus MC, Rotterdam, the Netherlands
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20
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Gastaldi M, Marchioni E, Banfi P, Mariani V, Di Lodovico L, Bergamaschi R, Alfonsi E, Borrelli P, Ferraro OE, Zardini E, Pichiecchio A, Cortese A, Waters P, Woodhall M, Ceroni M, Mauri M, Franciotta D. Predictors of outcome in a large retrospective cohort of patients with transverse myelitis. Mult Scler 2017; 24:1743-1752. [PMID: 28967297 DOI: 10.1177/1352458517731911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transverse myelitis (TM) is an inflammatory disorder that can be idiopathic or associated with central nervous system autoimmune/dysimmune inflammatory diseases, connective tissue autoimmune diseases, or post-infectious neurological syndromes. Prognosis of initial TM presentations is uncertain. OBJECTIVE To identify outcome predictors in TM. METHODS Retrospective study on isolated TM at onset. Scores ⩾3 on the modified Rankin scale (mRS) marked high disability. RESULTS A total of 159 patients were identified. TM was classified as follows: idiopathic (I-TM, n = 53), post-infectious (PI-TM, n = 48), associated with multiple sclerosis (MS-TM, n = 51), or neuromyelitis optica spectrum disorders/connective tissue autoimmune diseases/neurosarcoidosis ( n = 7). At follow-up (median, 55 months; interquartile range, 32-80), 42 patients were severely disabled, and patients with I-TM or PI-TM showed the worst outcomes. Predictors of disability were infectious antecedents, sphincter and pyramidal symptoms, high mRS scores, blood-cerebrospinal fluid barrier damage, lumbar magnetic resonance imaging (MRI) lesions on univariate analysis, and older age (odds ratio (OR), 1.1; 95% confidence interval (CI), 1.0-1.1), overt/subclinical involvement of the peripheral nervous system (PNS) (OR, 9.4; 95% CI, 2.2-41.0), complete TM (OR, 10.8; 95% CI, 3.4-34.5) on multivariate analysis. CONCLUSION Our findings help define prognosis and therapies in TM at onset. Infectious antecedents and PNS involvement associate with severe prognosis. Nerve conduction studies and lumbar MRI could improve the prognostic assessment of this condition.
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Affiliation(s)
- Matteo Gastaldi
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy/University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Enrico Marchioni
- Department of Neuro-Oncology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Valeria Mariani
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Laura Di Lodovico
- Department of Neuro-Oncology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Enrico Alfonsi
- Department of Neurophysiology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Borrelli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Ottavia Eleonora Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy; University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Andrea Cortese
- University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mauro Ceroni
- University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy/Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
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21
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Carnero Contentti E, Hryb JP, Diego A, Di Pace JL, Perassolo M. Etiologic spectrum and functional outcome of the acute inflammatory myelitis. Acta Neurol Belg 2017; 117:507-513. [PMID: 28074391 DOI: 10.1007/s13760-016-0742-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022]
Abstract
Clinical, neuroimaging, and laboratory features are not specific enough to establish the etiological diagnosis of the acute inflammatory myelitis (AIM). Longitudinally extensive transverse myelitis (LETM) seen on magnetic resonance imaging (MRI) has been associated with a poor functional prognosis. The aim of this study was to assess the functional outcomes of a first AIM event comparing patients with LETM vs. no LETM on MRI and to report the differential diagnosis. Clinical, radiological, biochemical aspects were collected, and Winner-Hughes Functional Disability Scale (WHFDS) was performed after 3 and 6 months. Centromedullary lesions were associated with LETM, lateral lesions with partial lesion (PL), and brain MRI lesions with multiple sclerosis and acute encephalomyelitis disseminated. LETM patients were associated with a worse functional outcome as the need of a wheelchair after 3 and 6 months (OR = 7.61 p = 0.01; OR 4.8 p = 0.04, respectively), a walker or cane (OR = 11.0 p = 0.002, OR = 4.3 p = 0.03, respectively). In addition, we found a correlation between LETM and acute complete transverse myelitis and PL with acute partial transverse myelitis (83.3 and 90.9%, respectively; p < 0.0001). In conclusion, AIM is a heterogeneous syndrome from an etiological point of view and LETM patients had worse functional prognosis compared with PL after 3 and 6 months.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurology, Hospital Carlos G. Durand, University of Buenos Aires, Av Díaz Vélez 5044, Buenos Aires, Argentina.
| | - Javier Pablo Hryb
- Department of Neurology, Hospital Carlos G. Durand, University of Buenos Aires, Av Díaz Vélez 5044, Buenos Aires, Argentina
| | - Ana Diego
- Department of Neurology, Hospital Carlos G. Durand, University of Buenos Aires, Av Díaz Vélez 5044, Buenos Aires, Argentina
| | - José Luis Di Pace
- Department of Neurology, Hospital Carlos G. Durand, University of Buenos Aires, Av Díaz Vélez 5044, Buenos Aires, Argentina
| | - Mónica Perassolo
- Department of Neurology, Hospital Carlos G. Durand, University of Buenos Aires, Av Díaz Vélez 5044, Buenos Aires, Argentina
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22
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Klein JP. Imaging of noninfectious inflammatory disorders of the spinal cord. HANDBOOK OF CLINICAL NEUROLOGY 2017; 136:733-46. [PMID: 27430439 DOI: 10.1016/b978-0-444-53486-6.00036-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Myelitis, or inflammation of the spinal cord, produces a characteristic clinical syndrome. Among the many causes of myelitis are the prototypical demyelinating diseases multiple sclerosis and neuromyelitis optica, each of which has distinct clinical, pathologic, and radiographic features. Less distinct are the myelitides associated with systemic autoimmune conditions like sarcoidosis and lupus. Nondemyelinating conditions such as arachnoiditis, dural arteriovenous fistula, and tumor infiltration may also produce inflammation of the spinal cord. The objective of this review is to aid the clinician in the radiographic diagnosis of noninfectious inflammatory diseases of the spinal cord.
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Affiliation(s)
- Joshua P Klein
- Departments of Neurology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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23
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Kayal AK, Goswami M, Das M, Basumatary LJ, Bhowmick SS, Synmon B. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India. Ann Indian Acad Neurol 2017; 20:41-50. [PMID: 28298841 PMCID: PMC5341266 DOI: 10.4103/0972-2327.199904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM) and chronic myelopathy (CM). In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 151 patients (96 ASM and 55 CM) with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23), multiple sclerosis (MS) (8), systemic lupus erythematosus (1), Hashimoto's disease (1), postinfectious acute disseminated encephalomyelitis (6), postinfectious myelitis (8), infections (9), spinal cord infarct (5), and electrocution (1). The causes of CM were MS (1), probable or possible sarcoidosis (7), mixed connective tissue disease (1), Hashimoto's disease (2), infections (9), Vitamin B12 deficiency (4), folate deficiency (2), hepatic myelopathy (2), radiation (11), and paraneoplastic (1). No etiology could be found in 48 (31.8%) patients (34 ASM and 14 CM). In 21/96 (21.9%) patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria. Conclusion: Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of noncompressive myelopathy.
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Affiliation(s)
- Ashok Kumar Kayal
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Munindra Goswami
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Marami Das
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | | | | | - Baiakmenlang Synmon
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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24
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Kasundra GM, Sood I, Bhushan B, Bhargava AN, Shubhkaran K. Distal cord-predominant longitudinally extensive myelitis with diffuse spinal meningitis and dural abscesses due to occult tuberculosis: A rare occurrence. J Pediatr Neurosci 2016; 11:77-9. [PMID: 27195042 PMCID: PMC4862298 DOI: 10.4103/1817-1745.181268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Tuberculous myelitis usually involves thoracic and only rarely, distal cord. Longitudinal lesions more than three spinal segments long in tuberculosis (TB) are usually due to intramedullary tuberculomas and not infectious myelitis. We report a 17-year-old male with acute myelitis from D7 to conus medullaris, diffuse spinal meningitis, subdural and epidural abscesses, normal vertebrae, intervertebral discs, and brain imaging. Cerebrospinal fluid (CSF) showed raised proteins, lymphocytosis, hypoglycorrhagia, and positive TB-polymerase chain reaction. Chest X-ray was normal, and sputum was negative for acid-fast Bacilli. Chest computed tomography (CT) revealed endobronchial TB. The patient was successfully treated with antitubercular drugs and steroids. In endemic areas, a high index of suspicion should be kept for TB in patients with myelitis, especially those with spinal abscesses and a suggestive CSF report. In selected cases, there may be a role of CT scan inspite of normal X-ray.
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Affiliation(s)
- Gaurav M Kasundra
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Isha Sood
- Department of Medicine, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Bharat Bhushan
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Amita Narendra Bhargava
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Khichar Shubhkaran
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
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25
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Presas-Rodríguez S, Grau-López L, Hervás-García J, Massuet-Vilamajó A, Ramo-Tello C. Myelitis: Differences between multiple sclerosis and other aetiologies. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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26
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Gupta A, Kumar SN, Taly AB. Neurological and functional recovery in acute transverse myelitis patients with inpatient rehabilitation and magnetic resonance imaging correlates. Spinal Cord 2016; 54:804-808. [PMID: 26927295 DOI: 10.1038/sc.2016.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 11/09/2022]
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27
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Presas-Rodríguez S, Grau-López L, Hervás-García JV, Massuet-Vilamajó A, Ramo-Tello C. Myelitis: Differences between multiple sclerosis and other aetiologies. Neurologia 2015; 31:71-5. [PMID: 26383061 DOI: 10.1016/j.nrl.2015.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/01/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Myelitis can appear as an initial symptom in the context of demyelinating diseases, systemic inflammatory diseases, and infectious diseases. We aim to analyse the differences between myelitis associated with multiple sclerosis (MS) and myelitis resulting from other aetiologies. METHODS Single-centre, retrospective analysis of patients with initial myelitis (2000-2013). Demographic, aetiological, clinical, radiological and prognostic variables were analysed and compared between patients with myelitis from MS and those with myelitis due to other aetiologies. RESULTS We included 91 patients; mean follow-up was 7 years. Diagnoses were as follows: MS 57 (63%), idiopathic transverse myelitis 22 (24%), associated systemic diseases 6 (7%), and other diagnoses (6%). Myelitis due to MS was associated with younger age of onset (35 ± 11 vs. 41 ± 13; P = .02), more pronounced sphincter involvement (40.4 vs. 27.3%; P=.05), greater multifocal involvement in spinal MRI (77.2 vs. 26.5%; P=.001), shorter lesion extension (2.4 vs. 1.4 vertebral segments; P=.001), cervical location (82.5 vs. 64.7%; P=.05) and posterior location (89.5 vs. 41.2%; P=.001). Myelitis due to other aetiologies more frequently showed anterior location (47.1 vs. 24.6%; P=.02), and central cord involvement (47.1 vs. 14.1%; P=.001), with better recovery at one year of follow up (EDSS 2.0 vs. 1.5; P=.01). Multivariate analysis showed that multifocal spinal cord involvement (OR 9.38, 95% CI: 2.04-43.1) and posterior cord involvement (OR 2.16, 95% CI: 2.04-2.67) were independently associated with the diagnosis of MS. CONCLUSIONS A high percentage of patients with an initial myelitis event will be diagnosed with MS. The presence of multifocal and posterior spinal cord lesions was significantly associated with the diagnosis of MS.
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Affiliation(s)
- S Presas-Rodríguez
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España.
| | - L Grau-López
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - J V Hervás-García
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - A Massuet-Vilamajó
- Institut de Diagnòstic per la Imatge, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - C Ramo-Tello
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
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Cobo-Calvo Á, Alentorn A, Mañé Martínez MA, Bau L, Matas E, Bruna J, Romero-Pinel L, Martínez-Yélamos S. Etiologic spectrum and prognosis of longitudinally extensive transverse myelopathies. Eur Neurol 2014; 72:86-94. [PMID: 24942967 DOI: 10.1159/000358512] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with a first episode of longitudinal extensive transverse myelopathy (LETM) were reviewed with two objectives: to evaluate the clinical spectrum of LETM and to analyze the related clinical and laboratory variables that can be used as functional prognostic markers. METHODS A retrospective review was conducted of clinical, radiologic and biochemical data of patients admitted for LETM between 1993 and 2011. RESULTS Our cohort included 72 patients [median age 41 years, interquartile range (IQR) 29-61.5]. Median follow-up was 34 months (IQR 17.2-63). The modified Rankin Scale (mRS) score was ≥2 at the end of follow-up in 72.2%. The final diagnosis was idiopathic LETM in 22 patients, multiple sclerosis in 18, parainfectious disease in 11, systemic disease in 9, spinal cord infarction and neuromyelitis optica spectrum disorders in 3 patients each, and acute demyelinating encephalomyelitis, dural fistula, and tumor-related LETM in 2 patients each. Unfavorable outcome was associated with mRS ≥2 at admission [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.16-1.66] and older age (OR 1.06, 95% CI 1.01-1.11). CONCLUSION Idiopathic LETM was the most frequent diagnosis at the end of follow-up. Older age and clinically severe disease at onset were independent prognostic factors of poorer functional recovery.
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Affiliation(s)
- Álvaro Cobo-Calvo
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
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29
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Tackley G, Kuker W, Palace J. Magnetic resonance imaging in neuromyelitis optica. Mult Scler 2014; 20:1153-64. [DOI: 10.1177/1352458514531087] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/16/2014] [Indexed: 12/18/2022]
Abstract
Neuromyelitis optica (NMO), or Devic’s disease, is a rare demyelinating disorder of the central nervous system that has a predilection for the optic nerve and spinal cord. Magnetic resonance imaging (MRI) is required to diagnose NMO. Longitudinally extensive transverse myelitis is NMO’s imaging hallmark and the presence of a brain MRI that is not diagnostic of multiple sclerosis (MS) also remains part of the diagnostic criteria. It is increasingly recognised that MS and NMO brain imaging can, however, have similar appearances but differences do exist: hypothalamic, periaqueductal grey and area postrema lesions implicate NMO whilst cortical, U-fibre or Dawson’s finger lesions are suggestive of MS. The timing of image acquisition, age, ethnicity and aquaporin-4 antibody status are all likely to alter the findings at MRI. This review therefore aims to overview and update the reader on NMO imaging, to provide clinically relevant guidance for diagnosing NMO and differentiating it from MS in order to guide management, and to highlight recent research insights.
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