1
|
Thornley K, Canepa C. Neuromyelitis optica spectrum disorder (NMOSD) presenting as acute transverse myelitis with positive aquaporin 4 antibodies. BMJ Case Rep 2021; 14:e238992. [PMID: 33504530 PMCID: PMC7843326 DOI: 10.1136/bcr-2020-238992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/26/2020] [Indexed: 01/29/2023] Open
Abstract
An 80-year-old, previously healthy patient presents with acute transverse myelitis with sensory level at T8. The MRI scan of the spinal cord showed longitudinal extensive transverse myelitis, and she tested positive for aquaporin 4 antibodies in serum. She received treatment with intravenous and oral steroids, with no improvement and then underwent plasma exchange. She was then started on azathioprine for prevention of relapses, while continuing physiotherapy and occupational therapy. Eventually, she was transferred to a specialised spinal cord centre for long-term rehabilitation.
Collapse
Affiliation(s)
- Katherine Thornley
- General Medicine, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Carlo Canepa
- Stroke and Neurology, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| |
Collapse
|
2
|
Roy D, Ghosh R, Dubey S, Dubey MJ, Benito-León J, Kanti Ray B. Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic. Can J Neurol Sci 2021; 48:9-24. [PMID: 32753076 PMCID: PMC7533477 DOI: 10.1017/cjn.2020.173] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [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] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations. METHODS PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: "COVID-19", "SARS-CoV-2", "pandemic", "neuro-COVID", "stroke-COVID", "epilepsy-COVID", "COVID-encephalopathy", "SARS-CoV-2-encephalitis", "SARS-CoV-2-rhabdomyolysis", "COVID-demyelinating disease", "neurological manifestations", "psychosocial manifestations", "treatment recommendations", "COVID-19 and therapeutic changes", "psychiatry", "marginalised", "telemedicine", "mental health", "quarantine", "infodemic" and "social media". A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes. CONCLUSION Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.
Collapse
Affiliation(s)
- Devlina Roy
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Mahua Jana Dubey
- Department of Psychiatry, Berhampore Mental Hospital, Behrampore, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital, “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| |
Collapse
|
3
|
Mariano R, Messina S, Kumar K, Kuker W, Leite MI, Palace J. Comparison of Clinical Outcomes of Transverse Myelitis Among Adults With Myelin Oligodendrocyte Glycoprotein Antibody vs Aquaporin-4 Antibody Disease. JAMA Netw Open 2019; 2:e1912732. [PMID: 31596489 PMCID: PMC6802235 DOI: 10.1001/jamanetworkopen.2019.12732] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/11/2019] [Indexed: 01/12/2023] Open
Abstract
Importance Recognizing the differences between transverse myelitis (TM) associated with myelin oligodendrocyte glycoprotein (MOG) antibody (Ab) disease vs aquaporin-4 (AQP4)-Ab disease and prognosticating patients within each group may be an important factor for better clinical treatment for these respective patients. Objectives To compare the clinical and radiological findings of the first TM episode in patients with MOG-Ab disease vs patients with AQP4-Ab disease and to assess factors associated with worse outcomes and relapse risk. Design, Setting, and Participants This retrospective cross-sectional study used data collected from the Oxford Neuromyelitis Optica Service database, a national service that serves the south of England, including detailed clinical data, and high-quality imaging from within 4 weeks of the first TM episode from patients with MOG-Ab disease or AQP4-Ab disease and a confirmed history of TM from April 2018 to January 2019. Data analyses were conducted from February 2019 to April 2019. Main Outcomes and Measures Onset features of each condition measured using the Expanded Disability Status Scale (EDSS) score, time to an EDSS score of 6, time to relapse, and residual sphincter dysfunction at least 6 months after the first TM episode and at last follow-up. Results The total cohort included 115 adult patients, including 46 patients with MOG-Ab disease and 69 patients with AQP4-Ab disease. Patients with AQP4-Ab disease, compared with patients with MOG-Ab disease, tended to be older at onset of disease (mean [SD] age, 48.5 [14.9] years vs 33.7 [1.2] years) and female (57 [83%] women vs 24 [52%] women). Transverse myelitis occurred at onset of disease for 32 patients (70%) with MOG-Ab disease and 57 patients (78%) with AQP4-Ab disease. Onset severity did not differ between groups. An acute disseminated encephalomyelitis-like presentation occurred at the time of the TM in 4 patients (9%) with MOG-Ab disease but no patients with AQP4-Ab disease. Compared with patients with AQP4-Ab disease, patients with MOG-Ab disease were more likely to have short cord lesions (22 patients [48%] vs 10 patients [15%]; P < .001) and multiple cord lesions (18 patients [39%] vs 7 patients [10%]; P < .001). Approximately 50% of patients with MOG-Ab disease had only short cord lesions when the TM occurred as a relapse. Median (range) recovery EDSS score was lower in patients with MOG-Ab disease than patients with AQP4-Ab disease (1.8 [1.0-8.0] vs 3.0 [1.0-8.0]). Persistent bladder dysfunction associated with an increased prevalence of conus lesions occurred more frequently in patients with MOG-Ab disease than in patients with AQP4-Ab disease (27 patients [59%] vs 33 patients [48%]). Long-term catheter requirement was roughly equal between groups (9 patients [20%] vs 16 patients [23%]). Relapses after TM occurred in 17 patients with MOG-Ab disease (37%) and 36 patients with AQP4-Ab disease (52%). Concomitant brainstem lesions in patients with MOG-Ab disease were associated with a higher mean (SD) EDSS score at recovery (3.5 [2.3] vs 1.4 [0.9]; P < .001). In patients with AQP4-Ab disease, those younger than 50 years were more likely to relapse (27 of 36 patients aged <50 years [75%] vs 9 of 33 patients aged ≥50 years [27%]; P < .001) and those 50 years and older were more likely to reach an EDSS score of 6 (19 of 33 patients aged ≥50 years [58%] vs 11 of 36 patients aged <50 years [31%]; P = .03). Conclusions and Relevance This study found that in patients who experienced a TM episode, short and multiple lesions at onset were more common in those with MOG-Ab disease than among those with AQP4-Ab disease. The presence of a brainstem lesion at the time of a TM episode in patients with MOG-Ab disease was associated with a worse recovery. In patients with AQP4-Ab disease, those 50 years and older at disease onset had more disability, and those younger than 50 years at disease onset had more relapses.
Collapse
Affiliation(s)
- Romina Mariano
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kurun Kumar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Wilhelm Kuker
- Department of Neuroradiology, Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
4
|
Wu J, Cheng Y, Qin Z, Liu X, Liu Z. Effects of electroacupuncture on bladder and bowel function in patients with transverse myelitis: a prospective observational study. Acupunct Med 2018; 36:261-266. [PMID: 29909400 PMCID: PMC6089199 DOI: 10.1136/acupmed-2016-011225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Accepted: 12/30/2017] [Indexed: 11/06/2022]
Abstract
Objective To preliminarily explore the effect of electroacupuncture (EA) on bladder and bowel dysfunction in patients with transverse myelitis. Methods Sixteen participants were treated with EA at bilateral BL32, BL33, and BL35 once a day, five times a week for the first 4 weeks, and once every other day, three times a week for the following 4 weeks. Patients were then followed up for 6 months. Bladder and bowel function, and the safety of EA, were assessed. Results After 8 weeks of treatment, five (5/16, 31%) patients resumed normal voiding, three (6/16, 38%) regained partially normal voiding, and five (5/16, 31%) had no change. After treatment, the residual urine volume decreased by 100 mL (IQR 53–393 mL; P<0.05) in nine patients with bladder voiding dysfunction; in 11 patients with urinary incontinence, the number of weekly urinary incontinence episodes, 24-hour urinary episodes, and nocturia episodes per night diminished by 14 (95% CI 5 to 22), 5 (95% CI 1 to 9), and 4 (95% CI 0 to 7) episodes, respectively (all P<0.05). After 8 weeks of treatment in eight patients with faecal retention, four (4/8, 50%) resumed normal bowel movements, three (3/8, 38%) regained partially normal bowel movements, and one (1/8, 13%) had no change. Conclusions EA might be a promising alternative for the management of bladder and bowel dysfunction in patients with transverse myelitis. Randomised controlled trials are needed to confirm the effectiveness and safety of EA for this condition.
Collapse
Affiliation(s)
- Jiani Wu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanjun Cheng
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Zongshi Qin
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoxu Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
5
|
Fukuoka M, Kuki I, Horino A, Kim K, Hattori Y, Tsuji H, Nukui M, Okazaki S, Kawawaki H, Yoshida Y, Ishikawa J, Rinka H. A child with acute transverse myelitis requiring permanent pacemaker implantation. Brain Dev 2017; 39:811-814. [PMID: 28551037 DOI: 10.1016/j.braindev.2017.05.002] [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: 02/01/2017] [Revised: 03/30/2017] [Accepted: 05/05/2017] [Indexed: 11/18/2022]
Abstract
We diagnosed a 3-year-old girl with acute transverse myelitis (ATM). She presented with weakness of the limbs and developed urination difficulty and respiratory disturbance. Magnetic resonance imaging revealed a symmetric area of high signal intensity on T2-weighted images involving the lower end of the medulla oblongata to the level of the fourth thoracic vertebra. Anti-aquaporin-4 antibody was negative. She was treated with intravenous methylprednisolone pulse therapy, immunoglobulin therapy, and plasmapheresis; however, her clinical symptoms did not change. At 10 and 20days after symptom onset, cardiac arrest occurred on postural change, requiring cardiopulmonary resuscitation. A permanent pacemaker was implanted 23days after onset. In the presence of sympathetic nerve hypofunction, relative hyperactivity of the parasympathetic nerves may have led to severe bradycardia and cardiac arrest in the presence of an inducer, such as a postural change. This is the first reported case of pacemaker implantation for management of ATM.
Collapse
Affiliation(s)
- Masataka Fukuoka
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Ichiro Kuki
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
| | - Asako Horino
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Kiyohiro Kim
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Yuka Hattori
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Hitomi Tsuji
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Megumi Nukui
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Shin Okazaki
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Hisashi Kawawaki
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Yoko Yoshida
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | - Jyunichi Ishikawa
- Department of Emergency Medicine, Osaka City General Hospital, Osaka, Japan
| | - Hiroshi Rinka
- Department of Emergency Medicine, Osaka City General Hospital, Osaka, Japan
| |
Collapse
|
6
|
Bruna J, Martínez-Yélamos S, Martínez-Yélamos A, Rubio F, Arbizu T. Idiopathic acute transverse myelitis: a clinical study and prognostic markers in 45 cases. Mult Scler 2016; 12:169-73. [PMID: 16629419 DOI: 10.1191/135248506ms1260oa] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 11/05/2022]
Abstract
Objective The Transverse Myelitis Consortium Working Group has proposed new diagnostic criteria for idiopathic acute transverse myelitis (ATM). We reviewed patients admitted to our center diagnosed with myelitis with two objectives: (i) to evaluate the usefulness of these criteria in distinguishing between myelitis as the first episode of multiple sclerosis (MS) and idiopathic ATM; and (ii) to analyse the clinical and laboratory variables that may be used as functional prognostic markers. Methods We selected patients who met the criteria. We recorded clinical epidemiological data, patients treated with methylprednisolone, maximal disability reached and disability at final follow-up. We also recorded cerebrospinal fluid (CSF) data and the number of levels affected in the spinal magnetic resonance imaging (MRI). Results Twenty-four patients fulfilled the criteria for definite ATM and 21 for possible ATM. Five patients converted to MS. Mean follow-up time was 3.5 years. There was an association between younger patients and female patients with conversion to MS. The highest Rankin score reached and increased CSF glucose levels were associated with a poor outcome. In multivariate analysis, only the admission Rankin score was associated with outcome. Conclusions (i) About 10% of patients who met the criteria may convert to MS; and (ii) admission Rankin score was the only independent prognostic factor found.
Collapse
Affiliation(s)
- J Bruna
- Department of Neurology, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Spain.
| | | | | | | | | |
Collapse
|
7
|
Affiliation(s)
- Shin C. Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
| | - Benjamin M. Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
| | - Teresa Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
| | - Elliot M. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
- Corresponding author. Multiple Sclerosis Clinical Care Center, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235.
| |
Collapse
|
8
|
Han J, Cheng Y, Wang MS. Bacillus thuringiensis poisoning related acute transverse myelitis. Can J Neurol Sci 2013; 40:435-437. [PMID: 24340786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
9
|
|
10
|
Ayuga-Loro F, Teijeira-Azcona A. [Clinical variability in neuromyelitis optica: three case reports]. Rev Neurol 2011; 52:154-158. [PMID: 21287491] [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: 05/30/2023]
Abstract
INTRODUCTION Three cases of neuromyelitis optica (NMO) admitted in our hospital with a heterogeneous clinical characteristics are presented. CASE REPORTS Case 1: a middle-aged woman with five acute transverse myelitis episodes and a high latency of the P100 in the visual evoked potentials. The MRI and the NMO antibodies were both negatives. Case 2: a young lady with a two months duration episode of optic neuritis in one eye first, and both myelitis and optic neuritis on the other eye burst secondly, with a very good evolution and positive NMO antibodies. Case 3: a 72 years-old woman with three episodes of acute transverse myelitis. After three years she had two more acute myelitis bursts and finally one optic neuritis, with no lesions in the brain MRI and negative NMO antibodies. CONCLUSIONS The concept of the NMO has changed from its original description. Today it is conceived as a clinical spectrum by a well definite diagnostic criteria, but very heterogeneous as for the clinical characteristics, the outbreak age, or the response to the treatment, since it remains reflected in this three cases.
Collapse
Affiliation(s)
- F Ayuga-Loro
- Hospital Nacional de Paraplejicos, 45071 Toledo, Espana.
| | | |
Collapse
|
11
|
Villanueva-Pérez VL, Asensio-Samper JM, Fabregat-Cid G, Carmen MR, de Andrés-Ibáñez JA. [Acute transverse myelitis: treatment of pain]. Rev Neurol 2010; 50:318-319. [PMID: 20217653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
12
|
Móser J, Liptai Z, Veres E, Rosdy B, Kollár K. [Acute transverse myelitis in childhood]. Ideggyogy Sz 2009; 62:405-410. [PMID: 20025131] [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: 05/28/2023]
Abstract
We reviewed the medical history, clinical signs, imaging studies, laboratory data and treatment effectiveness of our 10 patients presented with acute idiopathic transverse myelitis. We used the criteria of the Transverse Myelitis Consortium Working Group (2002). So we excluded all those cases by whom the cause of the inflammation could be detected (e. g. direct viral inflammatory disease, systemic autoimmune disease). Age of the patients at disease onset ranged from 3 to 15 years. The first clinical signs were pain in different locations, and urinary retention. Paraparesis or plegia reached its maximum within five days. By all patients spinal MRI and lumbar puncture were performed at admission. These results were interpreted together with the clinical signs, and therapy was started immediately. We used methylprednisolon pulse therapy. Within 10-30 days the patients started to walk. We have followed the children for 1.5-13 years. Few residual clinical signs were observed: by one child left sided spastic monoparesis persisted, by the other right sided latent monoparesis was stated, and by one partial urinary incontinence persisted. By the control spinal MRI persisting signal changes or atrophy were detected just by those two children who had residual clinical signs. In the follow-up period no clinical relapse occured. Neither did the brain or spinal MRI show new lesions. The quick diagnosis and the immediately started therapy determine mostly the clinical outcome of these children. We hope that our long follow-up period can help in better understanding the disease even in adult patients. In the future we try to join multicenter clinical studies.
Collapse
Affiliation(s)
- Judit Móser
- Heim Pál Gyermekkórház, Neurológiai Osztály, Budapest.
| | | | | | | | | |
Collapse
|
13
|
|
14
|
Greenberg BM, Thomas KP, Krishnan C, Kaplin AI, Calabresi PA, Kerr DA. Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide. Neurology 2007; 68:1614-7. [PMID: 17485649 DOI: 10.1212/01.wnl.0000260970.63493.c8] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [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: 11/15/2022] Open
Abstract
Transverse myelitis is a focal disorder of the spinal cord in which an immune-mediated process results in neural injury. In this large retrospective study, we compare patients who received one of four treatments to identify the most effective therapies. We identified subsets of patients who received clinical benefit from plasma exchange or cyclophosphamide being included in their treatment regimen.
Collapse
Affiliation(s)
- B M Greenberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287-5371, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
Several terms are now commonly used to describe various presentations of idiopathic myelitis, including acute transverse myelitis, acute partial transverse myelitis, and secondary myelitis. Ideally, a classification system would be able to encompass various presentations in a manner that not only assists in prognosis, but also in treatment decisions. Unfortunately, we are limited in our ability to accurately identify those patients who will progress to develop multiple sclerosis, Devic's syndrome, relapsing myelitis, or will remain monophasic. However, general principles are emerging that assist in prognosis based on the particular presenting features of any patient. We review the most recent criteria proposed for various forms of transverse myelitis and highlight the limitations of these classification schemes.
Collapse
Affiliation(s)
- Thomas F Scott
- Department of Neurology, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
| |
Collapse
|
16
|
|
17
|
Abstract
OBJECTIVE To relate clinical characteristics associated with acute transverse myelitis (ATM) in children with functional outcomes at follow-up. METHODS We identified 47 patients for whom ATM occurred under the age of 18 years. Chart analysis, clinical evaluation, and administration of functional measures were completed. RESULTS The age at onset clustered between ages 0 to 2 and 5 to 17. Febrile illness had occurred in 47% and vaccination in 28%. Major disability at the nadir of the clinical course was noted. Eighty-nine percent were unable to walk, required assisted ventilation, or both. At a median of 3.2 years after acute illness, 43% were unable to walk 30 ft and 21% required a walker or other support, 68% experienced urinary urgency, 50% required bladder catheterization, 54% were troubled by persistent dysesthesias, and 75% had numbness. Factors associated with a better functional outcome included older age at time of diagnosis, shorter time to diagnosis, lower sensory and anatomic levels of spinal injury, absence of T1 hypointensity on spinal MRI obtained during the acute period, lack of white blood cells in the CSF, and fewer affected spinal cord segments. Neither rapid progression to maximum impairment in less than 1 day nor any antecedent illness, immunization, or trauma was associated with a worse outcome. CONCLUSION Persisting disability was present in many children with acute transverse myelitis. Urinary problems and sensory symptoms were the most common issues. Age at onset below 3 years was associated with worse functional outcomes.
Collapse
Affiliation(s)
- F S Pidcock
- Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Kister I, Herbert J, Swerdlow ML, Bergamaschi R, Piccolo G, Oger J. Occurrence of CNS demyelinating disease in patients with myasthenia gravis. Neurology 2007; 68:1326-7; author reply 1327. [PMID: 17441230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
|
19
|
Ikeda K, Araki Y, Iwasaki Y. Occurrence of CNS demyelinating disease in patients with myasthenia gravis. Neurology 2007; 68:1326; author reply 1327. [PMID: 17441229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
|
20
|
Kahloon AA, Arif H, Baig SM, Khawaja MR. Characteristics of acute transverse myelitis at Aga Khan University Hospital, Karachi. J PAK MED ASSOC 2007; 57:215-8. [PMID: 17489536] [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: 05/15/2023]
Abstract
OBJECTIVE To determine the presenting features and etiological classification of acute transverse myelitis (ATM) at Aga Khan University Hospital, a tertiary care hospital in Pakistan. METHODS Twenty consecutive patients of ATM (1996-2003) fulfilling a preset criterion were analyzed for demographic features, clinical presentation, laboratory investigations and neuro-imaging. RESULTS Half of the patients were males and their median age was 29 years (range 6-73 years). Fever, paraparesis, quadri-paresis and bladder dysfunction were the most common presentations. Median score on disability rating scale (DRS) was twelve. Sixty percent of the patients were classified as Idiopathic-ATM while 30% and 10% as Para infectious associated-ATM and Multiple sclerosis associated-ATM respectively. CONCLUSION Idiopathic acute transverse myelitis is the most common type of ATM in the studied population. Our data suggested that the severity of motor impairment is greater in our population than that reported in western literature which might hint to different genetic or environmental etiological factors involved in the pathogenesis of acute transverse myelitis.
Collapse
|
21
|
Abstract
STUDY DESIGN Case report. SETTING University Hospital of Antwerp, tertiary referral hospital of the University of Antwerp, Edegem, Belgium. CASE REPORT Campylobacter jejuni infection is related to various syndromes in which the peripheral nervous system is involved. An immune response is triggered through molecular mimicry between gangliosides of the peripheral nervous system and lipo-oligosaccharides of C. jejuni. We report a case of a previously healthy 17-year-old girl, who developed clinical manifestations of acute transverse myelitis (ATM) 7 days after a culture-proven C. jejuni enteritis. High titres of serum IgG antibodies to the ganglioside GM1 were found in the acute phase of disease, which decreased with clinical recovery. These antibodies cross-reacted with C. jejuni lipo-oligosaccharides, indicating that C. jejuni infections may induce ATM. CONCLUSIONS Only a few cases of C. jejuni infection associated with demyelination of the central nervous system or spinal cord have been described. Physicians should be aware that C. jejuni might be another cause of transverse myelitis.
Collapse
Affiliation(s)
- I Baar
- Department of Neurology, University Hospital of Antwerp, Edegem, Belgium
| | | | | | | | | | | |
Collapse
|
22
|
Lanctin C, Wiertlewski S, Moreau C, Verny C, Derkinderen P, Damier P, Dubas F. Myélite aiguë transverse idiopathique : application des nouveaux critères diagnostiques à une cohorte de 17 patients. Rev Neurol (Paris) 2006; 162:980-9. [PMID: 17028566 DOI: 10.1016/s0035-3787(06)75108-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Idiopathic Acute Transverse Myelitis (ATM) is an inflammatory and immune-mediated disorder, distinct from infectious ATM, ATM of systemic lupus erythematosus or Sjögren's syndrome, and medullary manifestation of multiple sclerosis. Prognosis is not well-known. OBJECTIVE To evaluate clinical, paraclinical and pronognosis data in patients selected with new diagnosis criteria, classically described in idiopathic ATM. METHODS Seventeen patients with diagnosis criteria were retrospectively (1996-2005) studied. A telephone investigation was conducted in 2005 to obtained data on the clinical course. RESULTS Seven men and 10 women, ranging in age from 15 to 75 years (mean: 39.8 years) met these new criteria. Our study showed that epidemiological and clinical findings as well as laboratory results were in agreement with those presented in the literature. Conversely, prognosis was better since 76p.cent of the patients could walk without assistance. The clinical presentation of some of our patients and/or their progression towards other multifocal inflammatory disorders, suggests there might be links between ATM, neuromyelitis optica (NMO) and Acute Dissemined Encephalomyelitis (ADEM). CONCLUSION Patients with idiopathic ATM, selected with new criteria, have a rather good prognosis. ATM seems to be part of a continuum of neuroimmunologic disorders including NMO or ADEM although reasons explaining distinct focal disorders remain unclear.
Collapse
Affiliation(s)
- C Lanctin
- Pôle de Neurologie médicale et chirurgicale, Hôpital Laennec, CHU de Nantes, Saint-Herblain, France.
| | | | | | | | | | | | | |
Collapse
|
23
|
Iwasaki Y, Ikeda K. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology 2006; 67:728; author reply 728. [PMID: 16924043 DOI: 10.1212/01.wnl.0000239613.41934.40] [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: 11/15/2022] Open
|
24
|
Abstract
Acute transverse myelitis (ATM) is commonly para-infectious. Recurrent ATM occurs in connective tissue diseases (CTD), infective myelitis and idiopathic inflammatory demyelinating disorders (IIDD) including multiple sclerosis (MS) and neuromyelitis optica (NMO). Previous studies might include NMO and idiopathic recurrent transverse myelitis (IRTM) as MS. The aim was to study the outcome of patients after a first attack of idiopathic ATM. Idiopathic ATM patients over a 6-year period were retrospectively studied. Known causes of myelopathy were excluded. Among 32 patients studied, 20 (63%) had single ATM attack upon follow up for 39-93 months, three developed recurrent ATM related to CTD (two systemic lupus erythematosus and one anti-Ro antibody positive) and nine (28.1%) developed recurrent neuroinflammation compatible with IIDD. Among IIDD patients, three had NMO, two restricted variant of NMO, three IRTM and one classical MS. NMO, its variant and IRTM had mean spinal MRI abnormality of 3.7, 2.1 and 3.9 vertebral segments respectively while non-recurrent ATM had 1.6 vertebral segments. Four (80%) of the five patients with NMO or its variant had poor neurological prognosis versus only one (5%) of non-recurrent ATM patients. IRTM patients had advanced mean onset age, 62 years vs. 43 years for non-recurrent ATM patients. In IIDD patients presenting with ATM as first attack of neuroinflammation, NMO and its variant (56%) were most frequent, then IRTM (33%), with classical MS (11%) the rarest. As long-term treatments for NMO are different from MS, early recognition of NMO and its variant is important for prevention of serious neurological deficits.
Collapse
Affiliation(s)
- K H Chan
- Division of Neurology, University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | | | | | | | | |
Collapse
|
25
|
Lin PH, Chuang TY, Liao KK, Cheng H, Shih YS. Functional recovery of chronic complete idiopathic transverse myelitis after administration of neurotrophic factors. Spinal Cord 2006; 44:254-7. [PMID: 16151455 DOI: 10.1038/sj.sc.3101809] [Citation(s) in RCA: 13] [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: 11/09/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE To evaluate the functional recovery of chronic complete idiopathic transverse myelitis (ITM) after administration of acidic fibroblast growth factor (aFGF). METHODS A 28-year-old woman presented with a 4-year history of spastic paralysis, sensory level at T10, urinary retention and constipation due to ITM. In all, 20 microg aFGF bolus injection was applied via intradural lumbar puncture, which was repeated every 5 months for 15 months. RESULTS At 3 weeks after first injection, the patient experienced vague sensation at approximately T12-L1 dermatomes. At 2 months after the second injection, muscle activities and gait pattern were recorded in bilateral gluteus and hip abductors as she ambulated with long leg brace and axillary crutches. Increased walking speeds, reduced pelvic tilting and reduced compensatory trunk rotation during the swing phase were also demonstrated as compared to the initial gait analysis. At 18 months after injection, motor evoked potentials were obtained in hip abductors of both legs. CONCLUSIONS aFGF may increase the efficacy of spinal reactivation/regeneration and is a potential remedy for chronic transverse myelitis.
Collapse
MESH Headings
- Adult
- Drug Administration Schedule
- Evoked Potentials, Motor/drug effects
- Evoked Potentials, Motor/physiology
- Evoked Potentials, Somatosensory/drug effects
- Evoked Potentials, Somatosensory/physiology
- Female
- Fibroblast Growth Factor 1/administration & dosage
- Gait Disorders, Neurologic/drug therapy
- Gait Disorders, Neurologic/etiology
- Humans
- Injections, Spinal
- Myelitis, Transverse/diagnosis
- Myelitis, Transverse/drug therapy
- Myelitis, Transverse/physiopathology
- Nerve Growth Factors/administration & dosage
- Nerve Regeneration/drug effects
- Nerve Regeneration/physiology
- Paraplegia/drug therapy
- Paraplegia/etiology
- Physical Fitness/physiology
- Physical Therapy Modalities
- Recovery of Function/drug effects
- Recovery of Function/physiology
- Sensation Disorders/drug therapy
- Sensation Disorders/etiology
- Spinal Cord/drug effects
- Spinal Cord/pathology
- Spinal Cord/physiopathology
- Spinal Puncture
- Treatment Outcome
- Urination Disorders/drug therapy
- Urination Disorders/etiology
Collapse
Affiliation(s)
- P-H Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan
| | | | | | | | | |
Collapse
|
26
|
Abstract
Transverse myelitis (TM) is a focal inflammatory disorder of the spinal cord. Perivascular monocytic and lymphocytic infiltration, demyelination, and axonal injury are prominent histopathogic features of TM. The clinical manifestations of TM are consequent to dysfunction of motor, sensory, and autonomic pathways. At peak deficit, 50% of patients with TM are completely paraplegic (with no volitional movements of legs), virtually all have some degree of bladder dysfunction, and 80% to 94% have numbness, paresthesias, or band-like dysesthesias. Longitudinal case series of TM reveal that approximately one third of patients recover with little to no sequelae, one third are left with a moderate degree of permanent disability, and one third have severe disability. Recent studies have shown that the cytokine interleukin-6 may be a useful biomarker, as the levels of interleukin-6 in the cerebrospinal fluid of acute TM patients strongly correlate with and are highly predictive of disability. Clinical trials testing the efficacy of promising axonoprotective agents in combination with intravenous steroids in the treatment of TM are currently underway.
Collapse
Affiliation(s)
- Chitra Krishnan
- Department of Neurology, Johns Hopkins University School of Medicine, Pathology 627, 600 North Wolfe Street, Baltimore, MD 21287-6965, USA
| | | | | | | | | |
Collapse
|
27
|
Abstract
The clinical and paraclinical characteristics of acute transverse myelitis (ATM) were analyzed in 31 patients. In some patients there was clinical evidence of complete transection, in others of only partial lesions. Magnetic resonance imaging (MRI) in the acute phase in the first group was normal, but showed cord atrophy subsequently. It is probable that the clinical picture was due to parenchymatous neuronal lesions, analogous to those of axonal polyneuropathy. In the patients with incomplete transverse lesions, the most common finding was demyelination. In the patients with circumscribed demyelinating lesions, the symptoms and MRI were suggestive of clinically isolated syndromes (CIS) predictive of multiple sclerosis (MS). Extensive demyelination was indicative of acute disseminated encephalomyelitis (ADEM) due to hyperergic vasculopathy or various forms of chronic vasculitis. In two patients with variable clinical symptoms, a vascular malformation was the cause of the clinical presentation, and in one patient demyelination was due to the disc compression.
Collapse
Affiliation(s)
- Vesna V Brinar
- University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kispatićeva 12, Zagreb, Croatia.
| | | | | | | | | |
Collapse
|
28
|
Abstract
Eight patients with worsening neuromyelitis optica were treated with rituximab to achieve B cell depletion. Treatment was well tolerated. Six of eight patients were relapse free and median attack rate declined from 2.6 attacks/patient/year to 0 attacks/patient/year (p = 0.0078). Seven of eight patients experienced substantial recovery of neurologic function over 1 year of average follow-up. The pretreatment median Expanded Disability Status Scale score was 7.5, and at follow-up examination was 5.5 (p = 0.013).
Collapse
Affiliation(s)
- B A C Cree
- Multiple Sclerosis Center, University of California, San Francisco 94117, USA.
| | | | | | | | | | | |
Collapse
|
29
|
de Seze J, Lanctin C, Lebrun C, Malikova I, Papeix C, Wiertlewski S, Pelletier J, Gout O, Clerc C, Moreau C, Defer G, Edan G, Dubas F, Vermersch P. Idiopathic acute transverse myelitis: Application of the recent diagnostic criteria. Neurology 2005; 65:1950-3. [PMID: 16380618 DOI: 10.1212/01.wnl.0000188896.48308.26] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [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: 11/15/2022] Open
Abstract
Despite an extensive diagnostic workup, some cases of acute transverse myelitis (ATM) remain of unknown etiology and have been referred to as "idiopathic" by the Transverse Myelitis Consortium group. In a retrospective study of 288 patients with ATM, 45 cases (15.6%) met the criteria for idiopathic ATM. The patients formed a relatively homogeneous group in terms of clinical and MRI data, but the prognosis was highly variable.
Collapse
Affiliation(s)
- J de Seze
- Department of Neurology, University of Lille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Seet RCS, Lim ECH, Wilder-Smith EPV. Acute transverse myelitis following dengue virus infection. J Clin Virol 2005; 35:310-2. [PMID: 16226055 DOI: 10.1016/j.jcv.2005.08.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [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: 06/16/2005] [Revised: 08/17/2005] [Accepted: 08/31/2005] [Indexed: 11/28/2022]
Abstract
The spinal cord is infrequently affected following dengue virus infection. We report a case of transverse myelitis that developed 2 weeks after acute dengue infection and review the literature to elucidate the pathogenesis of spinal cord involvement in dengue infection. We postulate that temporal factors may play a role in the different clinical manifestations, i.e. that acute parainfectious dengue infection presents with flaccid paralysis, whereas late-stage (postinfectious) dengue infection, presents with spastic weakness. Further studies need to be performed to elucidate the mechanisms of spinal neurological damage in dengue.
Collapse
Affiliation(s)
- Raymond C S Seet
- Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
| | | | | |
Collapse
|
32
|
|
33
|
Abstract
Devic's neuromyelitis optica (NMO) onset is characterized by optic neuritis (ON) and transverse myelitis (TM), either simultaneously or in isolation. Thereafter, the course of the disease can be monophasic (no other attack) or relapsing (sequences of ON and TM, no other neurological system involved). The risk of having a relapsing course is related to gender, older age at onset, less severe motor impairment after the myelitic onset, interval length between first and second attack. The risk of an unfavourable evolution (severe disability or death) during a relapsing course is mainly related to high relapse rate during the first two years of the disease. In summary, relapsing NMO patients tend to have a poor prognosis, requiring more effective immunosuppressive treatments.
Collapse
Affiliation(s)
- R Bergamaschi
- Neurological Institute C. Mondino, Via Ferrata 6, I-27100 Pavia, Italy.
| | | |
Collapse
|
34
|
Affiliation(s)
- Christopher J Boes
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
35
|
García-Ramos R, Ruiz-Morales J, Moreno-Ramos T, Villarejo-Galende A, Ruiz-Giménez J, Díaz-Guzmán J, Esteban J. [Brachial presentation of spinal pseudochoreoathetosis. The result of proprioceptive information being processed in parallel]. Rev Neurol 2004; 39:435-9. [PMID: 15378457] [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: 04/30/2023]
Abstract
INTRODUCTION The term pseudochoreoathetosis is used to refer to the choreoathetoid movements that are produced by alterations in the proprioceptive sensitivity due to damage it has suffered at some point along its course. Proprioceptive sensitivity is considered to go up as far as the cortex along the posterior cords of the spinal cord, which means that if they are injured in the cervical region there should be a sensory deficit in both the upper (UL) and lower limbs (LL). CASE REPORTS We describe five cases of transverse myelitis with localised cervical injury that selectively and mainly affected the posterior cords of the spinal cord. In the five patients there was selective involvement of the proprioceptive sensitivity in the UL respecting the LL and pseudochoreoathetoid movements of the limb that has been deafferented for proprioceptive sensitivity. The dissociation between the UL and the LL occurs because the spinocerebellar and spinocervical tracts take the proprioceptive information from the LL in parallel to the posterior cords, which receive the proprioceptive sensitivity from the UL. CONCLUSIONS At present, the most widely accepted physiopathological mechanism explaining pseudochoreoathetosis consists in a failure in the integration of the sensory-motor afferences in the striatum, which causes faulty sensory-motor integration at this level and gives rise to pseudochoreoathetosis.
Collapse
Affiliation(s)
- R García-Ramos
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
36
|
Harzheim M, Schlegel U, Urbach H, Klockgether T, Schmidt S. Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients. J Neurol Sci 2004; 217:217-23. [PMID: 14706227 DOI: 10.1016/j.jns.2003.10.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [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: 11/24/2022]
Abstract
Acute transverse myelitis (ATM) is a pathogenetically heterogeneous inflammatory disorder of the spinal cord. Therefore, the identification of clinical and paraclinical features providing clues of the underlying etiologies is needed. The clinical presentation, blood and cerebrospinal fluid (CSF) findings as well as magnetic resonance imaging (MRI) and neurophysiological features were retrospectively analyzed in 45 unselected consecutive patients with ATM. Parainfectious ATM was diagnosed in 38% of patients. The underlying infectious agent, however, was identified only in a minority of patients. In 36% of patients, the etiology remained uncertain ("idiopathic" ATM) and in 22% ATM was the first manifestation of possible multiple sclerosis (ATM-MS) according to recently published diagnostic criteria. Spinal cord MRI showed signal alterations in 96% of the patients. In ATM-MS, monosegmental involvement of the spinal cord was most frequent while spinal cord involvement of two or more segments was more common in ATM of other etiologies. Of particular note, neurophysiological examinations showed evidence of peripheral nervous system (PNS) involvement in 27% of patients with ATM but not in patients with ATM-MS. Therefore, neurophysiological evidence of PNS involvement may provide additional discriminatory features between ATM-MS and ATM of other etiologies.
Collapse
Affiliation(s)
- Michael Harzheim
- Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.
| | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Neurological involvement occurs rarely with systemic sclerosis (SSc). Only a few cases of transverse myelopathy have been reported in the setting of SSc. OBJECTIVE To describe a patient with SSc who developed transverse myelitis that improved during a course of immunosuppression. RESULTS A 30-year-old woman with SSc presented with subacute onset of bilateral lower extremity weakness and numbness. Results of magnetic resonance imaging and cerebrospinal fluid studies supported a diagnosis of transverse myelitis. The patient responded favorably to a course of corticosteroids and cyclophosphamide. No overlapping autoimmune disorders were evident. Clinical follow-up showed significant recovery, with resolution of radiological abnormalities. CONCLUSION Transverse myelitis can occur as a rare manifestation of SSc and may respond favorably to immunosuppressive therapy.
Collapse
Affiliation(s)
- Amir M Torabi
- Department of Neurology, the University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8897, USA
| | | | | | | | | | | |
Collapse
|
38
|
Lins H, Kanakis D, Dietzmann K, Wallesch CW, Mawrin C. Paraneoplastic necrotizing myelopathy with hypertrophy of the cauda equina. J Neurol 2003; 250:1388-9. [PMID: 14648162 DOI: 10.1007/s00415-003-0213-2] [Citation(s) in RCA: 5] [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] [Received: 11/15/2002] [Revised: 06/24/2003] [Accepted: 07/07/2003] [Indexed: 10/26/2022]
|
39
|
Rocca MA, Mezzapesa DM, Ghezzi A, Falini A, Agosta F, Martinelli V, Scotti G, Comi G, Filippi M. Cord damage elicits brain functional reorganization after a single episode of myelitis. Neurology 2003; 61:1078-85. [PMID: 14581668 DOI: 10.1212/01.wnl.0000086821.49353.40] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 11/15/2022] Open
Abstract
OBJECTIVE To assess, using fMRI, the brain pattern of movement-associated cortical activations in patients with a previous remitting episode of acute cervical myelitis of possible demyelinating origin and to investigate whether the extent of cortical reorganization is associated with the extent of cervical cord pathology measured using magnetization transfer (MT) MRI. METHODS From 14 right-handed patients in a chronic and stable phase after an isolated myelitis (male/female = 7/7, mean age = 35.3 years, median disease duration = 21.2 months) involving the cervical cord and 15 sex- and age-matched healthy control subjects, we obtained 1) fMRI during repetitive flexion-extension of the last four fingers of the right hand, 2) brain diffusion tensor MRI, and 3) brain and cervical cord conventional and MT MRI. FMRI data were analyzed using Statistical Parametric Mapping software. Brain mean diffusivity, fractional anisotropy, and MT ratio (MTR) histograms of the normal-appearing white and gray matter and cervical cord MTR histograms were produced. RESULTS Patients with myelitis had lower average cord MTR (p < 0.0001) and cord MTR histogram peak position (p = 0.002) than control subjects. Compared with healthy volunteers, patients with myelitis showed increased recruitment of the ipsilateral hemisphere in the primary sensorimotor cortex (p < 0.0001), supplementary motor area (p = 0.002), and middle frontal gyrus (MFG) (p < 0.0001). Average cervical cord MTR was inversely correlated with relative activations of the ipsilateral MFG (r = -0.80) and of the ipsilateral postcentral gyrus (r = -0.80). The relative activation of the ipsilateral MFG was also correlated with cervical cord MTR peak position (r = -0.92). CONCLUSIONS An abnormal pattern of movement-associated cortical activations was found in patients with a previous episode of cervical myelitis. These functional cortical changes might have an adaptive role in limiting the clinical outcome of structural cord damage.
Collapse
Affiliation(s)
- M A Rocca
- Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND Acute transverse myelitis (ATM) is a severe disorder; recovery requires several months and often leaves neurologic residua. To determine what features of patients with acute transverse myelitis significantly influence prognosis, the authors reviewed reports of ATM in Japanese children published in the last 15 years (from 1987 to 2001). METHODS The authors studied reports of 50 Japanese patients (17 boys, 26 girls, 7 children of unspecified sex; mean age +/- SD, 8.0 +/- 3.8 years). Acute-phase and demographic features including age, increased deep tendon reflexes, Babinski reflex, sex, preceding infection, decreased deep tendon reflexes, time course of peak neurologic impairment, treatment with prednisolone and/or high-dose methylprednisolone, and the day of illness when treatment was started were used as independent variables in a regression analysis. The dependent variable was long-term persistence of neurologic deficits. RESULTS Younger patients and those without increased deep tendon reflexes or a Babinski reflex were more likely to have residual neurologic deficits such as paraplegia or tetraplegia, sensory loss and sphincter disturbance. No relationship was seen between prognosis and sex, preceding infections, decreased deep tendon reflexes, time course of peak neurologic impairment, treatment with prednisolone or high-dose methylprednisolone, or timing of treatment initiation. CONCLUSIONS Age at onset and neurologic features were important for outcome prediction in ATM. Steroid therapy did not associate with better outcome.
Collapse
Affiliation(s)
- Reiko Miyazawa
- Department of Pediatrics, Tone Central Hospital, Numata, Gunma University School of Medicine, Maebashi and Saku Central Hospital, Minamisaku, Nagano, Japan
| | | | | | | | | | | |
Collapse
|
41
|
Defresne P, Hollenberg H, Husson B, Tabarki B, Landrieu P, Huault G, Tardieu M, Sébire G. Acute transverse myelitis in children: clinical course and prognostic factors. J Child Neurol 2003; 18:401-6. [PMID: 12886975 DOI: 10.1177/08830738030180060601] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to describe the clinical course of acute transverse myelitis in children, to identify prognostic factors, and to compare our findings with published data Twenty-four children, aged 2 to 14 years and admitted with a diagnosis of acute transverse myelitis, were studied. Clinical features and results of investigations were collected at admission and during the course of the disease. Motor, sphincter, and global outcomes were compared with those in the main adult and pediatric series. During the initial phase, the most common presenting symptoms were pain (88%) and fever (58%). Motor loss preceded sphincter dysfunction in two thirds of patients and became bilateral in half of the patients. When maximal deficit was achieved (plateau), the patients presented a combination of sensory, motor, and sphincter dysfunctions without radicular involvement The motor loss consistently involved the lower limbs but was inconsistent and moderate in the upper limbs. The mean duration of the plateau was 1 week. The recovery phase was characterized by a progressive improvement of all deficits. Sphincter dysfunction improved more slowly than did the other deficits. A full recovery was achieved by 31% of the patients; minimal sequelae were present in 25% and mild to severe sequelae in 44%. An unfavorable outcome was associated with complete paraplegia (P = .03) and/or a time to maximal deficit shorter than 24 hours (P = .005). A favorable outcome was associated with a plateau shorter than 8 days (P = .03), the presence of supraspinal symptoms (P = .01), and a time to independent walking shorter than 1 month (P = .01). The course of acute transverse myelitis in children proceeds through three stages, an initial phase, a plateau, and a recovery phase, each characterized by specific clinical features. The global outcome was favorable in 56% of patients. Several prognostic factors were identified.
Collapse
Affiliation(s)
- Pierre Defresne
- Service de Neurologie, Département de Pédiatrie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Zandman-Goddard G, Levy Y, Weiss P, Shoenfeld Y, Langevitz P. Transverse myelitis associated with chronic hepatitis C. Clin Exp Rheumatol 2003; 21:111-3. [PMID: 12673901] [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: 03/01/2023]
Abstract
An infectious etiology is one of the postulated mechanisms for autoimmune diseases. An emergence of autoimmune phenomena associated with hepatitis C virus (HCV) infection has been reported. Transverse myelitis is an inflammatory disease of the spinal vasculature attributed to viral infections and to autoimmune diseases including systemic lupus erythematosus and the antiphospholipid syndrome. A 34-year-old male was admitted for the rapid onset of numbness of the lower extremities and urinary retention. His past history included hepatitis C infection. The neurological examination and MRI of the thoracic spine confirmed the diagnosis of transverse myelitis. Abnormal laboratory results were hyperglobulinemia, abnormal liver function tests, and positive ANF, anti-dsDNA antibodies, and p and c-ANCA. The patient was treated with high dose prednisone, then tapered to a low dose, but regained only partial neurological function after 15 months of prednisone therapy. Persistent neurological deficits and elevated ANF and ANCA were present at a follow-up of 30 months. We describe the first reported case of a patient with chronic HCV who developed transverse myelitis.
Collapse
Affiliation(s)
- G Zandman-Goddard
- Rheumatology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | | | | |
Collapse
|
43
|
Abstract
OBJECTIVES To report the elevation of the 14-3-3 protein and the complete denervation of hand muscles in idiopathic acute transverse myelitis (IATM) of the cervical cord. CASE DESCRIPTION In a 29-year-old woman with a 2-week history of neck pain and repeated attenuated flus, subacute quadriplegia, hypaesthesia of both arms, a T3 sensory level, and urinary dysfunction occurred. Based upon the clinical findings, the cervical MRIs, and an elevated 14-3-3 protein in the CSF, IATM C4-C7 was diagnosed. Ten, 17, 28 and 61 days after onset, nerve conduction studies revealed complete denervation of the right abductor pollicis brevis and abductor digiti minimi muscles but gradual improvement of the compound muscle action potential of the left abductor pollicis brevis muscle. F-waves of the right median nerve were absent. Tibial somatosensory evoked potentials showed a prolonged central conduction time. Transcranial magnetic stimulation evoked a response in the left but not the right abductor digiti minimi muscle. CONCLUSION IATM may cause elevation of the 14-3-3 protein and loss of motor axons originating from affected anterior horn cells.
Collapse
Affiliation(s)
- J Finsterer
- Neurological Hospital, Rosenhügel, Vienna, Austria.
| | | |
Collapse
|
44
|
Waltereit R, Küker W, Jürgens S, Weller M, Dichgans J, Wiendl H. Acute transverse myelitis associated with coxiella burnetii infection. J Neurol 2002; 249:1459-61. [PMID: 12532936 DOI: 10.1007/s00415-002-0823-0] [Citation(s) in RCA: 5] [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: 10/26/2022]
|
45
|
Abstract
Babinski's life and the story of the Babinski sign are summarised. The physiological basis of the sign is discussed.
Collapse
Affiliation(s)
- J W Lance
- Wales Medical Centre, 66 High Street, Randwick, NSW 2031, Australia.
| |
Collapse
|
46
|
Kalita J, Shah S, Kapoor R, Misra UK. Bladder dysfunction in acute transverse myelitis: magnetic resonance imaging and neurophysiological and urodynamic correlations. J Neurol Neurosurg Psychiatry 2002; 73:154-9. [PMID: 12122174 PMCID: PMC1737981 DOI: 10.1136/jnnp.73.2.154] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate micturition abnormalities in acute transverse myelitis and correlate these with evoked potentials, magnetic resonance imaging (MRI), and urodynamic findings. SETTING Tertiary care teaching hospital. PATIENTS 18 patients with acute transverse myelitis, aged 4-50 years; 15 had paraparesis and three quadriparesis. METHODS Patients with acute transverse myelitis had a neurological evaluation and tibial somatosensory and motor evoked potential studies in the lower limbs. Spinal MRI was carried out using a 1.5 T scanner. Urodynamic studies were done using Dantec UD 5500 equipment. Neurological outcome was determined on the basis of Barthel index score at six months as poor, partial, or complete. In some patients, urodynamic studies were repeated at six and 12 months. RESULTS Spinal MRI in 14 of the 18 patients revealed T2 hyperintense signal changes extending for at least three spinal segments in 13; one patient had normal MRI. In the acute stage, 17 patients had a history of urinary retention and one had urge incontinence. On follow up at six months two patients regained normal voiding, retention persisted in six, and storage symptoms developed in 10, of whom five also had emptying difficulties. Urodynamic studies showed an areflexic or hypocontractile bladder in 10, detrusor hyperreflexia with poor compliance in two, and detrusor sphincter dyssynergia in three. Early abnormal urodynamic findings commonly persisted at the six and 12 months examinations. Persistent abnormalities included detrusor hyperreflexia, dyssynergia, and areflexic bladder. The urodynamic abnormalities correlated with muscle tone and reflex changes but not with sensory or motor evoked potentials, muscle power, MRI signal changes, sensory level, or six months outcome. CONCLUSIONS Bladder dysfunction is common in acute transverse myelitis and may be the only sequel. Urodynamic study is helpful in evaluating the bladder dysfunction and also in its management.
Collapse
Affiliation(s)
- J Kalita
- Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, India
| | | | | | | |
Collapse
|
47
|
Abstract
Acute transverse myelitis is a group of disorders characterized by focal inflammation of the spinal cord and resultant neural injury. Acute transverse myelitis may be an isolated entity or may occur in the context of multifocal or even multisystemic disease. It is clear that the pathological substrate--injury and dysfunction of neural cells within the spinal cord--may be caused by a variety of immunological mechanisms. For example, in acute transverse myelitis associated with systemic disease (i.e. systemic lupus erythematosus or sarcoidosis), a vasculitic or granulomatous process can often be identified. In idiopathic acute transverse myelitis, there is an intraparenchymal or perivascular cellular influx into the spinal cord, resulting in the breakdown of the blood-brain barrier and variable demyelination and neuronal injury. There are several critical questions that must be answered before we truly understand acute transverse myelitis: (1) What are the various triggers for the inflammatory process that induces neural injury in the spinal cord? (2) What are the cellular and humoral factors that induce this neural injury? and (3) Is there a way to modulate the inflammatory response in order to improve patient outcome? Although much remains to be elucidated about the causes of acute transverse myelitis, tantalizing clues as to the potential immunopathogenic mechanisms in acute transverse myelitis and related inflammatory disorders of the spinal cord have recently emerged. It is the purpose of this review to illustrate recent discoveries that shed light on this topic, relying when necessary on data from related diseases such as acute disseminated encephalomyelitis, Guillain-Barré syndrome and neuromyelitis optica. Developing a further understanding of how the immune system induces neural injury will depend upon confirmation and extension of these findings and will require multicenter collaborative efforts.
Collapse
Affiliation(s)
- Douglas A Kerr
- Department of Neurology, School of Medicine, Johns Hopkins University, Pathology 627 C, 6000 N Wolfe Street, Baltimore, MD 21287-6965, USA.
| | | |
Collapse
|
48
|
Sherer Y, Hassin S, Shoenfeld Y, Levy Y, Livneh A, Ohry A, Langevitz P. Transverse myelitis in patients with antiphospholipid antibodies--the importance of early diagnosis and treatment. Clin Rheumatol 2002; 21:207-10. [PMID: 12111625 DOI: 10.1007/s10067-002-8287-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [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: 10/27/2022]
Abstract
Transverse myelitis (TM) is a rare manifestation of systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). No uniform therapeutic protocol exists for its treatment, and the prognosis is usually poor. Here we describe four patients having TM associated with antiphospholipid antibodies. Treatment measures and delay in diagnosis between symptom onset and the initiation of treatment varied between patients, but the earlier the diagnosis and the more aggressive the treatment the better was the patient's outcome. Based on these cases and on a literature review we suggest that early aggressive treatment (usually with pulses of methylprednisolone and cyclophosphamide) might improve the prognosis of patients with TM associated with antiphospholipid antibodies.
Collapse
Affiliation(s)
- Y Sherer
- Department of medicine B, Sheba Medical Center, Tel-Hashomer, 56121 Israel
| | | | | | | | | | | | | |
Collapse
|
49
|
Yang TF, Lee SS, Lin PH, Chen H, Chan RC. Effect of selective posterior rhizotomy on transverse myelitis in a patient with systemic lupus erythematosus. Am J Phys Med Rehabil 2002; 81:467-8. [PMID: 12023605 DOI: 10.1097/00002060-200206000-00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/27/2022]
Abstract
This report describes the case of a 26-yr-old man experiencing transverse myelitis, a rare but serious complication of systemic lupus erythematosus occurring in less than 1% of patients with systemic lupus erythematosus, 4 yr after the onset of systemic lupus erythematosus. Significant neurologic deficits, including spastic paraplegia, dysthetic pain, and impaired bladder control, which made him completely bedridden and dependent in activities of daily living, continued, despite his immediate diagnosis and treatment. The patient received bilateral L1 to S1 selective posterior rhizotomy 1 yr after the onset of transverse myelitis, and 10 mo after selective posterior rhizotomy, he was completely independent in ambulation and self-care, demonstrating that selective posterior rhizotomy can be safely performed and its goals achieved under different medical conditions, as long as thorough preoperative evaluation and every possible precaution have been taken.
Collapse
Affiliation(s)
- Tsui Fen Yang
- Departments of Physical therapy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
50
|
de Seze J, Peoc'h K, Ferriby D, Stojkovic T, Laplanche JL, Vermersch P. 14-3-3 Protein in the cerebrospinal fluid of patients with acute transverse myelitis and multiple sclerosis. J Neurol 2002; 249:626-7. [PMID: 12021955 DOI: 10.1007/s004150200074] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|