1
|
Salas JR, Farrell A, Potts C, Robinson P. Longitudinally Extensive Transverse Myelitis in a Patient With Systemic Lupus Erythematosus, Recent Influenza Infection, and Nutritional Deficiencies in the Setting of Chronic Alcohol Use. Cureus 2024; 16:e61601. [PMID: 38962621 PMCID: PMC11221627 DOI: 10.7759/cureus.61601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Longitudinally extensive transverse myelitis (LETM) is traditionally classified as an inflammatory disorder of the spinal cord spanning three or more vertebral segments. The differential diagnosis for TM is vast and can include infectious, nutritional, and can even be idiopathic in some reported cases. However, autoimmune etiologies such as systemic lupus erythematosus (SLE) can rarely present with neurological manifestations such as LETM. In this case report, we present a 33-year-old female with a prior history of SLE who developed an LETM in the setting of possible provoking factors such as nutritional deficiencies and a recent viral illness. In this case report, we highlight her clinical course, recovery, and working differential diagnosis after laboratory testing and neurological imaging. Finally, we discuss the different treatments that ultimately lead to her successful recovery after her prolonged clinical course.
Collapse
Affiliation(s)
- Jesus R Salas
- Neurology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Anna Farrell
- Internal Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Casey Potts
- Neurology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Peter Robinson
- Neurology, The Ohio State University Wexner Medical Center, Columbus, USA
| |
Collapse
|
2
|
Kurtanović N, Gogić E, Tanović E, Čelik D, Mulić Hadžiavdić E. Rehabilitation of Rare Neurological Complications of COVID-19 Infection in Health Resort Settings. Cureus 2024; 16:e58221. [PMID: 38745792 PMCID: PMC11091940 DOI: 10.7759/cureus.58221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
There is increasing evidence of neurological involvement in patients with coronavirus disease. Reports of neurological manifestations include altered mental status, Guillain-Barré syndrome (GBS) and its forms, encephalopathy, psychosis, neurocognitive (dementia) syndrome, ischemic strokes, intracerebral hemorrhage, and acute transverse myelitis. We present three patients with rare neurological manifestations of the COVID-19 disease, with a special focus on rehabilitation in a health resort setting. Outcomes were evaluated based on neurological examination and the modified Barthel index. We highlight the importance of an interdisciplinary approach to reduce disability and improve functionality and quality of life.
Collapse
Affiliation(s)
- Nadina Kurtanović
- Department of Physical Medicine and Rehabilitation, Health Institution Spa Gata - Bihać, Bihać, BIH
| | - Ena Gogić
- Clinic for Physical Medicine and Rehabilitation, Clinical Center University of Sarajevo, Sarajevo, BIH
| | - Edina Tanović
- Clinic for Physical Medicine and Rehabilitation, Clinical Center University of Sarajevo, Sarajevo, BIH
| | - Damir Čelik
- Clinic for Physical Medicine and Rehabilitation, Clinical Center University of Sarajevo, Sarajevo, BIH
| | - Elmina Mulić Hadžiavdić
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center - Tuzla, Tuzla, BIH
| |
Collapse
|
3
|
Li D, Chen X, Zhang Z, Liang X, Gao X, Tian Z, Meng C. Iagnosis and treatment of myelitis after lumbar reoperation: A case report. Medicine (Baltimore) 2023; 102:e36361. [PMID: 38065894 PMCID: PMC10713179 DOI: 10.1097/md.0000000000036361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE At present, acute myelitis (AM) is a great challenge to diagnosis and treatment because of its complicated etiology, critical condition, and poor prognosis, and it is easy to leave different degrees of limb motor dysfunction. The report of this case is helpful to improve the understanding of AM after lumbar surgery, reduce misdiagnosis and provide reference for clinical treatment. PATIENTS CONCERN This study reported a case of AM after lumbar reoperation. Before the patient was diagnosed as AM, we gave high-dose hormone anti-inflammatory and detumescence symptomatic treatment according to empirical treatment, and the effect was ideal and rehabilitation treatment was actively carried out at the right time. After 10 months of follow-up, the patient recovered well. DIAGNOSIS Because lumbar surgery is a contraindication of lumbar puncture, the patient's diagnosis was confirmed by thoracic magnetic resonance imaging. Magnetic resonance imaging of thoracic vertebra on the 17th day after lumbar operation showed that small round T1W1 signal, slightly higher T2W1 signal and T2-fat suppression imaging equal signal were seen in the horizontal spinal cord of thoracic vertebra 10. INTERVENTION According to the empirical treatment, patients have been given high-dose hormone therapy after operation, and comprehensive treatment such as comprehensive training of paraplegic limbs, joint loosening training, electric massage and other rehabilitation training will be carried out when the general condition of patients improves. OUTCOMES After 10 months of follow-up, there were no major sequelae such as limb paralysis. CONCLUSION Due to the rarity of AM in clinical work, it is easy for doctors to ignore the disease and miss the best treatment stage, which will lead to serious sequelae.
Collapse
Affiliation(s)
- Dongru Li
- Jining Medical University, Jining, China
| | - Xiao Chen
- Affiliated Hospital of Jining Medical University, Jining, China
| | - Zifang Zhang
- Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiao Liang
- Affiliated Hospital of Jining Medical University, Jining, China
| | - Xu Gao
- Affiliated Hospital of Jining Medical University, Jining, China
| | | | - Chunyang Meng
- Affiliated Hospital of Jining Medical University, Jining, China
| |
Collapse
|
4
|
Ter Horst L, van Zeggeren IE, Olie SE, van de Beek D, Brouwer MC. Predictors of unfavourable outcome in adults with suspected central nervous system infections: a prospective cohort study. Sci Rep 2023; 13:21250. [PMID: 38040800 PMCID: PMC10692224 DOI: 10.1038/s41598-023-48472-z] [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: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
Suspected central nervous system (CNS) infections may pose a diagnostic challenge, and often concern severely ill patients. We aim to identify predictors of unfavourable outcome to prioritize diagnostics and treatment improvements. Unfavourable outcome was assessed on the Glasgow Outcome Scale at hospital discharge, defined by a score of 1 to 4. Of the 1152 episodes with suspected CNS infection, from two Dutch prospective cohorts, the median age was 54 (IQR 37-67), and 563 episodes (49%) occurred in women. The final diagnoses were categorized as CNS infection (N = 358 episodes, 31%), CNS inflammatory disease (N = 113, 10%), non-infectious non-inflammatory neurological disorder (N = 388, 34%), non-neurological infection (N = 252, 22%), and other systemic disorder (N = 41, 4%). Unfavourable outcome occurred in 412 of 1152 (36%), and 99 died (9%). Predictors for unfavourable outcomes included advanced age, absence of headache, tachycardia, altered mental state, focal cerebral deficits, cranial nerve palsies, low thrombocytes, high CSF protein, and the final diagnosis of CNS inflammatory disease (odds ratio 4.5 [95% confidence interval 1.5-12.6]). Episodes suspected of having a CNS infection face high risk of experiencing unfavourable outcome, stressing the urgent need for rapid and accurate diagnostics. Amongst the suspected CNS infection group, those diagnosed with CNS inflammatory disease have the highest risk.
Collapse
Affiliation(s)
- Liora Ter Horst
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Ingeborg E van Zeggeren
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Sabine E Olie
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
5
|
Tang B, Han J, Wang F, Li X, Zhao C. GR-α and GR-β mRNA levels in peripheral blood mononuclear cells of acute myelitis patients can assist in the identification of glucocorticoid sensitivity and are correlated with glucocorticoid therapeutic effect. Ann Hum Genet 2022; 86:268-277. [PMID: 35730764 DOI: 10.1111/ahg.12472] [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: 11/23/2021] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Abstract
Acute myelitis (AM) is a rare neuro-immune spinal cord disease. This study sought to explore the transcription level of glucocorticoid (GC) receptors α and β (GR-α/GR-β) in peripheral blood mononuclear cells (PBMCs) and their correlation with GC efficacy and sensitivity in AM patients. AM patients were grouped into the GC-sensitive group (N = 80) and GC-refractory group (N = 67). The GR-α and GR-β mRNA levels in PBMCs were detected. The differentiating value of GR-α, GR-β, and GR-α + GR-β on GC sensitivity and resistance in AM patients was assessed. The independent correlation between GR-α and GR-β mRNA levels and GC sensitivity in AM patients,t and the correlation between GR-α and GR-β mRNA levels and spinal function after GC treatment were analyzed. GR-α mRNA level in PBMCs of GC-refractory patients was lower than that of GC-sensitive patients, while GR-β mRNA level was higher than that of GC-sensitive patients. GR-α + GR-β mRNA had a high diagnostic value for GC sensitivity and resistance in AM patients (area under the ROC curve = 0.881, sensitivity = 79.1%, specificity = 85.0%). GR-α and GR-β mRNA levels were independently correlated with GC sensitivity. GR-α and GR-β mRNA levels were correlated with the spinal function of AM patients after GC treatment. Overall, GR-α and GR-β mRNA levels in PBMCs of AM patients can assist in the identification of GC sensitivity and are correlated with GC efficacy.
Collapse
Affiliation(s)
- Bolin Tang
- Department of Neurology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jun Han
- Department of Neurology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Fen Wang
- Department of Neurology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Xiang Li
- Department of Pediatrics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Chaoyang Zhao
- Department of Pharmacy, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| |
Collapse
|
6
|
Fiani B, Covarrubias C, Jarrah R. Neuroimmunology and Novel Methods of Treatment for Acute Transverse Myelitis. Cureus 2021; 13:e17043. [PMID: 34522521 PMCID: PMC8428159 DOI: 10.7759/cureus.17043] [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] [Received: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/05/2022] Open
Abstract
Acute transverse myelitis (ATM) is a rare, immune-mediated pathology that is defined as an adverse inflammatory response in the spinal cord leading to neurologic injury. The pathophysiology of ATM is poorly understood, with no apparent differences in age, ethnicities, or race, along with variable radiographic and clinical presentation. Therefore, in this review, we will characterize what is known about ATM's etiology and diagnostic criteria, and relate it to properties of neuroimmunology. Moreover, we will further discuss current treatment options, along with potential novel methods, to provide a comprehensive overview of the status of ATM's research development. Among these novel treatments, potassium blockers reveal exciting early outcomes in restoring neurologic motor function. In addition, human glial progenitor cell transportations have been described as a potential treatment through integrating and remyelinating lesion sites. Nevertheless, despite these novel methods, there is a paucity of clinical trials establishing ATM's immunopathology and the therapeutic role of potential treatment methods. Therefore, we will highlight the importance of larger well-designed clinical trials in revealing significant biomarkers of injury and recovery.
Collapse
Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Claudia Covarrubias
- School of Medicine, Universidad Anáhuac Querétaro, Santiago de Querétaro, MEX
| | - Ryan Jarrah
- College of Arts and Sciences, University of Michigan - Flint, Flint, USA
| |
Collapse
|
7
|
Dual spinal cord injury: a case of acute traumatic T9 AIS A spinal cord injury complicated by transverse myelitis. Spinal Cord Ser Cases 2020; 6:81. [PMID: 32839453 DOI: 10.1038/s41394-020-00329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION While the general principles of treatment of TM are agreed upon, the rarity of the disease has made determining its clinical course and etiology quite difficult. This report aims to inform these debates by demonstrating the susceptibility of at least one individual to transverse myelitis following an acute SCI. CASE PRESENTATION This case report follows the clinical course of a 17 year old. Caucasian female that contracted transverse myelitis (TM) following an acute traumatic spinal cord injury. This patient originally presented as a T9 AIS A traumatic SCI, and was then re-graded as C6 AIS A SCI following diagnosis of TM. She was later seen in clinic for 6-month follow-up and displayed post-trauma baseline scores for both strength and sensation, indicating nearly complete recovery. DISCUSSION In addition, this report demonstrates the importance of adequate clinical management of TM in practical terms of patient performance on clinical exams. This report also adds to the existing body of evidence suggesting early intervention is associated with better functional outcomes.
Collapse
|