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Koc ER, Turan ÖF, Mengüç B. Covid-19 infection as a possible risk factor for longitudinally extensive transverse myelitis! Int J Neurosci 2024; 134:193-196. [PMID: 35791090 DOI: 10.1080/00207454.2022.2098731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION There is limited data about the neurological effects of Covid-19 in infected patients. In this report, we present 2 LETM cases that are possibly associated with Covid-19 infection. METHODS Here, we present 2 cases that subsequently developed LETM following Covid-19 infection. The first case presented a finding of tetraparesis prominent in the lower extremities that started ten days after the Covid-19 infection. The second patient was admitted with paraparesis and urinary-stool retention on the 12th day from the onset of symptoms of Covid-19 infection. RESULTS In these 2 cases, LETM developing following Covid'19 infection was associated with Covid-19 infection. Although Covid-19 PCR was negative in the CSF of both patients, the Covid-19 PCR test was positive in the samples taken from the oropharynx. CONCLUSION The mechanism of LETM caused by Covid-19 infection is not clearly known. However, both direct infection of the spinal cord and excessive inflammatory response to primary Covid-19 infection may cause spinal cord damage. Therefore, possible Covid-19-associated myelitis should be kept in mind in cases of long segment transverse myelitis grouped under the title of NMOSD and without any etiological factor.
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Affiliation(s)
- Emine Rabia Koc
- Faculty of Medicine, Department of Neurology, Uludag University, Bursa, Turkey
| | - Ömer Faruk Turan
- Faculty of Medicine, Department of Neurology, Uludag University, Bursa, Turkey
| | - Bedirhan Mengüç
- Faculty of Medicine, Department of Neurology, Uludag University, Bursa, Turkey
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Morgan HJ, Clothier HJ, Sepulveda Kattan G, Boyd JH, Buttery JP. Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis. Vaccine 2024; 42:2212-2219. [PMID: 38350771 DOI: 10.1016/j.vaccine.2024.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
Acute Disseminated Encephalomyelitis (ADEM) and Transverse Myelitis (TM) are within the group of immune mediated disorders of acquired demyelinating syndromes. Both have been described in temporal association following various vaccinations in case reports and case series and have been evaluated in observational studies. A recent analysis conducted by The Global Vaccine Data Network (GVDN) observed an excess of ADEM and TM cases following the adenoviral vectored ChAdOx1 nCoV-19 (AZD1222) and mRNA-1273 vaccines, compared with historically expected background rates from prior to the pandemic. Further epidemiologic studies were recommended to explore these potential associations. We utilized an Australian vaccine datalink, Vaccine Safety Health-Link (VSHL), to perform a self-controlled case series analysis for this purpose. VSHL was selected for this analysis as while VSHL data are utilised for GVDN association studies, they were not included in the GVDN observed expected analyses. The VSHL dataset contains vaccination records sourced from the Australian Immunisation Register, and hospital admission records from the Victorian Admitted Episodes Dataset for 6.7 million people. These datasets were used to determine the relative incidence (RI) of G040 (ADEM) and G373 (TM) ICD-10-AM coded admissions in the 42-day risk window following COVID-19 vaccinations as compared to control periods either side of the risk window. We observed associations between ChAdOx1 adenovirus vector COVID-19 vaccination and ADEM (all dose RI: 3.74 [95 %CI 1.02,13.70]) and TM (dose 1 RI: 2.49 [95 %CI: 1.07,5.79]) incident admissions. No associations were observed between mRNA COVID-19 vaccines and ADEM or TM. These findings translate to an extremely small absolute risk of ADEM (0.78 per million doses) and TM (1.82 per million doses) following vaccination; any potential risk of ADEM or TM should be weighed against the well-established protective benefits of vaccination against COVID-19 disease and its complications. This study demonstrates the value of the GVDN collaboration leveraging large population sizes to examine important vaccine safety questions regarding rare outcomes, as well as the value of linked population level datasets, such as VSHL, to rapidly explore associations that are identified.
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Affiliation(s)
- Hannah J Morgan
- Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Epi-Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia
| | - Hazel J Clothier
- Global Vaccine Data Network, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, New Zealand; Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Epi-Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia
| | - Gonzalo Sepulveda Kattan
- Global Vaccine Data Network, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, New Zealand; Epi-Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia
| | - James H Boyd
- Department of Digital Health, La Trobe University, 1 Kingsbury Drive, Bundoora, Victoria, Australia
| | - Jim P Buttery
- Global Vaccine Data Network, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, New Zealand; Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Epi-Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia; Infectious Diseases, Department of General Medicine, Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, Australia.
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Papantoniou M, Tsatinas KV, Gryllia M. Parainfectious Brown-Sequard syndrome associated with Mycoplasma pneumoniae in an adult patient: a case report. Spinal Cord Ser Cases 2024; 10:13. [PMID: 38490982 PMCID: PMC10943185 DOI: 10.1038/s41394-024-00627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Acute transverse myelitis (ATM) refers to a rare severe acquired spinal cord inflammation, with a challenging diagnostic work-up and treatment. CASE PRESENTATION We report the case of a 42-year-old patient who presented with loss of temperature and pain sensation beneath the C5 dermatome in her left side and reported a history of a possible respiratory tract illness 10 days ago. Within 2 days, clinical worsening was noted, compatible with Brown-Sequard syndrome. Spinal magnetic resonance imaging revealed a T2 sequence abnormal signal from level C4 to T3 and cerebrospinal fluid (CSF) studies showed only a mild pleocytosis mononuclear type. Extensive CSF and blood tests revealed only high Mycoplasma pneumoniae IgM and IgG titers. Treatment with high-dose intravenous methylprednisolone and oral azithromycin were administrated and the patient recovered completely within two months. DISCUSSION We would like to highlight the importance for physicians to consider M. pneumoniae in their differential diagnosis as a potential cause when encountering patients with symptoms of ATM and inflammatory Brown-Sequard syndrome.
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Affiliation(s)
- Michail Papantoniou
- Department of Neurology, G. Gennimatas General Hospital of Athens, Athens, Greece.
| | | | - Maria Gryllia
- Department of Neurology, G. Gennimatas General Hospital of Athens, Athens, Greece
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Pesante BD, Paro MR, Nadeem T, Bulsara KR, Choi DB. Lumbar decompression and fusion for symptomatic spinal stenosis in a patient with chronic thoracic sensory level from prior transverse myelitis: a case report. J Med Case Rep 2024; 18:42. [PMID: 38310259 PMCID: PMC10838414 DOI: 10.1186/s13256-024-04367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Many patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients. CASE PRESENTATION In this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression. CONCLUSION This is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.
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Affiliation(s)
- Benjamin D Pesante
- University of Connecticut School of Medicine, UConn Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Mitch R Paro
- University of Connecticut School of Medicine, UConn Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, Department of Surgery, UConn Health, Farmington, CT, USA
| | - David B Choi
- Division of Neurosurgery, Department of Surgery, UConn Health, Farmington, CT, USA
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Fjellbirkeland OW, Szpirt WM, Børresen ML. The role of plasmapheresis in severe acute disseminated encephalomyelitis with clinical findings of transverse myelitis. Ther Apher Dial 2024; 28:119-124. [PMID: 37646345 DOI: 10.1111/1744-9987.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Acute disseminated encephalomyelitis is a rare acute demyelinating disease of the central nervous system (CNS). The pathogenesis remains unclear but is suspected to be autoimmune. High doses of methylprednisolone (HDMP) are currently considered standard of treatment. Plasmapheresis (PE) is typically given in steroid refractory cases. There is currently limited evidence supporting its use in ADEM. MATERIALS AND METHODS We report a 16-year-old girl with ADEM who improved rapidly after initiating PE. RESULTS The patient presented with acute onset of multifocal CNS symptoms, including encephalopathy, requiring intensive care unit management. Despite HDMP administration, her clinical condition continued to deteriorate. PE was therefore initiated on the same day as HDMP. Her clinical condition improved significantly following the first session. She was extubated and discharged from the intensive care unit the following day. CONCLUSION HDMP combined with PE may be an effective first-line treatment in patients with fulminant ADEM.
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Affiliation(s)
| | - Wladimir M Szpirt
- Department of Nephrology, Plasmapheresis Services, Copenhagen, Denmark
| | - Malene L Børresen
- Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
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Lafian A, Mahani T, Hojjati M, Sarlati T. A Case Report of NMO Transverse Myelitis. Curr Rheumatol Rev 2024; 20:208-212. [PMID: 37861018 DOI: 10.2174/0115733971261420230919110103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Transverse myelitis is considered one of the cardinal features of neuromyelitis optica spectrum disorder (NMOSD), an immune-mediated inflammatory condition of the CNS characterized by severe, immune-mediated demyelination and axonal damage predominantly targeting optic nerves and spinal cord. We describe a case in which a diagnosis of NMOSD was established, associated with West Nile Virus (WNV) infection. CASE PRESENTATION A healthy 18-year-old female presented with intractable hiccups and rapidly progressing paraparesis. MRI demonstrated T2 edema extending from the medulla to the conus, consistent with longitudinally extensive transverse myelitis. Serum and CSF Aquaporin-4 IgG (AQP4) were both positive with high titers. In conjunction with antiviral therapy, immunomodulatory treatment was initiated using pulse methylprednisolone, plasmapheresis and Rituximab. A month and a half after admission, the patient was fully ambulatory with no residual symptoms. On her rheumatology follow-up visit, West Nile Virus-specific IgM in CSF was found to be positive from the patient's initial presentation. CONCLUSION We propose that West Nile Virus may have been the autoimmune trigger to the patient's development of NMOSD, highlighting the importance of evaluating viral triggers in autoimmune diseases.
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Affiliation(s)
- Anna Lafian
- Division of Rheumatology, Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Tandis Mahani
- Department of Internal Medicine, University of California, Riverside San Bernardino, California, USA
| | - Mehrnaz Hojjati
- Division of Rheumatology, Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Taraneh Sarlati
- Department of Internal Medicine, Kaiser Permanente Riverside Medical Center, Riverside, California, USA
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Caliskan E, Sager SG, Yukselmis U, Kilic AK, Gunbey HP. Coexistence of longitudinally extensive transverse myelitis and diffuse midline glioma in the brainstem in an adolescent boy with acute flaccid paralysis. Childs Nerv Syst 2024; 40:227-232. [PMID: 37737897 DOI: 10.1007/s00381-023-06163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
We present the case of a previously healthy 13-year-old boy who was admitted to the emergency department with acute flaccid paralysis. Magnetic resonance imaging revealed radiological evidence of longitudinally extensive transverse myelitis. Additionally, homogeneous T2 signal increase was observed in the pons and medulla oblongata, initially indicating brainstem encephalitis. Subsequent evaluations confirmed a coexistence of diffuse midline glioma (DMG) in the brain stem alongside acute transverse myelitis (ATM). Children with ATM generally have a more favorable prognosis than adults. However, despite the implementation of advanced treatment methods, the patient's quadriplegia did not improve and resulted in spinal cord sequela atrophy. DMG exhibits an aggressive growth pattern and lacks a known curative treatment. This case represents an exceedingly rare synchronous occurrence of aggressive conditions, underscoring the importance of raising awareness among physicians. Furthermore, we aim to discuss the radiologic differential diagnosis, as this is the first documented instance in the literature.
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Affiliation(s)
- Emine Caliskan
- Department of Pediatric Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey.
| | - Safiye Gunes Sager
- Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey
| | - Ufuk Yukselmis
- Department of Pediatric Intensive Care, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey
| | - Ahmet Kasim Kilic
- Department of Neurology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey
| | - Hediye Pınar Gunbey
- Department Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal Istanbul, Turkey
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Moore L, Munir A, Bae S, Miller J, Jordan A, Segal B. Transverse myelitis associated with Mpox infection. J Neuroimmunol 2023; 383:578190. [PMID: 37689031 DOI: 10.1016/j.jneuroim.2023.578190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/11/2023]
Abstract
Neurologic manifestations of mpox (monkeypox) infection are common. Rarely, transverse myelitis has been associated with mpox infection. We describe a case of longitudinally extensive transverse myelitis in a patient with recently diagnosed mpox, presenting as acute flaccid paraplegia. The patient underwent an extensive work-up that included serological and cerebrospinal fluid (CSF) testing and magnetic resonance imaging (MRI). They were treated with tecoviromat, high dose steroids, and intravenous immunoglobulin, followed by plasma exchange. Despite these interventions, there was minimal neurologic improvement. This case underscores the importance of instituting measures designed to prevent mpox infection, including public education initiatives.
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Affiliation(s)
- Lisa Moore
- Ohio State University Wexner Medical Center, 395 W 12(th) Ave, Columbus, OH 43210, USA.
| | - Armin Munir
- Ohio State University Wexner Medical Center, 395 W 12(th) Ave, Columbus, OH 43210, USA.
| | - Sonu Bae
- Ohio State University Wexner Medical Center, 395 W 12(th) Ave, Columbus, OH 43210, USA.
| | - Jaret Miller
- Ohio State University Wexner Medical Center, 395 W 12(th) Ave, Columbus, OH 43210, USA.
| | - Allison Jordan
- Ohio State University Wexner Medical Center, 395 W 12(th) Ave, Columbus, OH 43210, USA.
| | - Benjamin Segal
- Ohio State University Wexner Medical Center, 395 W 12(th) Ave, Columbus, OH 43210, USA.
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Abstract
Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss infectious myelitis, mainly the patterns of spinal cord involvement caused by each infectious agent and the contribution of magnetic resonance imaging as a major tool to establish the specific diagnosis.
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Affiliation(s)
| | | | | | | | - Mariana Dalaqua
- Departement d'Imagerie Médicale, Réseau Hospitalier Neuchatelois, Pourtalès, Switzerland
| | - Juliana de Ávila Duarte
- Department of Radiology and Diagnostic Imaging, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fabiano Reis
- Medicine Department of Anesthesiology, Oncology and Radiology, UNICAMP, Campinas, SP, Brazil.
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Lan D, Liu L. Concomitant transverse myelitis and Guillain-Barré syndrome following varicella-zoster virus infection. Chin Med J (Engl) 2023; 136:1256-1257. [PMID: 37253254 PMCID: PMC10278752 DOI: 10.1097/cm9.0000000000002662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Indexed: 06/01/2023] Open
Affiliation(s)
- Danmei Lan
- Department of Neurorehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China
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Goldschmidt C, Galetta SL, Lisak RP, Balcer LJ, Hellman A, Racke MK, Lovett-Racke AE, Cruz R, Parsons MS, Sattarnezhad N, Steinman L, Zamvil SS, Frohman EM, Frohman TC. Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200037. [PMID: 36270950 PMCID: PMC9673749 DOI: 10.1212/nxi.0000000000200037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.
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Affiliation(s)
- Carolyn Goldschmidt
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Steven L Galetta
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Robert P Lisak
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Laura J Balcer
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Andrew Hellman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Michael K Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Amy E Lovett-Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Roberto Cruz
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Matthew S Parsons
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Neda Sattarnezhad
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Lawrence Steinman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Elliot M Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA.
| | - Teresa C Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
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Walker JL, Schultze A, Tazare J, Tamborska A, Singh B, Donegan K, Stowe J, Morton CE, Hulme WJ, Curtis HJ, Williamson EJ, Mehrkar A, Eggo RM, Rentsch CT, Mathur R, Bacon S, Walker AJ, Davy S, Evans D, Inglesby P, Hickman G, MacKenna B, Tomlinson L, Ca Green A, Fisher L, Cockburn J, Parry J, Hester F, Harper S, Bates C, Evans SJ, Solomon T, Andrews NJ, Douglas IJ, Goldacre B, Smeeth L, McDonald HI. Safety of COVID-19 vaccination and acute neurological events: A self-controlled case series in England using the OpenSAFELY platform. Vaccine 2022; 40:4479-4487. [PMID: 35715350 PMCID: PMC9170533 DOI: 10.1016/j.vaccine.2022.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We investigated the potential association of COVID-19 vaccination with three acute neurological events: Guillain-Barré syndrome (GBS), transverse myelitis and Bell's palsy. METHODS With the approval of NHS England we analysed primary care data from >17 million patients in England linked to emergency care, hospital admission and mortality records in the OpenSAFELY platform. Separately for each vaccine brand, we used a self-controlled case series design to estimate the incidence rate ratio for each outcome in the period following vaccination (4-42 days for GBS, 4-28 days for transverse myelitis and Bell's palsy) compared to a within-person baseline, using conditional Poisson regression. RESULTS Among 7,783,441 ChAdOx1 vaccinees, there was an increased rate of GBS (N = 517; incidence rate ratio 2·85; 95% CI2·33-3·47) and Bell's palsy (N = 5,350; 1·39; 1·27-1·53) following a first dose of ChAdOx1 vaccine, corresponding to 11.0 additional cases of GBS and 17.9 cases of Bell's palsy per 1 million vaccinees if causal. For GBS this applied to the first, but not the second, dose. There was no clear evidence of an association of ChAdOx1 vaccination with transverse myelitis (N = 199; 1·51; 0·96-2·37). Among 5,729,152 BNT162b2 vaccinees, there was no evidence of any association with GBS (N = 283; 1·09; 0·75-1·57), transverse myelitis (N = 109; 1·62; 0·86-3·03) or Bell's palsy (N = 3,609; 0·89; 0·76-1·03). Among 255,446 mRNA-1273 vaccine recipients there was no evidence of an association with Bell's palsy (N = 78; 0·88, 0·32-2·42). CONCLUSIONS COVID-19 vaccines save lives, but it is important to understand rare adverse events. We observed a short-term increased rate of Guillain-Barré syndrome and Bell's palsy after first dose of ChAdOx1 vaccine. The absolute risk, assuming a causal effect attributable to vaccination, was low.
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Affiliation(s)
- Jemma L Walker
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation; UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK
| | - Anna Schultze
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - John Tazare
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Arina Tamborska
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Bhagteshwar Singh
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Katherine Donegan
- Medicines and Healthcare products Regulatory Agency (MHRA), 10 South Colonnade, Canary Wharf, London E14 4PU, UK
| | - Julia Stowe
- UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK
| | - Caroline E Morton
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - William J Hulme
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Helen J Curtis
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Elizabeth J Williamson
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Amir Mehrkar
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Rosalind M Eggo
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Christopher T Rentsch
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rohini Mathur
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sebastian Bacon
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Alex J Walker
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Simon Davy
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - David Evans
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Peter Inglesby
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - George Hickman
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Brian MacKenna
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Laurie Tomlinson
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Amelia Ca Green
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Louis Fisher
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Jonathan Cockburn
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - John Parry
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Frank Hester
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Sam Harper
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Christopher Bates
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Stephen Jw Evans
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Tom Solomon
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Nick J Andrews
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation; UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK
| | - Ian J Douglas
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Ben Goldacre
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Liam Smeeth
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation
| | - Helen I McDonald
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation.
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Kim JY, Lee YH, Kim JY, Lee HH, Kim YH. Intrathecal drug delivery to treat intractable neuropathic pain following Sjögren's syndrome-induced transverse myelitis: A case report. Medicine (Baltimore) 2021; 100:e26141. [PMID: 34087868 PMCID: PMC8183848 DOI: 10.1097/md.0000000000026141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Transverse myelitis (TM) is a spinal cord inflammatory myelopathy that causes motor/sensory loss and urinary retention below the level of the affected spinal cord. Although a few case reports have described the control of neuropathic pain in patients with TM via spinal cord stimulation, no documented case regarding the control of severe allodynia following TM via intrathecal pump has been described. PATIENT CONCERNS A 37-year-old woman was referred to a pain clinic for severe intractable pain below the T5 level followed by Sjögren's syndrome-induced TM. DIAGNOSES A neurological examination revealed paresthesia and allodynia below the T5 level. The sensory evaluation was limited by extreme pain and jerking movements. The muscle strength of both lower limbs was grade 3. INTERVENTIONS Intrathecal pump was inserted into the left lower abdomen. Catheter tip was placed at the midline of the T8 level. OUTCOMES The numeric rating scale (NRS) for pain score decreased from 10 to 5. Functional Independence Measure score increased from 67 before implantation to 92 at the time of discharge, while the patient's Barthel score increased from 31 to 46. LESSONS Neuropathic pain due to Sjögren's syndrome-related TM could be controlled effectively using the intrathecal morphine pump.
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Affiliation(s)
- Ji Yeong Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul
| | - Yong Ho Lee
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Hwa Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Gritsch D, Mbonde AA, Harahsheh EY, Chong BW, Wingerchuk DM. Reversible Cerebral Vasculopathy, Transverse Myelitis, and Active Systemic Lupus Erythematosus in an Aquaporin-4 Antibody–Positive Patient. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/2/e956. [PMID: 33468561 PMCID: PMC7862100 DOI: 10.1212/nxi.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022]
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Isaacs DJ, Johnson EJ, Hofmann ER, Rangarajan S, Vinson DR. Primary care physicians comprehensively manage acute pulmonary embolism without higher-level-of-care transfer: A report of two cases. Medicine (Baltimore) 2020; 99:e23031. [PMID: 33157953 PMCID: PMC7647577 DOI: 10.1097/md.0000000000023031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
RATIONALE The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting. As such, the role of the primary care physician in the complete diagnosis, risk stratification for outpatient eligibility, and initiation of treatment is unclear. CASE PRESENTATIONS Case 1: A 33-year-old man with known heterozygous Factor V Leiden mutation and a remote history of deep vein thrombosis presented to his primary care physician's office with 2 days of mild pleuritic chest pain and a dry cough after a recent transcontinental flight. Case 2: A 48-year-old man with a complex medical history including recent transverse myelitis presented to his primary care family physician with dyspnea and pleuritic chest pain for 6 days. DIAGNOSIS Case 1: Computed tomographic pulmonary angiography that same afternoon showed multiple bilateral segmental and subsegmental emboli as well as several small pulmonary infarcts. Case 2: The patient's D-dimer was elevated at 1148 ng/mL. His physician ordered a computed tomographic pulmonary angiography, performed that evening, which showed segmental and subsegmental PE. INTERVENTIONS Both patients were contacted by their respective physicians shortly after their diagnoses and, in shared decision-making, opted for treatment at home with 5 days of enoxaparin followed by dabigatran. OUTCOMES Neither patient developed recurrence nor complications in the subsequent 3 months. LESSONS These cases, stratified as low risk using the American College of Chest Physicians criteria and the PE Severity Index, are among the first in the literature to illustrate comprehensive primary care-based outpatient PE management. Care was provided within an integrated delivery system with ready, timely access to laboratory, advanced radiology, and allied health services. This report sets the stage for investigating the public health implications of comprehensive primary care-based PE management, including cost-savings as well as enhanced patient follow-up and patient satisfaction.
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Affiliation(s)
| | | | - Erik R. Hofmann
- The Permanente Medical Group, Oakland
- Department of Emergency Medicine, Kaiser Permanente South Sacramento Medical Center, Sacramento
| | - Suresh Rangarajan
- The Permanente Medical Group, Oakland
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland
| | - David R. Vinson
- The Permanente Medical Group, Oakland
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville
- Kaiser Permanente Northern California Division of Research, Oakland, CA
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Reddy R, Prasad R, Rejai S, Halter K, Chen J. Relief of Neuropathic Pain After Spinal Cord Stimulator Implantation in a Patient With Idiopathic Thoracic Transverse Myelitis: A Case Report. A A Pract 2019; 13:409-412. [PMID: 31449073 PMCID: PMC7017750 DOI: 10.1213/xaa.0000000000001078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transverse myelitis (TM) is a rare neurologic disorder of acute inflammation resulting in spinal cord injury. Chronic pain in TM is a significant detriment to quality of life. Spinal cord stimulation (SCS) is an emerging treatment that has shown significant efficacy in neuropathic pain. We present a 37-year-old man with a history of idiopathic thoracic TM and refractory chronic neuropathic pain who underwent an SCS trial. He reported 70% improvement during the trial and was subsequently implanted with an SCS. He continues to experience significant pain relief and functional improvement (>80%) with conventional paresthesia programming at the 9-month follow-up.
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Affiliation(s)
- Rajiv Reddy
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine
| | - Rupa Prasad
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine
| | - Sepehr Rejai
- Sutter East Bay Medical Group, Department of Pain Medicine
| | - Kenneth Halter
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine
| | - Jeffrey Chen
- UC San Diego Health Center, Department of Anesthesia, Pain Medicine
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Abbas SA, El Helou J, Chalah MA, Hilal H, Saliba G, Abboud H, Ayache SS. Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual-A Rare Complication of Varicella-Zoster Virus Reactivation. ACTA ACUST UNITED AC 2019; 55:medicina55050201. [PMID: 31126152 PMCID: PMC6572170 DOI: 10.3390/medicina55050201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022]
Abstract
Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult—a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.
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Affiliation(s)
- Samar A Abbas
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Jeanine El Helou
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France.
| | - Hanine Hilal
- Department of Neurology, Bellevue Medical Center University Hospital, Beirut 1104-2020, Lebanon.
| | - Gaby Saliba
- Department of Infectious diseases, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Halim Abboud
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France.
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Román GC, Anaya JM, Mancera-Páez Ó, Pardo-Turriago R, Rodríguez Y. Concurrent Guillain-Barré syndrome, transverse myelitis and encephalitis post-Zika: A case report and review of the pathogenic role of multiple arboviral immunity. J Neurol Sci 2019; 396:84-85. [PMID: 30423542 DOI: 10.1016/j.jns.2018.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Gustavo C Román
- Houston Methodist Hospital, Department of Neurology, Houston Neurological Institute, Houston, Texas and Weill Cornell College of Medicine, Cornell University, New York, NY, United States.
| | - Juan-Manuel Anaya
- Universidad del Rosario, Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Bogotá, Colombia.
| | - Óscar Mancera-Páez
- Universidad Nacional de Colombia, Hospital Universitario Nacional, Faculty of Medicine, Department of Neurology, Bogotá, Colombia.
| | - Rodrigo Pardo-Turriago
- Universidad Nacional de Colombia, Hospital Universitario Nacional, Faculty of Medicine, Department of Neurology, Bogotá, Colombia.
| | - Yohan Rodríguez
- Universidad del Rosario, Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Bogotá, Colombia
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Poorthuis MHF, Battjes S, Dorigo-Zetsma JW, de Kruijk JR. Primary Epstein-Barr virus infection in immunocompetent patients with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome as neurological manifestations. BMJ Case Rep 2018; 2018:bcr-2018-225333. [PMID: 30158264 PMCID: PMC6119397 DOI: 10.1136/bcr-2018-225333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2018] [Indexed: 11/04/2022] Open
Abstract
Neurological manifestations of a primary Epstein-Barr virus (EBV) infection are rare. We describe a case with acute transverse myelitis and another case with a combination of polyradiculitis and anterior horn syndrome as manifestations of a primary EBV infection.The first case is a 50-year-old immunocompetent male diagnosed with acute transverse myelitis, 2 weeks after he was clinically diagnosed with infectious mononucleosis. The second case is an 18-year-old immunocompetent male diagnosed with a combination of polyradiculitis and anterior horn syndrome while he had infectious mononucleosis. The first patient was treated with methylprednisolone. After 1 year, he was able to stop performing clean intermittent self-catheterisation. The second patient completely recovered within 6 weeks without treatment.Primary EBV infection should be considered in immunocompetent patients presenting with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome. Antiviral treatment and steroids are controversial, and the prognosis of neurological sequelae is largely unknown.
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Zakhour R, Mancias P, Heresi G, Pérez N. Transverse Myelitis and Guillain-Barré Syndrome Associated with Cat-Scratch Disease, Texas, USA, 2011. Emerg Infect Dis 2018; 24:1754-1755. [PMID: 30124417 PMCID: PMC6106413 DOI: 10.3201/eid2409.180008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We describe a case of coexisting transverse myelitis and Guillain-Barré syndrome related to infection with Bartonella henselae proteobacterium and review similar serology-proven cases. B. henselae infection might be emerging as a cause of myelitis and Guillain-Barré syndrome and should be considered as an etiologic factor in patients with such clinical presentations.
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Abstract
RATIONALE Longitudinally extensive transverse myelitis (LETM) is characterized by contiguous inflammatory lesions of spinal cord extending to ≥3 vertebral segments. The etiology of LETM is complicated, including various infection, autoimmune disease, and so on. Neuromyelitis optic spectrum disorder (NMOSD) is the most common cause of LETM. Several case reports have suggested the associations between NMOSD and pulmonary tuberculosis (PTB). PATIENT CONCERNS Patient 1, a 20-year-old woman who had a past history of PTB, presented with weakness, numbness, and pain in the limbs. The serum anti-aquaporin-4 antibody (AQP4-Ab) was strongly positive, and the magnetic resonance imaging (MRI) scan of cervical and thoracic spinal cord after admission to the hospital revealed hyperintensity lesions extending from C3 to T8 on T2-weighted (T2W) image, T1-weighted (T1W) image, and fluid-attenuated inversion recovery (FLAIR) image. Patient 2, a 21-year-old woman who had a past medical history of PTB without receiving any treatment, presented for numbness in bilateral lower limbs and in the chest. The anti-AQP4-Ab was negative both in the serum and in the cerebral spinal fluid (CSF) of the patient. The MRI scan during hospitalization of cervical and thoracic spinal cord revealed diffuse hyperintense signal extending C3 to T11 on T2W and FLAIR images and hypointense signal on T1W image. DIAGNOSIS The first patient was diagnosed with anti-AQP4-Ab positive NMOSD, while the second case was an anti-AQP4-Ab negative LETM patient. INTERVENTIONS Both of the patients received a combination of corticosteroid and anti-tuberculosis (isonicotinyl hydrazide 0.3 g/d, rifampin 0.45 g/d, pyrazinamide 1 g/d, and ethambutol 1 g/d) treatment. OUTCOMES The patients were followed up for up to 1 year. The Expanded Disability Status Scale (EDSS) of both patients were decreased and the lesion size in the spinal cord was significantly reduced at the time point of the follow-up. LESSONS Combination of anti-tuberculosis and corticosteroid treatment may have better prognosis for patient of LETM with PTB.
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Dmochowski RR. Editorial. Neurourol Urodyn 2017; 36:220. [PMID: 28235167 DOI: 10.1002/nau.23246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Alsukhni RA, Aboras Y, Jriekh Z, Almalla M, El-Kahwateya AS. LETM presented with causalgia and ensued by sudden death. BMC Neurol 2017; 17:13. [PMID: 28109254 PMCID: PMC5251226 DOI: 10.1186/s12883-017-0791-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Longitudinally Extensive Transverse Myelitis LETM is a specific pattern of myelitis wherein at least three continuous vertebral segments are involved. Characteristically, it is a defining feature of neuromyelitis optica NMO. However, it is described in many other etiologies. CASE PRESENTATION We present a case of 60 year old male who presented with symptoms and signs of regional sympathetic dystrophy RSD followed by symptoms of myelitis. Spinal cord MRI revealed cervical LETM extending to the brainstem. In spite of serological negativity, treatment of suspected neuromyelitis optica spectrum disorder NMOSD was initiated and resulted in symptom relief. Meanwhile, sudden death occurred and autonomic dysreflexia was the main culprit. CONCLUSIONS This case suggests that RSD could be the mere primary presentation of LETM, discusses the differential diagnoses of LETM in elderly patients, and suggests the possible risk of autonomic dysreflexia in such patients.
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Affiliation(s)
- Rana Alnasser Alsukhni
- Division of Neurology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria
| | - Yasmin Aboras
- Division of Neurology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria
| | - Ziena Jriekh
- Division of Rheumatology, Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria
| | - Mahmoud Almalla
- Department of Laboratory Medicine, Aleppo University Hospital, Aleppo, Syria
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Abstract
BACKGROUND Acute transverse myelitis is uncommon and presumably results from an autoimmune process or a preceding infection. Most cases of bacterial myelitis are due to hematogenous dissemination from urinary or respiratory tract infections or contiguous spreading from a neighboring infected structure. A psoas abscess rarely spreads to higher levels of the spinal cord. No cases of acute cervical myelitis due to a psoas abscess have been previously reported. CASE PRESENTATION A 34-year-old man was transferred to our hospital due to progressive muscle weakness, sensory deficits and severe hypotension. Two weeks prior to admission, he had received low back injection to relieve back pain in a healthcare clinic. One day prior to admission, his condition had worsened. On admission, he was tetraplegic with absence of sensation below the level of the suprasternal fossa. A lumbar CT scan demonstrated an abscess in the left psoas, and the magnetic resonance imaging (MRI) scan of the entire spinal suggested a cervical spine infection. A cerebrospinal fluid (CSF) analysis performed before surgery indicated the possibility of bacterial infection. An operation was performed to drain the abscess. Microbiological cultivation revealed a Methicillin-resistant Staphylococcus aureus (MRSA) infection. The patient was administered with vancomycin for 10 days and followed by oral formulations of linezolid for 6 weeks. The patient's general condition improved, and he was successfully discharged. Six months later, a follow-up MRI revealed that the lesion of the cervical spine had been ameliorated, and the sensation and myodynamia of his upper limbs had partially recovered. CONCLUSION This was a rare case of a high-level cervical spine pyogenic infection complicating psoas abscess. An invasive paravertebral injection procedure was thought to be the initial damaging event that created a port of entry for MRSA into the psoas muscle and caused a subsequent psoas abscess. This case indicated that evaluation of higher levels of the spine is warranted when a psoas abscess coexists with severe weakness.
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Affiliation(s)
- Hongyu He
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lirong Jin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minjie Ju
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guowei Tu
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Intensive Care Medicine, Floor 4, Building A, No 180, Fenglin Road, Shanghai, China
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Perinpanathan K, Paramaguru S, Kazibwe NJ. A 20-Year-Old Woman with Sudden Onset of Neurologic Deficits of Unknown Cause. Pediatr Ann 2016; 45:e112-5. [PMID: 27064465 DOI: 10.3928/00904481-20160301-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Mahajan SK, Kumar S, Garg M, Kaushik M, Sharma S, Raina R. Scrub typhus with longitudinally extensive transverse myelitis. J Vector Borne Dis 2016; 53:84-86. [PMID: 27004584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Sanjay K Mahajan
- Department of Medicine, Indira Gandhi Medical College, Shimla, India
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Mazarakis NK, Ughratdar I, Vloeberghs MH. Excellent functional outcome following selective dorsal rhizotomy in a child with spasticity secondary to transverse myelitis. Childs Nerv Syst 2015; 31:2189-91. [PMID: 26077594 DOI: 10.1007/s00381-015-2779-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used to treat spasticity in children with cerebral palsy (CP). The vast majority of studies to date suggest SDR is particularly effective in reducing lower limb spasticity in spastic diplegia with long-lasting effect. METHOD We report, to the best of our knowledge for the first time, the case of a teenager who underwent SDR for the management of spasticity secondary to transverse myelitis. RESULTS This is an unusual indication for SDR which resulted in completely loose lower limbs and an excellent functional outcome. At a follow-up 18 months following the procedure, the child had no re-occurrence of his symptoms. CONCLUSION This report raises the possibility that the use of SDR could be expanded to include other pathologies. We discuss the case and the relevant literature. Our spasticity service at NUH has to date inserted 300 baclofen pumps and performed 60 SDRs mainly in children with cerebral palsy.
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Affiliation(s)
- N K Mazarakis
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - I Ughratdar
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - M H Vloeberghs
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Chang T, Withana M. Gaze palsy, hypogeusia and a probable association with miscarriage of pregnancy--the expanding clinical spectrum of non-opticospinal neuromyelitis optica spectrum disorders: a case report. BMC Res Notes 2015; 8:36. [PMID: 25888897 PMCID: PMC4328076 DOI: 10.1186/s13104-015-0991-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuromyelitis optica is characterised by optic neuritis, longitudinally-extensive transverse myelitis and presence of anti-aquaporin-4 antibodies in the serum. However, non-opticospinal central nervous system manifestations have been increasingly recognised. Awareness of the widening clinical spectrum of neuromyelitis optica (unified within the nosology of 'neuromyelitis optica spectrum disorders') is key to earlier diagnosis and appropriate therapy. We report 2 patients to illustrate the varied clinical manifestations of neuromyelitis optica spectrum disorders while postulating an effect of anti-aquaporin-4 antibodies on the miscarriage of pregnancy. This is the first report of horizontal gaze palsy as a presenting symptom of neuromyelitis optica spectrum disorders. CASE PRESENTATION Patient 1: A 17-year-old Sri Lankan female presented with hypersomnolence, lateral gaze palsy and loss of taste of 1 week duration. Two years previously she had presented with intractable hiccups and vomiting followed by a brainstem syndrome. Magnetic resonance imaging showed a lesion in the left cerebellum extending into the pons while lesions in bilateral hypothalami and medulla noted 2 years ago had resolved. Autoimmune, vasculitis and infection screens were negative. Anti-aquaporin-4 antibodies were detected in serum. All her symptoms resolved with immunosuppressive therapy. Patient 2: A 47-Year-old Sri Lankan female presented with persistent vomiting lasting over 3 weeks. Three years previously, at 25-weeks of her 4(th) pregnancy, she had presented with quadriparesis and was found to have a longitudinally extensive transverse myelitis from C2 to T2 vertebral levels, which gradually improved following intravenous steroid therapy. Magnetic resonance imaging showed a hyper-intense lesion in the area postrema and longitudinally extensive atrophy of the cord corresponding to her previous myelitis. Autoimmune, vasculitis and infection screens were negative. Anti-aquaporin-4 antibodies were detected in serum. Her vomiting subsided with immunosuppressive therapy. Her second pregnancy had resulted in a first-trimester miscarriage. CONCLUSION The clinical spectrum of neuromyelitis optica spectrum disorders has expanded beyond optic neuritis and myelitis to include non-opticospinal syndromes involving the diencephalon, brainstem and cerebrum. Our report highlights the varied central nervous system manifestations of neuromyelitis optica spectrum disorders and miscarriage of pregnancy possibly related to anti-aquaporin-4 antibodies.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 08, Sri Lanka.
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Milinda Withana
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
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Austin E, Betz B, Arndt D. The value of 3-T magnetic resonance imaging in acute transverse myelitis. Pediatr Neurol 2014; 51:860-1. [PMID: 25444094 DOI: 10.1016/j.pediatrneurol.2014.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/25/2014] [Accepted: 07/26/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Erica Austin
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan.
| | - Bradford Betz
- Helen DeVos Children's Hospital, Department of Radiology, Detroit, Michigan
| | - Daniel Arndt
- Beaumont Children's Hospital, Pediatric Neurology Department, Royal Oak, Michigan
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Zagrajek M, Haas J. [Acute idiopathic longitudinally extensive transverse myelitis with peripheral axonal motor neuropathy]. Wiad Lek 2014; 67:495-498. [PMID: 26030955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute longitudinally extensive transverse myelitis (LETM) is a rare disease of autoimmune, connective tissue or infectious etiology (bacterial or viral) in which spinal cord lesion extends vertically over three or more vertebral segments. The most common cause of LETM is neuromyelitis optica (Devic's syndrome). It's typically clinically characterized by a tetraparesis or paraparesis of the lower extremities, superficial and deep sensation disturbances and sphincter dysfunction. Differential diagnosis is complex and based on immunological, serological, biochemical tests. Authors present 37-year-old healthy woman with sudden onset of flaccid tetraplegia preceded by upper limbs paresthesia. MRI examination of cervical and thoracic part of the spinal cord revealed extensive, multiple hyperintensive lesions extending from C3 up toTh9. In electroneurography examination coexistent severe peripheral axonal motor neuropathy was diagnosed. Despite performed profound tests the etiology of LETM in our patient remained unknown.
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Llorenç V, Rey A, Mesquida M, Pelegrín L, Adán A. [Central nervous system demyelinating disease-associated uveitis]. Arch Soc Esp Oftalmol 2012; 87:324-329. [PMID: 23021230 DOI: 10.1016/j.oftal.2012.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 02/24/2012] [Accepted: 04/17/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe the epidemiology, clinical features and visual prognosis in uveitis associated with demyelinating disease (DD) of the CNS. METHODS A clinical, retrospective, and descriptive study was performed. Data regarding age at presentation, gender, time from onset was recorded, as well as, type of uveitis, complications, treatment and initial and final visual acuity (BCVA) on all patients with DD-associated uveitis diagnosed in our Unit between January 2009 and June 2011. RESULTS Five women and 4 men were finally included (1.3% of 697 with uveitis). There was associated multiple sclerosis in 78% of cases. Mean age at presentation was 36.6 years for uveitis and 40 years for DD. The uveitis preceded the DD in 3 cases (33%). Typically, uveitis was bilateral (89%), chronic (89%), intermediate (89%), and associated with previous inflammation (29%), with synechiae (65%), and granulomatous (44%). The most frequent complications were cataract (71%) and macular oedema (53%). Besides local treatment, uveitis was managed with systemic steroids (78%), immunosuppressants (44%), and surgery (41% of eyes). After a mean follow up of 5 years, 47% of the eyes had a worse BCVA, among which, 12% lost ≥ 3 Snellen lines. The only patient treated with interferon (IFN), remained stable without treatment for the last 7 years. CONCLUSIONS DD-associated uveitis typically affected young adult women with intermediate-anterior uveitis of chronic, bilateral and synechiae type. Complications are common and there is a risk of visual loss, despite treatment. IFN therapy may be an effective alternative to be investigated.
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Affiliation(s)
- V Llorenç
- Hospital Clínic i Provincial de Barcelona, Institut Clínic d'Oftalmologia (ICOF), Barcelona, España.
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Garcia-Rodriguez R, Fernandez-Dominguez J, Gomez-Illan R, Lopez-Roger R, Mateos V. [Recurring neuromyelitis without optic neuritis: a case report]. Rev Neurol 2012; 55:87-90. [PMID: 22760768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Neuromyelitis optica, or Devic's disease, is an inflammatory, demyelinating disease of the central nervous system that selectively affects the optic nerves and the spinal cord, with a high rate of relapses. Anti-aquaporin-4 (AQP4) antibodies are a highly specific marker for this condition. CASE REPORT A 66-year-old female with longitudinally extensive dorsal transverse myelitis with complete remission following steroidal treatment and later acute relapse, with palsy in one limb. The differential diagnoses considered included a spinal tumour and arteriovenous malformation of the spinal cord. Being positive for AQP4 was the decisive factor in the final diagnosis. CONCLUSIONS Early detection of anti-AQP4 antibodies together with appropriate immunotherapy can be the key to a better prognosis. An early diagnosis is essential to be able to start treatment at an early stage and thus prevent relapses and severe sequelae.
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Haghikia A, Décard BF, Hellwig K, Kraus P, Gold R. Wheels within wheels: multifocal autoimmune myelitis in a woman with Huntington's disease. J Neurol 2012; 259:1973-5. [PMID: 22460588 DOI: 10.1007/s00415-012-6484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/13/2012] [Accepted: 03/15/2012] [Indexed: 11/25/2022]
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Marinkovic SP, Gillen L, Marinkovic CM. Transverse myelitis with urinary retention and clean, intermittent catheterization treated with neuromodulation. J Reprod Med 2011; 56:153-157. [PMID: 21542534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Transverse myelitis is a chronic, debilitating neurologic disease with numerous urological manifestations, including urinary detrusor overactivity, detrusor sphincter dyssynergia and urinary retention. We review our results with sacral neuromodulation for urinary retention in female patients with transverse myelitis. STUDY DESIGN A retrospective, observational study was conducted among female patients with transverse myelitis and urinary retention hospitalized between January 2002 and January 2009. Five of seven consecutive women underwent Stage 1 and 2 sacral neuromodulation under general anesthesia. RESULTS Four ambulatory patients (57%) were successfully implanted, while three nonambulatory patients did not achieve implantation, with a mean follow-up of 3.87 +/- 2.11 years and mean postoperative postvoid residual of 72.5 +/- 45.6 mL (p < 0.001). Postoperative uroflowmetry revealed a mean maximum uroflow of 16.7 +/- 5.9 mL/sec (preoperative max flow was 0.0 mL/sec) (p < 0.001). Two implanted patients required revisional surgeries for lead migration and increased impedance. CONCLUSION Ambulatory female patients with transverse myelitis and urinary retention may be successfully treated with sacral neuromodulation. Insignificant improvements in postvoid residual urine/maximum uroflow were attained with nonambulatory and assisted ambulatory patients.
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Affiliation(s)
- Serge P Marinkovic
- Division of Urology, Leonard Chabert Medical Center, Houma, Louisiana, USA.
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Tan LF, Li H, Liang LQ, Zhan ZP, Lian F. [Clinical analysis of 6 cases of systemic lupus erythematosus complicated by transverse myelitis]. Nan Fang Yi Ke Da Xue Xue Bao 2011; 31:313-316. [PMID: 21354919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To summarize the clinical features and therapeutic approach of systemic lupus erythematosus (SLE) complicated by transverse myelitis (TM). METHODS The clinical characteristics, laboratory examinations, treatment and prognosis of 6 SLE cases with TM were retrospectively analyzed with review of the literatures. RESULTS The 6 patients consisted of 5 females and 1 male aged 14 to 36 years (mean 23 years). The mean duration from symptom onset of SLE to TM was 8 months (1 to 13 months). All the patients had lower limb hypodynamia, and 3 of them developed upper limb hypodynamia. MRI scanning of the spine identified lesions in the cervical spinal cord in 2 cases, thoracic lesions in 3 cases, and multiple involvement of the cervical, thoracic and lumbar cord in 1 case. Examination of the cerebrospinal fluid yielded no specific findings except for leukocytosis in 1 case and hypoglycemia in another. Five cases were treated with high-dose MP+CTX, and the other case was treated with MP (80 mg/day)+CTX. Five patients responded favorably to the treatment, while the other showed no obvious improvement. CONCLUSION TM is a rare complication of SLE affecting mostly young patients and occurring in the early stage of the disease. Early diagnosis and aggressive treatment might improve the prognosis.
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Affiliation(s)
- Li-fu Tan
- Fifth Department of Internal Medicine, Huiyang People's Hospital, Huizhou 516211, China.
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Papayannidis C, Iacobucci I, Abbenante MC, Curti A, Paolini S, Parisi S, Baccarani M, Martinelli G. Complete paraplegia after nelarabine treatment in a T-cell acute lymphoblastic leukemia adult patient. Am J Hematol 2010; 85:608. [PMID: 20658590 DOI: 10.1002/ajh.21719] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Cristina Papayannidis
- Institute of Hematology/Oncology "L. and A. Seràgnoli," S.Orsola-Malpighi Hospital, University of Bologna, Italy
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Singhal SR, Nanda S. Transverse myelitis: a rare cause of puerperal pyrexia. Eur J Obstet Gynecol Reprod Biol 2009; 147:234. [PMID: 19709799 DOI: 10.1016/j.ejogrb.2009.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 07/20/2009] [Indexed: 11/18/2022]
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Shah S, Sangari T, Qasim M, Martin T. Severe hypertension and bradycardia after dexmedetomidine for radiology sedation in a patient with acute transverse myelitis. Paediatr Anaesth 2008; 18:681-2. [PMID: 18331550 DOI: 10.1111/j.1460-9592.2008.02521.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hobaika ABS, Cançado CL, Dettogni PL, Guedes VC. Hysterical paraplegia simulating acute transverse myelitis after general anesthesia. Acta Anaesthesiol Scand 2008; 52:449-50. [PMID: 18269403 DOI: 10.1111/j.1399-6576.2007.01543.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Young KM. Simple rules, complex behavior. J Miss State Med Assoc 2008; 49:40-43. [PMID: 19297896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Kevin M Young
- Department of Family Medicine, University of Mississippi Medical Center, Jackson, USA.
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Drozdowski W. [Transverse myelitis]. Przegl Epidemiol 2008; 62 Suppl 1:30-38. [PMID: 22320033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Transverse myelitis is a disease with various pathogenesis. It leads to a partial or total transverse lesion of the spinal cord structures resulting in an acute or subacute: motor (paralysis or paresis), sensory (most often with sensory level) and autonomic symptoms and signs. Its etiology is complex and sometimes difficult to establish explicitly. The most frequent reason of transverse myelitis is infection, but there are other factors like: postinfectious, neoplastic, paraneoplastic, demyelinating, immunological (connective tissue diseases), vascular and others. Idiopathic transverse myelitis accounts for about 10-40% of cases, and despite thorough diagnostics its aetiology cannot be established. Transeverse myelitis has been known for years, but it still poses a big problem both diagnostically and therapeuthically. Its course is frequently serious leading to persistent neurological damage and permanent disability. Diagnostic methods of choice are spinal cord MRI and CSF examination with assessment of oligoclonal bands, biomarkers of inflammatory process, 14-3-3 protein and neuronal specific enolase. Its treatment is determined by established aetiology. Many inconsistencies, no clear cut definition of the disease and lack of diagnostic criteria are being discussed by the group of experts working in Transverse Myelitis Consortium Group.
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Jensen RM, Kinkel RP. Acute paraplegia with vanishing white matter lesions. Rev Neurol Dis 2008; 5:159-166. [PMID: 18838956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Young adults presenting with an acute myelopathy often represent a diagnostic challenge. We present the case of a 20-year-old man who demonstrated many of the diagnostic issues involved in the evaluation of this syndrome.
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Affiliation(s)
- Rikke M Jensen
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Motozaki Y, Komai K, Hirohata M, Asaka T, Ono K, Yamada M. Hereditary inclusion body myopathy with a novel mutation in the GNE gene associated with proximal leg weakness and necrotizing myopathy. Eur J Neurol 2007; 14:e14-5. [PMID: 17718674 DOI: 10.1111/j.1468-1331.2007.01905.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baylor P, Garoufi A, Karpathios T, Lutz J, Mogelof J, Moseley D. Transverse Myelitis in 2 Patients With Bartonella henselae Infection (Cat Scratch Disease). Clin Infect Dis 2007; 45:e42-5. [PMID: 17638185 DOI: 10.1086/519998] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 04/24/2007] [Indexed: 11/04/2022] Open
Abstract
Cat scratch disease is usually a benign, self-limiting condition. Neurological manifestations are uncommon and may consist of encephalopathy, seizures, and coma. This report describes 2 cases of transverse myelitis: 1 case in a 46-year-old man who had lymph node biopsy and serological testing results that were positive for Bartonella henselae and 1 case in a 13-year-old adolescent boy who had serological testing results that were positive for B. henselae. These are 2 of the only 3 cases of transverse myelitis associated with cat scratch disease that have been reported since the causative organism was first reported.
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Affiliation(s)
- Peter Baylor
- Department of Medicine, Veteran's Affairs Medical Center, Fresno, CA 93703, USA.
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Eser O, Yaman M, Coşar M, Petik B. Idiopathic recurrent transverse myelitis with syringomyelia: a case report. Turk Neurosurg 2007; 17:228-231. [PMID: 17939113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Idiopathic transverse myelitis is a monophasic demyelinating disease of the central nervous system (CNS) and its recurrence is a rare entity. Existence of syringomyelia in the spinal cord in inflammatory CNS disease is not usually encountered. This case study describes a 45-year-old man who was admitted with features of a cervical demyelinating disease. The history of the patient indicated that this could be a recurring attack. Cervical MRI and laboratory examination of the patient showed evidence of recurrent transverse myelitis. The patient was managed with medical therapy. The follow-up cervical MRI of the patient 2 years later indicated syringomyelia in the cervical cord.
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Affiliation(s)
- Olcay Eser
- Afyon Kocatepe University, Faculty of Medicine, Neurosurgery Department, Afyonkarahisar, Turkey.
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Guillotreau J, Gamé X, Castel-Lacanal E, Mallet R, De Boissezon X, Malavaud B, Marque P, Rischmann P. [Laparoscopic cystectomy and transileal ureterostomy for neurogenic vesicosphincteric disorders. Evaluation of morbidity]. Prog Urol 2007; 17:208-12. [PMID: 17489320 DOI: 10.1016/s1166-7087(07)92265-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the morbidity and mortality of laparoscopic cystectomy combined with transileal ureterostomy to treat neurogenic vesicosphincteric disorders. MATERIAL Prospective study performed between february 2004 and april 2006 on 26 consecutive patients with a mean age of 55.0 +/- 12.7 years treated by laparoscopic cystectomy for neurogenic vesicosphincteric disorders. The underlying neurological disease was multiple sclerosis (MS) in 20 cases, spinal cord injury in 4 cases and transverse myelitis in 2 cases. The median preoperative ASA score was 3 (range: 2-3). RESULTS No open conversion was necessary. One intraoperative complication was observed (vascular injury). No perioperative death was observed. The nasogastric tube was maintained postoperatively for an average of 8.69 +/- 5.9 hours. The mean time to resumption of oral fluids was 1.4 +/- 0.7 days and mean time to resumption of solids was 2.6 +/- 1.0 days. The mean time to resumption of bowel movements was 3.8 +/- 3.2 days. The mean intensive care stay was 3.9 +/- 1.1 days. Two postoperative complications were observed in the same patient (ileus and bronchial congestion). Postoperative narcotic analgesics were necessary in 60% of cases. The mean hospital stay was 10.3 +/- 4.1 days. Two late postoperative complications were observed in the same patient (two episodes of pyelonephritis). CONCLUSION Laparoscopic cystectomy has a low morbidity in neurological patients, allowing early return of feeding and a moderate length of hospital stay.
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Affiliation(s)
- Julien Guillotreau
- Service d'Urologie, d'Andrologie et de Transplantation Rénale, CHU Rangueil, Toulouse, France
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Lan HHC, Chen DY, Chen CCC, Lan JL, Hsieh CW. Combination of transverse myelitis and arachnoiditis in cauda equina syndrome of long-standing ankylosing spondylitis: MRI features and its role in clinical management. Clin Rheumatol 2007; 26:1963-7. [PMID: 17332972 DOI: 10.1007/s10067-007-0593-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 02/09/2007] [Accepted: 02/09/2007] [Indexed: 10/23/2022]
Abstract
The cauda equina syndrome (CES) is a rare neurological complication of ankylosing spondylitis (AS). Imaging diagnosis of CES in long-standing AS patients (CES-AS) using myelography, computed tomography (CT), and magnetic resonance imaging (MRI) were reported in the literature. They, however, demonstrate only the chronic abnormalities of CES-AS, i.e., dural ectasia, dorsal dural diverticula, and selective bone erosion at the posterior elements of the vertebrae. To our knowledge, imaging features of acute intradural inflammation in CES-AS were not described. We report a patient of CES-AS in whom MRI disclosed acute transverse myelitis and arachnoiditis along the lower spinal cord, and discuss the pathogenesis of CES-AS and the role of MRI in clinical management.
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Affiliation(s)
- Howard Haw-Chang Lan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
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Noray Malgrat M, Mateu G, Luján M. [Lung collapse caused by hiatal hernia secondary to manual abdominal compression]. Arch Bronconeumol 2007; 43:53. [PMID: 17257567 DOI: 10.1016/s1579-2129(07)60023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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