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Ahmed HS, Thrishulamurthy CJ. Enterovirus-Related Parainfectious Acute Disseminated Encephalomyelitis Presenting With Dorsal Midbrain Syndrome: A Pediatric Case Report. Pediatr Neurol 2024; 156:128-130. [PMID: 38761644 DOI: 10.1016/j.pediatrneurol.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/20/2024]
Affiliation(s)
- H Shafeeq Ahmed
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
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2
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Naggar A, Laasri K, Kabila B, Izi Z, Allali N, Haddad SE, Chat L. Myelin insults differentials on MRI in children: In the light of an ADEM case. Radiol Case Rep 2024; 19:408-413. [PMID: 38033671 PMCID: PMC10681876 DOI: 10.1016/j.radcr.2023.08.107] [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: 06/26/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute and rapidly progressive auto-immune demyelinating disorder in the central nervous system. It is a rare disease but is more frequently observed in the pediatric population. We report a case of a monophasic postvaccination ADEM, which presented with paraparesis associated with fever. It showed a favorable evolution under corticosteroids, without recurrence after 3 years of follow-up. The diagnosis was established due to the postvaccination context and the MRI abnormalities characteristics. This case prompted a general discussion about the etiologies of myelin insults in children, especially demyelinating disorders, by shedding the light on their MRI features.
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Affiliation(s)
- Amine Naggar
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Khadija Laasri
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Badr Kabila
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Zineb Izi
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
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3
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Brock K, Reyes SC, Connor C, Gilson N, Weiss M, Elfituri O, Paydar A. Acute disseminated encephalomyelitis (ADEM)-like illness in a pediatric patient following COVID-19 vaccination. BJR Case Rep 2023; 9:20220097. [PMID: 36998331 PMCID: PMC10043599 DOI: 10.1259/bjrcr.20220097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Since the inception of the COVID-19 pandemic, over 60 cases of ADEM or ADEM-like clinically isolated syndromes have been linked to COVID-19 infection. However, cases linked to COVID-19 vaccination remain exceptionally rare. To the author’s knowledge, eight published cases of ADEM or ADEM-like clinically isolated syndrome have been described after patients received COVID-19 vaccinations, all of which occurred in adults. This report details the first documented case of an acute disseminated encephalomyelitis (ADEM)-like illness in a pediatric patient, which developed shortly after receiving the Pfizer (Pfizer-BioNTech, Germany) COVID-19 vaccination. The patient made a near complete clinical recovery over 10 days after receiving a 5 day course of intravenous immunoglobulin (IVIG) therapy.
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Affiliation(s)
- Kenneth Brock
- Newark Beth Israel Medical Center, Newark, United States
| | | | | | - Natalie Gilson
- Golisano Children’s Hospital, Southwest Florida, United States
| | - Michael Weiss
- Florida Radiology Consultants, Florida, United States
| | - Osama Elfituri
- Ameripath, HCA Florida Aventura Hospital, Florida, United States
| | - Amir Paydar
- AdventHealth Orlando, Orlando, United States
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4
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Kwok PL, Lai AYT, Lai BMH, Luk SY, Tang KYK, Wong WWC, Khoo JLS. Magnetic resonance imaging of disorders with white matter changes in children and adolescents: a pictorial essay. Pediatr Radiol 2023; 53:1188-1206. [PMID: 36625927 DOI: 10.1007/s00247-022-05580-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
White matter changes are seen in a spectrum of disorders in children and adolescents. Understanding their distribution and appearance helps to reach diagnoses in daily radiologic practice. This pictorial essay will outline the magnetic resonance imaging (MRI) appearances of diseases with white matter changes including demyelinating diseases, dysmyelinating disorders/leukodystrophies, infections, autoimmune diseases, vascular causes, mitochondrial disorders and neurocutaneous syndromes, along with a brief overview of clinical aspects of the diseases such as typical age of presentation, etiology, symptoms and signs and treatment options. This article highlights important features in common white matter diseases in children and adolescents.
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Affiliation(s)
- Po Lam Kwok
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China.
| | - Alta Y T Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
| | - Billy M H Lai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Shiobhon Y Luk
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
| | - Kendrick Y K Tang
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
| | - Wendy W C Wong
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
| | - Jennifer L S Khoo
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China
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Lim H, Hwang SK, Lee YJ, Kwon S. The Wide Variety of Acute Disseminated Encephalomyelitis in Children: A Clinical Perspective. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating inflammatory disorder of the central nervous system. It is characterized by encephalopathy, multifocal neurological deficits, and typical magnetic resonance imaging findings of widespread demyelinating lesions, predominantly involving the white matter of the brain and spinal cord. ADEM mainly affects children and is commonly associated with preceding viral and bacterial infections, and, rarely, vaccinations. Despite substantial advances in the understanding of the association of myelin oligodendrocyte glycoprotein antibody with recurrent forms of ADEM or other demyelinating conditions, specific etiologic agents or biological markers have not been identified. Therefore, the diagnosis of ADEM is still based on clinical and radiological findings and the exclusion of other conditions mimicking ADEM. However, a prompt diagnosis and adequate treatment are crucial because diagnostic delays or inappropriate treatment may lead to unwanted neurological sequelae in some children. There is no standardized treatment protocol for ADEM, but the use of corticosteroids, intravenous immunoglobulin, and plasmapheresis has been associated with good clinical outcomes. Adequate treatment has reportedly resulted in favorable outcomes, with full or almost full recovery in most children with ADEM, although some children may develop neurological sequelae, such as cognitive impairment and motor deficits. Further studies are needed to identify biological clues and optimal treatment protocols to minimize the incidence of neurological sequelae.
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Mousa H, Patel TH, Meadows I, Ozdemir B. Acute Disseminated Encephalomyelitis (ADEM) After Consecutive Exposures to Mycoplasma and COVID Vaccine: A Case Report. Cureus 2022; 14:e26258. [PMID: 35911280 PMCID: PMC9312359 DOI: 10.7759/cureus.26258] [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] [Accepted: 06/17/2022] [Indexed: 11/12/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system, commonly triggered by viral infections or after immunization. ADEM occurrences in adults are rare. Full spectrum of complications is unknown for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines. A previously healthy 44-year-old female presented to the emergency room (ER) with acute onset of tingling, numbness, and weakness of both lower extremities, urinary retention, blurred vision in right eye, and midline lower back pain. Physical examination revealed bilateral lower extremity weakness 1/5, absent deep tendon reflexes, and decreased sensation. She received the first dose of SARS-CoV-2 vaccine six days prior to presentation to ER. Imaging of her lumbar spine and head were consistent with an active demyelinating plaque consistent with demyelinating disease either multiple sclerosis (MS) or ADEM. The patient was started on SoluMedrol 500 mg IV twice daily for five days. Serological workup and CSF analysis were nonsignificant except for Mycoplasma pneumonia IgM, elevated myelin basic protein, and positive IgG, IgA, and IgM. Patient gradually improved and was transferred to rehabilitation. Repeat MRI brain and spine showed improvement in previous lesions. However, she had worsening left eye symptoms that prompted her transfer to another facility for plasmapheresis. Plasma exchange was done for five treatments for ADEM. Patient started noticing improvement in vision and was discharged on steroid taper. We report a case of a possible association between ADEM and SARS-CoV-2 mRNA vaccine. It should be considered in the differential diagnosis in any case suggestive of acute demyelination after COVID-19 vaccination.
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Gupta S, Biswas A, Chandra A, Ray BK, Dutta A, Pandit A. Post-Varicella Neurological Complications: A Preliminary Observation from a Tertiary Care Centre of Eastern India. Ann Indian Acad Neurol 2022; 25:207-213. [PMID: 35693688 PMCID: PMC9175418 DOI: 10.4103/aian.aian_270_21] [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: 03/31/2021] [Revised: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: The objective of this study is to analyse detailed clinical presentations, imaging findings, and outcome in a series of 17 cases (n = 17) with neurological complications following acute varicella infection. Methods: It is an observational study on the patients who presented to the neurology outpatient department of our institute with neurological abnormalities following acute varicella infection within the last 3 months. Results: Neuroimaging, either computed tomography or magnetic resonance imaging, cerebrospinal fluid analysis, electroencephalography and nerve conduction studies were performed in all the patients along with other specialized investigations as per clinical context. The age of presentation varied from childhood to middle age (median age was 23 years) and range of clinical spectrum was also wide. Peripheral nervous system involvement was more common in the form of Guillain–Barré syndrome (29.4%) and isolated lower motor neuron facial nerve palsy (23.5%) compared to central nervous system (CNS) involvement. CNS involvement was documented in the form of ataxia (11.76%), myelopathy (17.6%), stroke (5.88%) and encephalitis (5.88%). Conclusion: Chickenpox is a common viral disease and most patients recover without any complication. Although rare, neurological complications following acute varicella infection may have myriad presentations ranging from lower motor neuron facial palsy to life-threatening encephalitis. Compared to other studies, varicella encephalitis and ataxia were not so common in our study group. Response to therapy was uniformly good except in the patients presenting with ataxia. Response was particularly good to central and peripheral demyelinating disorders.
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Affiliation(s)
- Subhadeep Gupta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Atanu Biswas
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Arpan Dutta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Acute Disseminated Encephalomyelitis Presenting as Bilateral Ptosis in a Sri Lankan Child. Case Rep Pediatr 2022; 2022:5492155. [PMID: 35178264 PMCID: PMC8847039 DOI: 10.1155/2022/5492155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Acute disseminated encephalomyelitis is a rare inflammatory demyelinating disease characterized by acute onset polyfocal neurological deficits associated with encephalopathy. It commonly presents with fever, meningism, seizures, ataxia, motor deficits, and bladder dysfunction. Although cranial neuropathies, including optic neuritis and facial nerve palsies, have previously been reported, children presenting with bilateral ptosis is extremely rare. Here, we report a 3-year-old child with acute disseminated encephalomyelitis presenting with acute onset bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. Case Presentation. A 3-year-old Sri Lankan boy presented with drooping of the upper eyelids for three days and unsteady gait for two days. He did not have seizures, blurring of vision, limb weakness, swallowing or breathing difficulties, or bladder dysfunction. On examination, he had bilateral ptosis, gait ataxia, and dysmetria. His vision, eye movements, and examination of other cranial nerves were normal. MRI brain revealed high signal intensities involving the subcortical white matter of parietal and occipital lobes, midbrain in the area of single central levator subnucleus of the oculomotor nerve, cerebellar vermis, and right cerebellar hemisphere. Based on the clinical features suggesting polyfocal neurological involvement of the midbrain and cerebellum and characteristic MRI findings, the diagnosis of acute disseminated encephalomyelitis was made. He responded well and rapidly to high-dose intravenous methylprednisolone and showed a complete clinical and radiological recovery. Conclusion This case report describes a rare presentation of acute disseminated encephalomyelitis, bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. It highlights that the presenting manifestations of acute disseminated encephalomyelitis can be subtle and vary; however, timely diagnosis and treatment result in complete recovery.
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Mehra B, Aggarwal V, Kumar P, Gupta D, Kundal M, Kumar A, Dugaya SK. MIS-C is a Clinically Different Entity from Acute COVID-19 in Adults. Indian J Crit Care Med 2021; 25:954-955. [PMID: 34733044 PMCID: PMC8559736 DOI: 10.5005/jp-journals-10071-23927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mehra B, Aggarwal V, Kumar P, Gupta D, Kundal M, Kumar A, et al. MIS-C is a Clinically Different Entity from Acute COVID-19 in Adults. Indian J Crit Care Med 2021;25(8):954–955.
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Affiliation(s)
- Bharat Mehra
- Department of Pediatric Intensive Care, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India
| | - Vyom Aggarwal
- Department of Pediatrics, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
| | - Dhiren Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
| | - Mohan Kundal
- Department of Pediatrics, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India
| | - Arun Kumar
- Department of Pediatrics, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India
| | - Sandeep K Dugaya
- Department of Pediatrics, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India
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Florian IA, Lupan I, Sur L, Samasca G, Timiș TL. To be, or not to be… Guillain-Barré Syndrome. Autoimmun Rev 2021; 20:102983. [PMID: 34718164 DOI: 10.1016/j.autrev.2021.102983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023]
Abstract
Guillain-Barré Syndrome (GBS) is currently the most frequent cause of acute flaccid paralysis on a global scale, being an autoimmune disorder wherein demyelination of the peripheral nerves occurs. Its main clinical features are a symmetrical ascending muscle weakness with reduced osteotendinous reflexes and variable sensory involvement. GBS most commonly occurs after an infection, especially viral (including COVID-19), but may also transpire after immunization with certain vaccines or in the development of specific malignancies. Immunoglobulins, plasmapheresis, and glucocorticoids represent the principal treatment modalities, however patients with severe disease progression may require supportive therapy in an intensive care unit. Due to its symptomology, which overlaps with numerous neurological and infectious illnesses, the diagnosis of GBS may often be misattributed to pathologies that are essentially different from this syndrome. Moreover, many of these require specific treatment methods distinct to those recommended for GBS, in lack of which the prognosis of the patient is drastically affected. Such diseases include exposure to toxins either environmental or foodborne, central nervous system infections, metabolic or serum ion alterations, demyelinating pathologies, or even conditions amenable to neurosurgical intervention. This extensive narrative review aims to systematically and comprehensively tackle the most notable and challenging differential diagnoses of GBS, emphasizing on the clinical discrepancies between the diseases, the appropriate paraclinical investigations, and suitable management indications.
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Affiliation(s)
- Ioan Alexandru Florian
- Department of Neurology, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania, Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, Cluj-Napoca, Romania.
| | - Lucia Sur
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Satheesh NJ, Salloum-Asfar S, Abdulla SA. The Potential Role of COVID-19 in the Pathogenesis of Multiple Sclerosis-A Preliminary Report. Viruses 2021; 13:2091. [PMID: 34696521 PMCID: PMC8540806 DOI: 10.3390/v13102091] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus 2019 (COVID-19) is an infectious respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that mainly affects the lungs. COVID-19 symptoms include the presence of fevers, dry coughs, fatigue, sore throat, headaches, diarrhea, and a loss of taste or smell. However, it is understood that SARS-CoV-2 is neurotoxic and neuro-invasive and could enter the central nervous system (CNS) via the hematogenous route or via the peripheral nerve route and causes encephalitis, encephalopathy, and acute disseminated encephalomyelitis (ADEM) in COVID-19 patients. This review discusses the possibility of SARS-CoV-2-mediated Multiple Sclerosis (MS) development in the future, comparable to the surge in Parkinson's disease cases following the Spanish Flu in 1918. Moreover, the SARS-CoV-2 infection is associated with a cytokine storm. This review highlights the impact of these modulated cytokines on glial cell interactions within the CNS and their role in potentially prompting MS development as a secondary disease by SARS-CoV-2. SARS-CoV-2 is neurotropic and could interfere with various functions of neurons leading to MS development. The influence of neuroinflammation, microglia phagocytotic capabilities, as well as hypoxia-mediated mitochondrial dysfunction and neurodegeneration, are mechanisms that may ultimately trigger MS development.
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Affiliation(s)
| | - Salam Salloum-Asfar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha 34110, Qatar;
| | - Sara A. Abdulla
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha 34110, Qatar;
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12
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Esakia T, Antia T, Janelidze M, Mariamidze A, Okujava M. Acute Disseminated Encephalomyelitis Following Chemoradiotherapy in an Adult Patient With Nasopharyngeal Cancer. Cureus 2021; 13:e14137. [PMID: 33927940 PMCID: PMC8074876 DOI: 10.7759/cureus.14137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disorder predominantly affecting children. It typically follows a viral illness or vaccination. We present a case of a 34-year-old white male treated with chemo-radiotherapy for nasopharyngeal cancer who developed ADEM. Prompt initiation of intravenous steroids led to the resolution of symptoms and normalization of the brain imaging. We hypothesized that direct brain tissue damage by chemotherapy and radiation therapy, combined possibly with a viral infection, triggered an immune inflammatory response and subsequent demyelination.
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Affiliation(s)
- Tamar Esakia
- Oncology and hematology, Acad. F. Todua Medical Center, Tbilisi, GEO
| | - Tamar Antia
- Radiology, Acad. F. Todua Medical Center, Tbilisi, GEO
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13
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Yadav A, Sharma R, Ganiger MP, Sharma G. Anti-Myelin Oligodendrocyte Glycoprotein Antibody Positive Acute Disseminated Encephalomyelitis Post-Varicella Zoster Virus Infection. Ann Indian Acad Neurol 2021; 24:797-799. [PMID: 35002156 PMCID: PMC8680871 DOI: 10.4103/aian.aian_1054_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Abhishek Yadav
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Roopa Sharma
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India,Address for correspondence: Dr. Roopa Sharma, PO Sultanpur, Chamba, Himachal Pradesh, India. E-mail:
| | | | - Gaurav Sharma
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
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14
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Shukla A, Kaur P, Narayanan DL, do Rosario MC, Kadavigere R, Girisha KM. Genetic disorders with central nervous system white matter abnormalities: An update. Clin Genet 2021; 99:119-132. [PMID: 33047326 PMCID: PMC9951823 DOI: 10.1111/cge.13863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022]
Abstract
Several genetic disorders have variable degree of central nervous system white matter abnormalities. We retrieved and reviewed 422 genetic conditions with prominent and consistent involvement of white matter from the literature. We herein describe the current definitions, classification systems, clinical spectrum, neuroimaging findings, genomics, and molecular mechanisms of these conditions. Though diagnosis for most of these disorders relies mainly on genomic tests, specifically exome sequencing, we collate several clinical and neuroimaging findings still relevant in diagnosis of clinically recognizable disorders. We also review the current understanding of pathophysiology and therapeutics of these disorders.
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Affiliation(s)
- Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Parneet Kaur
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Michelle C do Rosario
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Katta Mohan Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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15
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Gonçalves R, Gomes J, Martins A, Duque V, Lemos JM, Trindade L. Acute disseminated encephalomyelitis after mumps infection in a vaccinated patient. IDCases 2020; 23:e01017. [PMID: 33335835 PMCID: PMC7732859 DOI: 10.1016/j.idcr.2020.e01017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 11/06/2022] Open
Abstract
Mumps is an infectious disease caused by a paramyxovirus. It can involve several organs in the acute stage of the infection, including central nervous system. (Rubin et al., 2015) [1] Neurological complications in the post-infectious period are also described, one of which is acute disseminated encephalomyelitis (ADEM). (Jonhson et al., 2004) [2] We present the case of an healthy young man previously vaccinated, who contracted ADEM after mumps.
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Affiliation(s)
- Raquel Gonçalves
- Infectious Diseases' Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - João Gomes
- Internal Medicine A' Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - André Martins
- Infectious Diseases' Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Vitor Duque
- Infectious Diseases' Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - João Manuel Lemos
- Neurology' Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Luís Trindade
- Infectious Diseases' Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
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16
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Lee MJ, Aronberg R, Manganaro MS, Ibrahim M, Parmar HA. Diagnostic Approach to Intrinsic Abnormality of Spinal Cord Signal Intensity. Radiographics 2020; 39:1824-1839. [PMID: 31589577 DOI: 10.1148/rg.2019190021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intramedullary cord hyperintensity at T2-weighted MRI is a common imaging feature of disease in the spinal cord, but it is nonspecific. Radiologists play a valuable role in helping narrow the differential diagnosis by integrating patient history and laboratory test results with key imaging characteristics. The authors present an algorithmic approach to evaluating intrinsic abnormality of spinal cord signal intensity (SI), which incorporates clinical evaluation results, time of onset (acute vs nonacute), cord expansion, and pattern of T2 SI abnormality. This diagnostic approach provides a practical framework to aid both trainees and practicing radiologists in workup of myelopathy.©RSNA, 2019.
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Affiliation(s)
- Michael J Lee
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Ryan Aronberg
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Matthew S Manganaro
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Mohannad Ibrahim
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Hemant A Parmar
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
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17
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De Nardo TFS, Bertolo PHL, Bernardes PA, Munari DP, Machado GF, Jardim LS, Moreira PRR, Rosolem MC, Vasconcelos RO. Contribution of astrocytes and macrophage migration inhibitory factor to immune-mediated canine encephalitis caused by the distemper virus. Vet Immunol Immunopathol 2020; 221:110010. [PMID: 31981823 DOI: 10.1016/j.vetimm.2020.110010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 12/20/2022]
Abstract
Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine that is produced by many cell types in situations of homeostasis or disease. One of its functions is to act as a proinflammatory molecule. In humans, several studies have shown that MIF levels become elevated in the serum, urine, cerebrospinal fluid and tissues of patients with chronic inflammatory diseases (systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, sepsis, atheromas, diabetes and cancer). In dogs, distemper is a viral infectious condition that may lead to demyelination and inflammation in the central nervous system (CNS). In addition to the action of the virus, the inflammatory process may give rise to lesions in the white matter. Therefore, the objectives of the present study were to evaluate the role of MIF in the encephalitis that the canine distemper virus causes and to compare this with immunodetection of major histocompatibility complex-II (MHC-II), CD3 T lymphocytes, MMP-9 and glial fibrillary acidic protein (GFAP; astrocytes) in demyelinated areas of the encephalon, in order to ascertain whether these findings might be related to the severity of the encephalic lesions. To this end, a retrospective study on archived paraffinized blocks was conducted, in which 21 encephala from dogs that had been naturally infected with the canine distemper virus (infected group) and five from dogs that had been free from systemic or CNS-affecting diseases (control group) were used. In the immunohistochemical analysis on the samples, the degree of marking by GFAP, MHC-II, MMP-9 and MIF was greater in the demyelinated areas and in the adjacent neuropil, and this was seen particularly in astrocytes. Detection of CD3 was limited to perivascular cuffs. In areas of liquefactive necrosis, Gitter cells were positive for MMP-9, MIF and MHC-II. Hence, it was concluded that activated astrocytes influenced the afflux of T lymphocytes to the encephalon (encephalitis). In the more advanced phases, activated phagocytes in the areas of liquefactive necrosis (Gitter cells) continued to produce inflammatory mediators even after the astrocytes in these localities had died, thereby worsening the encephalic lesions. Distemper virus-activated astrocytes and microglia produce MIF that results in proinflammatory stimulus on glial cells and brain-infiltrating leukocytes. Therefore, the effect of the inflammatory response is potentiated on the neuropil, resulting in neurological clinical signs.
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Affiliation(s)
- Tatianna F S De Nardo
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil
| | - Paulo H L Bertolo
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil
| | - Priscila A Bernardes
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil
| | - Danísio P Munari
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil
| | - Gisele F Machado
- School of Veterinary Medicine of Araçatuba (FMVA), UNESP, Araçatuba, SP, Brazil
| | | | - Pamela R R Moreira
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil
| | - Mayara C Rosolem
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil
| | - Rosemeri O Vasconcelos
- School of Agrarian and Veterinary Sciences (FCAV), São Paulo State University (UNESP), Via de Acesso Paulo Donato Castellane s/n, 14884-900, Jaboticabal, SP, Brazil.
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18
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Sheikh AAE, Sheikh AB, Sagheer S, Tariq U, Bukhari MM, Fatima Z, Afzal RM. Acute Intermittent Porphyria: A Rare Cause of Acute Disseminated Encephalomyelitis. Cureus 2018; 10:e2989. [PMID: 30237948 PMCID: PMC6141216 DOI: 10.7759/cureus.2989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system (CNS) with no distinct etiology but implications include infections and commonly administered vaccinations. In this case report, we present the case of ADEM in a young female who was subsequently diagnosed with acute intermittent porphyria (AIP) that was the instigator of the initial CNS assault. Our case highlights the peculiar presentation of ADEM which can present as a diagnostic challenge and brings forth AIP as a new and previously unknown affiliate of this rare CNS disease. We also discuss the pathophysiology, diagnostic criteria, and subsequent treatment options for this rare clinical entity.
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Affiliation(s)
| | | | - Shazib Sagheer
- Internal Medicine, University of New Mexico Hospital, Albuquerque, USA
| | - Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | - Marvi M Bukhari
- Internal Medicine, Shifa College Of Medicine, Islamabad, PAK
| | - Zainab Fatima
- Medicine, Shifa International Hospital, Islamabad, PAK
| | - Rao M Afzal
- Internal Medicine, Shifa College Of Medicine, Islamabad, PAK
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19
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Maller VV, Bathla G, Moritani T, Helton KJ. Imaging in viral infections of the central nervous system: can images speak for an acutely ill brain? Emerg Radiol 2016; 24:287-300. [DOI: 10.1007/s10140-016-1463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022]
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Esposito S, Di Pietro GM, Madini B, Mastrolia MV, Rigante D. A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children. Autoimmun Rev 2015; 14:923-9. [PMID: 26079482 PMCID: PMC7105213 DOI: 10.1016/j.autrev.2015.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that involves multifocal areas of the white matter, rarely the gray matter and spinal cord, mainly affecting children and mostly occurring 1-2weeks after infections or more rarely after vaccinations. Though a specific etiologic agent is not constantly identified, to evaluate carefully patient's clinical history and obtain adequate samples for the search of a potential ADEM causal agent is crucial. In the case of a prompt diagnosis and adequate treatment, most children with ADEM have a favorable outcome with full recovery, but in the case of diagnostic delays or inappropriate treatment some patients might display neurological sequelae and persistent deficits or even show an evolution to multiple sclerosis. The suspicion of ADEM rises on a clinical basis and derives from systemic and neurologic signs combined with magnetic resonance imaging of the central nervous system. Other advanced imaging techniques may help an appropriate differential diagnosis and definition of exact disease extension. Although there is no standardized protocol or management for ADEM, corticosteroids, intravenous immunoglobulin, and plasmapheresis have been successfully used. There is no marker that permits to identify the subset of children with worse prognosis and future studies should try to detect any biological clue for prevision of neurologic damage as well as should optimize treatment strategies using an approach based on the effective risk of negative evolution.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giada Maria Di Pietro
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Madini
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Vincenza Mastrolia
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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21
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Acute disseminated encephalomyelitis progressing to multiple sclerosis: are infectious triggers involved? Immunol Res 2015; 60:16-22. [PMID: 24668297 PMCID: PMC7091333 DOI: 10.1007/s12026-014-8499-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are demyelinating disorders affecting the central nervous system. An autoimmune aetiology has been proposed for both. ADEM principally affects adolescents following acute infection by a variety of pathogens and has also been reported to occur following vaccination. ADEM typically resolves following medical treatment, whereas MS follows a more relapsing and remitting course. The pathogenesis of MS remains unclear, but it is thought that a combination of infectious and non-infectious environmental factors and host genetics act synergistically to cause disease. A variety of viruses, including Epstein Barr virus, cytomegalovirus, herpes simplex virus and varicella zoster virus, have been implicated as possible infectious triggers. The similar clinical and pathological presentation of ADEM and MS presents a diagnostic challenge for distinguishing ADEM from a first episode of MS. Some cases of ADEM progress to MS for reasons that are not currently clear. This review examines the evidence for infectious agents as triggers for ADEM progressing to MS and suggests potential methods that may facilitate identification of infectious agents that may be responsible for the pathogenesis of ADEM to MS.
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Wu X, Wang J, Liu K, Zhang H. Multiphasic acute disseminated encephalomyelitis associated with atypical rubella virus infection. Mult Scler 2015; 21:1088-9. [PMID: 25662343 DOI: 10.1177/1352458514567729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xiujuan Wu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Juan Wang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Hongliang Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
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24
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Neurologic emergencies: case studies. Neurol Clin 2012; 30:345-56, x. [PMID: 22284067 DOI: 10.1016/j.ncl.2011.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the past 2 decades, the world has witnessed a significant improvement in the understanding of the pathogenesis and treatment of neurologic diseases, which presents emergencies. Every day neurologists are consulted for patients who present with neurologic emergencies to the emergency departments. In this article, we present a series of case reports about patients with acute neurologic and psychiatric problems and discuss their management briefly.
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