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Murphy OC, Messacar K, Benson L, Bove R, Carpenter JL, Crawford T, Dean J, DeBiasi R, Desai J, Elrick MJ, Farias-Moeller R, Gombolay GY, Greenberg B, Harmelink M, Hong S, Hopkins SE, Oleszek J, Otten C, Sadowsky CL, Schreiner TL, Thakur KT, Van Haren K, Carballo CM, Chong PF, Fall A, Gowda VK, Helfferich J, Kira R, Lim M, Lopez EL, Wells EM, Yeh EA, Pardo CA. Acute flaccid myelitis: cause, diagnosis, and management. Lancet 2021; 397:334-346. [PMID: 33357469 PMCID: PMC7909727 DOI: 10.1016/s0140-6736(20)32723-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022]
Abstract
Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.
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Affiliation(s)
- Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Messacar
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica L Carpenter
- Department of Neurology, Children's National Health System, Washington, DC, USA
| | - Thomas Crawford
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janet Dean
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Roberta DeBiasi
- Department of Pediatric Infectious Diseases, Children's National Health System, Washington, DC, USA
| | - Jay Desai
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Matthew J Elrick
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel Farias-Moeller
- Department of Neurology, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grace Y Gombolay
- Department of Neurology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin Greenberg
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew Harmelink
- Department of Neurology, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sue Hong
- Division of Pediatric Critical Care, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hopkins
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joyce Oleszek
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
| | - Catherine Otten
- Department of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, USA
| | - Cristina L Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Teri L Schreiner
- Department of Child Neurology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Keith Van Haren
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Carolina M Carballo
- Department of Infectious Diseases, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Amary Fall
- Institut Pasteur de Dakar, Département de Virologie, Dakar, Senegal
| | - Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Jelte Helfferich
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ming Lim
- Children's Neuroscience Center, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, and Faculty of Life Sciences, King's College, London, UK
| | - Eduardo L Lopez
- Department of Infectious Diseases, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Elizabeth M Wells
- Department of Neurology, Children's National Health System, Washington, DC, USA
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Murphy OC, Salazar-Camelo A, Jimenez JA, Barreras P, Reyes MI, Garcia MA, Moller DR, Chen ES, Pardo CA. Clinical and MRI phenotypes of sarcoidosis-associated myelopathy. Neurol Neuroimmunol Neuroinflamm 2020; 7:e722. [PMID: 32269072 PMCID: PMC7176244 DOI: 10.1212/nxi.0000000000000722] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the characteristic clinical and spinal MRI phenotypes of sarcoidosis-associated myelopathy (SAM), we analyzed a large cohort of patients with this disorder. METHODS Patients diagnosed with SAM at a single center between 2000 and 2018 who met the established criteria for definite and probable neurosarcoidosis were included in a retrospective analysis to identify clinical profiles, CSF characteristics, and MRI lesion morphology. RESULTS Of 62 included patients, 33 (53%) were male, and 30 (48%) were African American. SAM was the first clinical presentation of sarcoidosis in 49 patients (79%). Temporal profile of symptom evolution was chronic in 81%, with sensory symptoms most frequently reported (87%). CSF studies showed pleocytosis in 79% and CSF-restricted oligoclonal bands in 23% of samples tested. Four discrete patterns of lesion morphology were identified on spine MRI: longitudinally extensive myelitis (n = 28, 45%), short tumefactive myelitis (n = 14, 23%), spinal meningitis/meningoradiculitis (n = 14, 23%), and anterior myelitis associated with areas of disc degeneration (n = 6, 10%). Postgadolinium enhancement was seen in all but 1 patient during the acute phase. The most frequent enhancement pattern was dorsal subpial enhancement (n = 40), followed by meningeal/radicular enhancement (n = 23) and ventral subpial enhancement (n = 12). In 26 cases (42%), enhancement occurred at locations with coexisting structural changes (e.g., spondylosis). CONCLUSIONS Recognition of the clinical features (chronically evolving myelopathy) and distinct MRI phenotypes (with enhancement in a subpial and/or meningeal pattern) seen in SAM can aid diagnosis of this disorder. Enhancement patterns suggest that SAM may have a predilection for areas of the spinal cord susceptible to mechanical stress.
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Affiliation(s)
- Olwen C Murphy
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Andrea Salazar-Camelo
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Jorge A Jimenez
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Paula Barreras
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Maria I Reyes
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Maria A Garcia
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - David R Moller
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Edward S Chen
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Carlos A Pardo
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD.
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3
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Cortese MM, Kambhampati AK, Schuster JE, Alhinai Z, Nelson GR, Guzman Perez-Carrillo GJ, Vossough A, Smit MA, McKinstry RC, Zinkus T, Moore KR, Rogg JM, Candee MS, Sejvar JJ, Hopkins SE. A ten-year retrospective evaluation of acute flaccid myelitis at 5 pediatric centers in the United States, 2005-2014. PLoS One 2020; 15:e0228671. [PMID: 32053652 PMCID: PMC7018000 DOI: 10.1371/journal.pone.0228671] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics. Methods We conducted a retrospective study covering 2005–2014 at 5 pediatric centers in 3 U.S. regions. Possible AFM cases aged ≤18 years were identified by searching discharge ICD-9 codes and spinal cord MRI reports (>37,000). Neuroradiologists assessed MR images, and medical charts were reviewed; possible cases were classified as AFM, not AFM, or indeterminate. Results At 5 sites combined, 26 AFM cases were identified from 2005–2013 (average annual number, 3 [2.4 cases/100,000 pediatric hospitalizations]) and 18 from 2014 (12.6 cases/100,000 hospitalizations; Poisson exact p<0.0001). A cluster of 13 cases was identified in September–October 2014 (temporal scan p = 0.0001). No other temporal or seasonal trend was observed. Compared with cases from January 2005–July 2014 (n = 29), cases from August–December 2014 (n = 15) were younger (p = 0.002), more frequently had a preceding respiratory/febrile illness (p = 0.03), had only upper extremities involved (p = 0.008), and had upper extremity monoplegia (p = 0.03). The cases had higher WBC counts in cerebrospinal fluid (p = 0.013). Conclusion Our data support emergence of AFM in 2014 in the United States, and those cases demonstrated distinctive features compared with preceding sporadic cases.
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Affiliation(s)
- Margaret M. Cortese
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Anita K. Kambhampati
- Contracting Agency to the Division of Viral Diseases, IHRC, Inc., Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer E. Schuster
- Division of Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri, United States of America
| | - Zaid Alhinai
- Division of Infectious Diseases, Department of Pediatrics, Alpert Medical School, Hasbro Children’s Hospital, Brown University, Providence, Rhode Island, United States of America
| | - Gary R. Nelson
- Division of Child Neurology, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah, United States of America
| | - Gloria J. Guzman Perez-Carrillo
- Neuroradiology Section, Mallinckrodt Institute of Radiology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Arastoo Vossough
- Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michael A. Smit
- Division of Infectious Diseases, Department of Pediatrics, Alpert Medical School, Hasbro Children’s Hospital, Brown University, Providence, Rhode Island, United States of America
| | - Robert C. McKinstry
- Neuroradiology Section, Mallinckrodt Institute of Radiology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Timothy Zinkus
- Department of Radiology, Children’s Mercy Kansas City, Kansas City, Missouri, United States of America
| | - Kevin R. Moore
- Department of Medical Imaging, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah, United States of America
| | - Jeffrey M. Rogg
- Department of Diagnostic Imaging, Alpert Medical School, Hasbro Children’s Hospital, Brown University, Providence, Rhode Island, United States of America
| | - Meghan S. Candee
- Division of Child Neurology, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah, United States of America
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E. Hopkins
- Division of Neurology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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4
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Schibler M, Brito F, Zanella MC, Zdobnov EM, Laubscher F, L'Huillier AG, Ambrosioni J, Wagner N, Posfay-Barbe KM, Docquier M, Schiffer E, Savoldelli GL, Fournier R, Lenggenhager L, Cordey S, Kaiser L. Viral Sequences Detection by High-Throughput Sequencing in Cerebrospinal Fluid of Individuals with and without Central Nervous System Disease. Genes (Basel) 2019; 10:genes10080625. [PMID: 31431002 PMCID: PMC6723360 DOI: 10.3390/genes10080625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/11/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022] Open
Abstract
Meningitis, encephalitis, and myelitis are various forms of acute central nervous system (CNS) inflammation, which can coexist and lead to serious sequelae. Known aetiologies include infections and immune-mediated processes. Despite advances in clinical microbiology over the past decades, the cause of acute CNS inflammation remains unknown in approximately 50% of cases. High-throughput sequencing was performed to search for viral sequences in cerebrospinal fluid (CSF) samples collected from 26 patients considered to have acute CNS inflammation of unknown origin, and 10 patients with defined causes of CNS diseases. In order to better grasp the clinical significance of viral sequence data obtained in CSF, 30 patients without CNS disease who had a lumbar puncture performed during elective spinal anaesthesia were also analysed. One case of human astrovirus (HAstV)-MLB2-related meningitis and disseminated infection was identified. No other viral sequences that can easily be linked to CNS inflammation were detected. Viral sequences obtained in all patient groups are discussed. While some of them reflect harmless viral infections, others result from reagent or sample contamination, as well as index hopping. Altogether, this study highlights the potential of high-throughput sequencing in identifying previously unknown viral neuropathogens, as well as the interpretation issues related to its application in clinical microbiology.
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Affiliation(s)
- Manuel Schibler
- Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Francisco Brito
- Swiss Institute of Bioinformatics, 1206 Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine of Geneva, 1206 Geneva, Switzerland
| | - Marie-Céline Zanella
- Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Evgeny M Zdobnov
- Swiss Institute of Bioinformatics, 1206 Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine of Geneva, 1206 Geneva, Switzerland
| | - Florian Laubscher
- Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Arnaud G L'Huillier
- Paediatric Infectious Diseases Unit, Department of Women-Children-Teenagers, Geneva University Hospitals and Medical School, 1205 Geneva, Switzerland
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Noémie Wagner
- Paediatric Infectious Diseases Unit, Department of Women-Children-Teenagers, Geneva University Hospitals and Medical School, 1205 Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Paediatric Infectious Diseases Unit, Department of Women-Children-Teenagers, Geneva University Hospitals and Medical School, 1205 Geneva, Switzerland
| | - Mylène Docquier
- iGE3 Genomics Platform, University of Geneva, 1206 Geneva, Switzerland
| | - Eduardo Schiffer
- Anaesthesiology Division, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Faculty of Medicine of Geneva, University of Geneva, 1205 Geneva, Switzerland
| | - Georges L Savoldelli
- Anaesthesiology Division, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Faculty of Medicine of Geneva, University of Geneva, 1205 Geneva, Switzerland
| | - Roxane Fournier
- Anaesthesiology Division, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Lauriane Lenggenhager
- Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Samuel Cordey
- Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Faculty of Medicine of Geneva, University of Geneva, 1205 Geneva, Switzerland
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5
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Mishra N, Ng TFF, Marine RL, Jain K, Ng J, Thakkar R, Caciula A, Price A, Garcia JA, Burns JC, Thakur KT, Hetzler KL, Routh JA, Konopka-Anstadt JL, Nix WA, Tokarz R, Briese T, Oberste MS, Lipkin WI. Antibodies to Enteroviruses in Cerebrospinal Fluid of Patients with Acute Flaccid Myelitis. mBio 2019; 10:e01903-19. [PMID: 31409689 PMCID: PMC6692520 DOI: 10.1128/mbio.01903-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/05/2023] Open
Abstract
Acute flaccid myelitis (AFM) has caused motor paralysis in >560 children in the United States since 2014. The temporal association of enterovirus (EV) outbreaks with increases in AFM cases and reports of fever, respiratory, or gastrointestinal illness prior to AFM in >90% of cases suggest a role for infectious agents. Cerebrospinal fluid (CSF) from 14 AFM and 5 non-AFM patients with central nervous system (CNS) diseases in 2018 were investigated by viral-capture high-throughput sequencing (VirCapSeq-VERT system). These CSF and serum samples, as well as multiple controls, were tested for antibodies to human EVs using peptide microarrays. EV RNA was confirmed in CSF from only 1 adult AFM case and 1 non-AFM case. In contrast, antibodies to EV peptides were present in CSF of 11 of 14 AFM patients (79%), significantly higher than controls, including non-AFM patients (1/5 [20%]), children with Kawasaki disease (0/10), and adults with non-AFM CNS diseases (2/11 [18%]) (P = 0.023, 0.0001, and 0.0028, respectively). Six of 14 CSF samples (43%) and 8 of 11 sera (73%) from AFM patients were immunoreactive to an EV-D68-specific peptide, whereas the three control groups were not immunoreactive in either CSF (0/5, 0/10, and 0/11; P = 0.008, 0.0003, and 0.035, respectively) or sera (0/2, 0/8, and 0/5; P = 0.139, 0.002, and 0.009, respectively).IMPORTANCE The presence in cerebrospinal fluid of antibodies to EV peptides at higher levels than non-AFM controls supports the plausibility of a link between EV infection and AFM that warrants further investigation and has the potential to lead to strategies for diagnosis and prevention of disease.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Antibodies, Viral/immunology
- Antigens, Viral/immunology
- Central Nervous System Viral Diseases/blood
- Central Nervous System Viral Diseases/cerebrospinal fluid
- Child
- Enterovirus D, Human/genetics
- Enterovirus D, Human/immunology
- Enterovirus D, Human/isolation & purification
- Enterovirus Infections/blood
- Enterovirus Infections/cerebrospinal fluid
- Female
- High-Throughput Nucleotide Sequencing
- Humans
- Male
- Middle Aged
- Myelitis/blood
- Myelitis/cerebrospinal fluid
- Neuromuscular Diseases/blood
- Neuromuscular Diseases/cerebrospinal fluid
- Protein Array Analysis
- RNA, Viral/blood
- RNA, Viral/cerebrospinal fluid
- RNA, Viral/genetics
- Young Adult
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Affiliation(s)
- Nischay Mishra
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel L Marine
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komal Jain
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - James Ng
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Riddhi Thakkar
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adrian Caciula
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adam Price
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joel A Garcia
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia Irving University Medical Center, New York, New York, USA
| | - Kimbell L Hetzler
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janell A Routh
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rafal Tokarz
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Thomas Briese
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, USA
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6
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Elmouden H, Louhab N, Kissani N. Medullary involvement in neurosyphilis: a report of 12 cases and a review of the literature. Spinal Cord Ser Cases 2019; 5:38. [PMID: 31632699 PMCID: PMC6786502 DOI: 10.1038/s41394-019-0185-9] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 01/18/2023] Open
Abstract
Study design Retrospective case series. Objectives To describe the epidemiological, clinical, MRI and therapeutic features and the outcomes of patients with syphilitic myelitis in a third-level hospital in Marrakesh in southern Morocco. Setting The Neurology Department, University Hospital Mohamed VI Marrakesh, Morocco. Methods Twelve charts of persons with syphilitic myelitis over a period of 17 years were reviewed to determine demographics, presenting symptoms, clinical and radiological findings, biological features, treatment received and outcomes. Results There were 120 reports of neurosyphilis. Twelve patients (10%) had syphilitic myelitis. Eleven patients (92%) were male with mean age of 44 at presentation. Tabes dorsalis was the most common clinical form. Cerebrospinal fluid analysis showed lymphocytic meningitis in nine patients (75%). Spine MRI was abnormal in four patients (33%). All patients were treated with 30 million units of aqueous penicillin G IV per day for 10 days, every 3 months. In follow-up, two patients (17%) with clinical syphilitic meningomyelitis improved significantly, eight patients (66%) with tabes dorsalis and subacute transverse myelitis showed partial improvement but clinical status was stationary for two patients (17%) with Erb paraplegia. Conclusions All patients with myelopathy should undergo syphilitic serology because of nonspecific manifestations and curability of this disease.
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Affiliation(s)
- Hafida Elmouden
- Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco
| | - Nisserine Louhab
- Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco
| | - Najib Kissani
- Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco
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7
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Miller S, Naccache SN, Samayoa E, Messacar K, Arevalo S, Federman S, Stryke D, Pham E, Fung B, Bolosky WJ, Ingebrigtsen D, Lorizio W, Paff SM, Leake JA, Pesano R, DeBiasi R, Dominguez S, Chiu CY. Laboratory validation of a clinical metagenomic sequencing assay for pathogen detection in cerebrospinal fluid. Genome Res 2019; 29:831-842. [PMID: 30992304 PMCID: PMC6499319 DOI: 10.1101/gr.238170.118] [Citation(s) in RCA: 293] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023]
Abstract
Metagenomic next-generation sequencing (mNGS) for pan-pathogen detection has been successfully tested in proof-of-concept case studies in patients with acute illness of unknown etiology but to date has been largely confined to research settings. Here, we developed and validated a clinical mNGS assay for diagnosis of infectious causes of meningitis and encephalitis from cerebrospinal fluid (CSF) in a licensed microbiology laboratory. A customized bioinformatics pipeline, SURPI+, was developed to rapidly analyze mNGS data, generate an automated summary of detected pathogens, and provide a graphical user interface for evaluating and interpreting results. We established quality metrics, threshold values, and limits of detection of 0.2-313 genomic copies or colony forming units per milliliter for each representative organism type. Gross hemolysis and excess host nucleic acid reduced assay sensitivity; however, spiked phages used as internal controls were reliable indicators of sensitivity loss. Diagnostic test accuracy was evaluated by blinded mNGS testing of 95 patient samples, revealing 73% sensitivity and 99% specificity compared to original clinical test results, and 81% positive percent agreement and 99% negative percent agreement after discrepancy analysis. Subsequent mNGS challenge testing of 20 positive CSF samples prospectively collected from a cohort of pediatric patients hospitalized with meningitis, encephalitis, and/or myelitis showed 92% sensitivity and 96% specificity relative to conventional microbiological testing of CSF in identifying the causative pathogen. These results demonstrate the analytic performance of a laboratory-validated mNGS assay for pan-pathogen detection, to be used clinically for diagnosis of neurological infections from CSF.
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Affiliation(s)
- Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California 94143, USA
| | - Samia N Naccache
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California 94143, USA
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California 90027, USA
| | - Erik Samayoa
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | - Kevin Messacar
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Shaun Arevalo
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California 94143, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California 94143, USA
| | - Doug Stryke
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California 94143, USA
| | - Elizabeth Pham
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | - Becky Fung
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | | | - Danielle Ingebrigtsen
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | - Walter Lorizio
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | - Sandra M Paff
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | - John A Leake
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California 92675, USA
| | - Rick Pesano
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California 92675, USA
| | - Roberta DeBiasi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Children's National Health System, Washington, DC 20010, USA
- Department of Pediatrics, Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine, Washington, DC 20037, USA
| | - Samuel Dominguez
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California 94143, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California 94143, USA
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8
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Abstract
Infection with Angiostrongylus cantonensis roundworms is endemic in Southeast Asia and the Pacific Basin. A. cantonensis meningitis and myelitis occurred in summer 2013 in a child with no history of travel outside of Texas, USA. Angiostrongyliasis is an emerging neurotropic helminthic disease in Texas and warrants increased awareness among healthcare providers.
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9
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Van Haren K, Ayscue P, Waubant E, Clayton A, Sheriff H, Yagi S, Glenn-Finer R, Padilla T, Strober JB, Aldrovandi G, Wadford DA, Chiu CY, Xia D, Harriman K, Watt JP, Glaser CA. Acute Flaccid Myelitis of Unknown Etiology in California, 2012-2015. JAMA 2015; 314:2663-71. [PMID: 26720027 DOI: 10.1001/jama.2015.17275] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There has been limited surveillance for acute flaccid paralysis in North America since the regional eradication of poliovirus. In 2012, the California Department of Public Health received several reports of acute flaccid paralysis cases of unknown etiology. OBJECTIVE To quantify disease incidence and identify potential etiologies of acute flaccid paralysis cases with evidence of spinal motor neuron injury. DESIGN, SETTING, AND PARTICIPANTS Case series of acute flaccid paralysis in patients with radiological or neurophysiological findings suggestive of spinal motor neuron involvement reported to the California Department of Public Health with symptom onset between June 2012 and July 2015. Patients meeting diagnostic criteria for other acute flaccid paralysis etiologies were excluded. Cerebrospinal fluid, serum samples, nasopharyngeal swab specimens, and stool specimens were submitted to the state laboratory for infectious agent testing. MAIN OUTCOMES AND MEASURES Case incidence and infectious agent association. RESULTS Fifty-nine cases were identified. Median age was 9 years (interquartile range [IQR], 4-14 years; 50 of the cases were younger than 21 years). Symptoms that preceded or were concurrent included respiratory or gastrointestinal illness (n = 54), fever (n = 47), and limb myalgia (n = 41). Fifty-six patients had T2 hyperintensity of spinal gray matter on magnetic resonance imaging and 43 patients had cerebrospinal fluid pleocytosis. During the course of the initial hospitalization, 42 patients received intravenous steroids; 43, intravenous immunoglobulin; and 13, plasma exchange; or a combination of these treatments. Among 45 patients with follow-up data, 38 had persistent weakness at a median follow-up of 9 months (IQR, 3-12 months). Two patients, both immunocompromised adults, died within 60 days of symptom onset. Enteroviruses were the most frequently detected pathogen in either nasopharynx swab specimens, stool specimens, serum samples (15 of 45 patients tested). No pathogens were isolated from the cerebrospinal fluid. The incidence of reported cases was significantly higher during a national enterovirus D68 outbreak occurring from August 2014 through January 2015 (0.16 cases per 100,000 person-years) compared with other monitoring periods (0.028 cases per 100,000 person-years; P <.001). CONCLUSIONS AND RELEVANCE In this series of patients identified in California from June 2012 through July 2015, clinical manifestations indicated a rare but distinct syndrome of acute flaccid paralysis with evidence of spinal motor neuron involvement. The etiology remains undetermined, most patients were children and young adults, and motor weakness was prolonged.
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Affiliation(s)
- Keith Van Haren
- Department of Neurology, Stanford University School of Medicine, Stanford, California2Division of Child Neurology, Lucile Packard Children's Hospital, Stanford, California
| | - Patrick Ayscue
- US Centers for Disease Control and Prevention, Atlanta, Georgia4Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond5Now with Metabiota, San Francisco, California
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco7Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco
| | - Anna Clayton
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Heather Sheriff
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Shigeo Yagi
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Rose Glenn-Finer
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Tasha Padilla
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Jonathan B Strober
- Department of Neurology, University of California, San Francisco7Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco
| | - Grace Aldrovandi
- Children's Hospital Los Angeles and University of Southern California, Los Angeles
| | - Debra A Wadford
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Charles Y Chiu
- Departments of Laboratory Medicine and Medicine, Division of Infectious Diseases, University of California, San Francisco10University of California, San Francisco, Viral Diagnostics and Discovery Center, San Francisco
| | - Dongxiang Xia
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Kathleen Harriman
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - James P Watt
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Carol A Glaser
- Center for Infectious Diseases, Division of Communicable Disease Control, California Department of Public Health, Richmond7Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco11Now with Department of Pediatrics, K
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10
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Mancino P, Dalessandro M, Falasca K, Ucciferri C, Pizzigallo E, Vecchiet J. Acute urinary retention due to HSV-1: a case report. Infez Med 2009; 17:38-40. [PMID: 19359825] [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: 05/27/2023]
Abstract
Complications in urinary tract nervous routes due to herpes viruses as VZV and HSV-2 are well known. Acute urinary retention and chronic neuropathic pain are not rare when sacral dermatomes are involved by these viruses. However, an analogous condition has not yet been clearly ascribed to HSV-1 infection. We present a 32-year-old immunocompetent patient with fever, lumbar pain and acute urinary retention who had never had herpetic clinical manifestations. Urodynamic studies diagnosed a neurologic bladder with an absent filling sensation. Cystoscopic assessment revealed the presence of reddened and isolated small mucosal areas in the bladder walls. The search for herpes viruses in plasma and CSF by PCR assay were positive for HSV-1. After treatment with antiviral therapy the disease resolved. Intermittent catheterization was necessary and voiding dysfunction resolved after three weeks by its appearance. Neurological damage to the central nervous system (CNS) and/or PNS due to HSV-1 seems to be the most likely reason. The course of disease was benign and self-remitting.
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Affiliation(s)
- P Mancino
- Clinic of Infectious Diseases, University of Chieti, Italy
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11
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Łukjanowicz M, Brzosko M. Myelitis in the course of systemic lupus erythematosus: review. Pol Arch Med Wewn 2009; 119:67-72. [PMID: 19341181] [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: 05/27/2023]
Abstract
Myelopathy manifested clinically as acute longitudinal or transverse myelitis constitutes one of the most severe and rare neuropsychiatric manifestations of systemic lupus erythematosus (SLE) (1-3% of patients). Myelitis has been observed less commonly in other connective tissue diseases, mostly in antiphospholipid syndrome, and rarely in Sjögren's syndrome, Behçet's disease and mixed connective tissue disease. Acute transverse myelitis (ATM) may also be present in diseases of various etiology, including multiple sclerosis, sarcoidosis, infectious diseases and malignancies. Myelitis in SLE is manifested as a dramatic spinal cord injury leading to paralysis or muscular paresis, sensory deficits, and smooth muscle dysfunction usually in the form of sphincter dysfunction. The imaging technique of choice in case of suspected ATM is magnetic resonance imaging with intravenous contrast agent (gadolinium diethylenetriamine-pentaacid). Cerebrospinal fluid (CSF) examination in patients with ATM in the course of SLE indicate usually pleocytosis with prevalence of granulocytes, increased protein levels, low glucose levels, significantly hindering differential diagnosis in the early stage of the disease. Observations made by the authors (2 female patients with SLE) show that antibodies specific to SLE can be found in the CSF collected in the acute phase of myelitis. These observations have not yet been confirmed by other researchers. Early introduction of intravenous immunosuppression with large doses of cyclophosphamide and glucocorticosteroids improves the long-term prognosis. Other therapeutic approaches have been also used in more severe cases. Even with appropriate therapy, prognosis in this disease is uncertain.
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12
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Abstract
BACKGROUND Cerebrospinal fluid (CSF) analysis is the basis for establishing a diagnosis of central nervous system (CNS) inflammation. However, the information provided by routine CSF analysis is limited. Determination of CSF beta-2-microglobulin (beta2m) concentration has been used diagnostically in humans to identify inflammatory CNS disease; we hypothesized that it may have similar value in dogs. OBJECTIVES The objective of this study was to measure (beta2m concentration in the CSF of clinically healthy dogs and compare the values to those observed in dogs with inflammatory CNS disease and intervertebral disc disease (IVDD). METHODS CSF was collected from 10 clinically healthy laboratory dogs and 11 dogs each with inflammatory CNS disease and IVDD. Routine CSF analysis was performed, and (beta2m concentration was measured by ELISA. CSF (beta2m concentration and CSF:serum (beta2m ratio were compared between groups by ANOVA. Linear relationships between CSF total nucleated cell count (TNCC), RBC count, total protein concentration, and (beta2m concentration were assessed by regression analysis. RESULTS The mean (+/- SD) CSF (beta2m concentration in clinically healthy dogs was 0.36 (+/- 0.05 microg/mL (cisternal) and 0.40 (+/- 0.07 microg/mL (lumbar). Median CSF (beta2m concentration in dogs with IVDD (0.46 microg/mL) and inflammatory CNS disease (0.85 microg/mL) differed from that of controls (0.36 microg/mL; P=.002). The concentration also differed between the 2 disease groups (P=.01). Five dogs with inflammatory CNS disease had CSF:serum (beta2m ratios >1. A correlation was identified between TNCC and (beta2m concentration (r=0.69, P=.0003). CONCLUSIONS CSF (beta2m concentration is higher in dogs with IVDD and inflammatory CNS disease, with highest values seen with inflammatory disease. This may be attributed in part to the correlation between CSF (beta2m concentration and TNCC, but also may reflect intrathecal immune activation.
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Affiliation(s)
- Karen R Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
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13
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Abstract
BACKGROUND A sensitive method to detect intrathecal IgG production is important in diagnosing inflammatory central nervous system (CNS) diseases, including multiple sclerosis (MS). OBJECTIVE To compare cerebrospinal fluid (CSF) electrophoresis with isoelectric focusing (IEF), immunofixation-peroxidase electrophoresis (IFPE) and high-resolution agarose electrophoresis with protein-staining (HRAGE). METHODS Paired serum and CSF samples from 307 consecutive patients attending a general neurology clinic were examined with IEF, IFPE and HRAGE. Clinical diagnosis was based on review of the patients' medical records after an average of 4 years. RESULTS The sensitivity for detecting any inflammatory (autoimmune or infectious) CNS disease (52 patients) was 67% for IEF, 50% for IFPE and 29% for HRAGE. The sensitivity for detecting MS (14 patients) was 93%, 86% and 29% respectively. The sensitivity for detecting clinically isolated syndrome (eight patients) was 75%, 25% and 13% respectively. The number of oligoclonal bands in IEF was higher in inflammatory than in non-inflammatory neurological diseases or symptoms, but similar in MS and other inflammatory diseases. CONCLUSION IEF is the method of choice in diagnosing intrathecal IgG synthesis.
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Affiliation(s)
- A Mygland
- Department of Neurology, Sørlandet Sykehus, Kristiansand, Norway.
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14
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Soares CN, Faria LC, Peralta JM, de Freitas MRG, Puccioni-Sohler M. Dengue infection: neurological manifestations and cerebrospinal fluid (CSF) analysis. J Neurol Sci 2006; 249:19-24. [PMID: 16870213 DOI: 10.1016/j.jns.2006.05.068] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 05/25/2006] [Accepted: 05/26/2006] [Indexed: 11/20/2022]
Abstract
Neurological manifestation is considered a rare complication of dengue infection. Neurological and cerebrospinal fluid (CSF) findings of 13 patients with dengue infection were studied. Seven patients had encephalitis, two had myelitis and four showed Guillain-Barré syndrome (GBS). No alteration in CSF was found from 57% of those with encephalitis. Patients with GBS and myelitis showed a CSF-blood barrier dysfunction. The differences in the CSF may be related to the location of the lesion and multiple mechanisms of the disease in the nervous system.
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Affiliation(s)
- C N Soares
- Neurology Service, HUAP/UFF (Hospital Universitário Antônio Pedro/Universidade Federal Fluminense), Niterói, RJ, Brazil.
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15
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Ferrari TCA, Moreira PRR, Sampaio MJ, da Cunha AS, de Oliveira JT, Gazzinelli G, Correa-Oliveira R. Intrathecal cytokines in spinal cord schistosomiasis. J Neuroimmunol 2006; 177:136-41. [PMID: 16822551 DOI: 10.1016/j.jneuroim.2006.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 01/27/2006] [Revised: 05/13/2006] [Accepted: 05/16/2006] [Indexed: 10/24/2022]
Abstract
We investigate the cytokine profile in the cerebrospinal fluid (CSF) and serum of patients with spinal cord schistosomiasis (SCS). Increased levels of IL-1beta, IL-4, IL-6 and IL-10 and low concentrations of TNF-alpha and IFN-gamma were observed in both CSF and serum. CSF showed higher levels of IL-4 and IL-6 when compared to the paired serum samples. A negative correlation between the concentrations of IL-10 and IFN-gamma was observed in the CSF. These findings suggest an inflammatory as well as a skewed type-2 immune response that probably occur both locally and systemically and may be involved in the pathogenesis of SCS.
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Affiliation(s)
- Teresa Cristina Abreu Ferrari
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Av. Prof. Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil.
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16
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Eberhardt O, Bialek R, Nägele T, Dichgans J. Eosinophilic meningomyelitis in toxocariasis: case report and review of the literature. Clin Neurol Neurosurg 2005; 107:432-8. [PMID: 16023542 DOI: 10.1016/j.clineuro.2004.10.003] [Citation(s) in RCA: 40] [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: 07/13/2004] [Revised: 09/15/2004] [Accepted: 10/04/2004] [Indexed: 10/26/2022]
Abstract
Toxocariasis is a worldwide-occurring parasitic infection leading to tissue damage in various organs due to wandering Toxocara larvae (visceral larva migrans). More than 40 cases of CNS involvement in children and immunocompetent adults have been documented in detail to date. Here, we present evidence of eosinophilic meningomyelitis in an adult without known risk factors and with positive Toxocara antibody response in CSF, but not in blood. Toxocariasis has to remain among the differential diagnosis in patients with eosinophilic CNS infection even if serological tests in blood are negative. Adult cases seem to be more frequent than previously thought (about 60%).
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Affiliation(s)
- O Eberhardt
- Department of Neurology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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17
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Sakai M, Ohashi K, Kobayashi T, Yamashita T, Akiyama H, Nemoto T, Kishida S, Kamata N, Sakamaki H. Meningeal hematopoiesis following radiation myelitis in a hematopoietic stem-cell transplant recipient. Am J Hematol 2005; 79:291-3. [PMID: 16044440 DOI: 10.1002/ajh.20341] [Citation(s) in RCA: 2] [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: 11/11/2022]
Abstract
Extramedullary meningeal hematopoiesis (EMH) represents an uncommon finding after stem-cell transplantation. We describe the case of an allogeneic bone marrow transplantation (BMT) recipient who developed EMH 1 month after radiation myelitis had been diagnosed. A 39-year-old man with multiple myeloma underwent matched unrelated BMT following a myeloablative conditioning regimen of cyclophosphamide and total-body irradiation (200 cGyx6). This was followed by delivery of 40 Gy of involved-field radiation to an extramedullary plasmacytoma compressing the spinal cord. Although transplantation went extremely well, the patient developed radiation myelitis 7 months after transplantation, and EMH ensued 1 month later. Because the patient was not in a disease state known to cause EMH, it is tempting to speculate that radiation-related neural injuries might cause donor cells to migrate to the central nervous system.
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Affiliation(s)
- Miwa Sakai
- Hematology Division, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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18
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Affiliation(s)
- O Eberhardt
- University of Tubingen Medical School, Tubingen, Germany
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19
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Affiliation(s)
- H Jacobus Gilhuis
- Department of Neurology, Reinier de Graaf Group, Delft, The Netherlands.
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20
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Satoh JI, Yukitake M, Kurohara K, Takashima H, Kuroda Y. Detection of the 14-3-3 protein in the cerebrospinal fluid of Japanese multiple sclerosis patients presenting with severe myelitis. J Neurol Sci 2003; 212:11-20. [PMID: 12809994 DOI: 10.1016/s0022-510x(03)00083-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [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: 11/30/2022]
Abstract
Recent studies showed that the 14-3-3 protein is detectable in the cerebrospinal fluid (CSF) of prion-unrelated neurological diseases, such as meningoencephalitis and myelitis. To investigate the possible association between the amounts of the 14-3-3 protein in the CSF and the clinical severity of multiple sclerosis (MS), its levels were determined by Western blot in the CSF of the patients with relapsing-remitting MS (RRMS) (n=10), secondary progressive MS (SPMS) (n=7), primary progressive MS (PPMS) (n=2), and non-MS inflammatory diseases of the CNS (n=5). The 14-3-3 protein was identified in seven CSF samples, including four patients with SPMS in acute relapse, one with SPMS in remission accompanied by fresh cerebral infarction, one with RRMS in acute relapse, and one with human T-lymphotropic virus type I (HTLV-I)-associated myelopathy. The patients positive for the CSF 14-3-3 protein immunoreactivity showed more severe disability and higher levels of pleocytosis, protein, IgG, beta2-microglobulin, and neuron-specific enolase in the CSF, compared with those negative for its immunoreactivity. Four of these patients exhibited extensive lesions distributed along multiple vertebral segments in the spinal cord on MRI. In contrast, none of the MS patients without an extensive involvement of the spinal cord showed the CSF 14-3-3 protein immunoreactivity. These results suggest that detection of the 14-3-3 protein in the CSF provides a marker for severe inflammation-induced extensive damage of the central nervous system tissues responsible for poor therapeutic responses and irreversible neurological deficits in MS.
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Affiliation(s)
- Jun-ichi Satoh
- Department of Immunology, National Institute of Neuroscience, NCNP, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8502, Japan.
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Perini P, Calabrese M, Ranzato F, Tiberio M, Gallo P. Cerebrospinal fluid examination in the differential diagnosis of inflammatory myelopathies. Neurol Sci 2001; 22 Suppl 2:S65-8. [PMID: 11794481 DOI: 10.1007/s100720100037] [Citation(s) in RCA: 7] [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
Among the diagnostic procedures aimed at defining the etiology and the pathogenesis of inflammatory myelopathies, the examination of the cerebrospinal fluid (CSF) plays a central role. Indeed, for several autoimmune and inflammatory syndromes and diseases involving the spinal cord, in addition to immunological screening of the blood, a detailed analysis of the CSF may allow the achievement of the diagnosis. Routine CSF analysis should include a detailed cytology, the evaluation of the blood-brain barrier dysfunction, quantitative and qualitative analysis of the intrathecal IgG synthesis (i.e. calculation of the IgG index and demonstration of oligoclonal IgG bands), and immunological and virological tests based on immunoenzymatic (ELISA, RIA) and molecular biology techniques (PCR, nested PCR). A more advanced step includes fluorescence-activated cell sorting (FACS) analysis of CSF lymphocytes, and, when possible, virological and immunological tests on cell culture supernatants.
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Affiliation(s)
- P Perini
- Department of Neurological and Psychiatric Sciences, First Neurology Clinic, Multiple Sclerosis Centre, University of Padova, Padua, Italy
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22
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Arias M, Requena I, Lema C, Pereiro I, Núñez J, Villalba C. [Tuberculous myelomeningitis without vertebral involvement: diagnostic value of the MR study]. Rev Neurol 2001; 32:1196-7. [PMID: 11708258] [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: 02/22/2023]
MESH Headings
- Adult
- Diagnosis, Differential
- Humans
- Magnetic Resonance Imaging
- Male
- Myelitis/cerebrospinal fluid
- Myelitis/diagnosis
- Myelitis/pathology
- Spine/pathology
- Tuberculosis, Central Nervous System/cerebrospinal fluid
- Tuberculosis, Central Nervous System/complications
- Tuberculosis, Central Nervous System/diagnosis
- Tuberculosis, Central Nervous System/pathology
- Tuberculosis, Meningeal/cerebrospinal fluid
- Tuberculosis, Meningeal/complications
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/pathology
- Tuberculosis, Spinal/diagnosis
- Urinary Retention/etiology
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Nakajima H, Furutama D, Kimura F, Shinoda K, Ohsawa N, Nakagawa T, Shimizu A, Shoji H. Herpes simplex virus myelitis: clinical manifestations and diagnosis by the polymerase chain reaction method. Eur Neurol 2000; 39:163-7. [PMID: 9605393 DOI: 10.1159/000007927] [Citation(s) in RCA: 50] [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] [Indexed: 11/19/2022]
Abstract
Herpes simplex virus (HSV) myelitis has previously been reported to be a form of acute ascending necrotizing myelitis caused by HSV type 2 (HSV-2). We studied neurological symptoms, clinical course, magnetic resonance imaging (MRI) findings, and diagnosis by polymerase chain reaction (PCR) methods in 9 patients with HSV myelitis. In 6 cases, disease onset was marked by sensorimotor disturbances of lower extremities and urinary disturbances, with the transverse myelopathy gradually ascending to the cervicothoracic spinal cord level. The other 3 cases showed transverse myelopathy without an ascending pattern. Six cases showed acute progression, while 3 cases showed a subacute course. There were 2 cases with recurrent episodes. Three patients recovered, however, in the remaining 6 patients severe sequelae such as paraplegia persisted despite antiviral therapy. MRI showed a hyperintense lesion on T2-weighted images. Gadolinium enhancement was observed in 2 cases, and 1 case showed a hyperintense lesion both on T1- and on T2-weighted images, suggesting hemorrhagic necrosis. HSV-2 was detected by PCR techniques in all 6 cases with an ascending pattern. HSV-1 DNA was detected in 2 and HSV-2 DNA in 1 of the 3 cases with a nonascending pattern. Our findings demonstrate diverse clinical manifestations of HSV myelitis.
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Affiliation(s)
- H Nakajima
- First Department of Internal Medicine, Osaka Medical College, Takatsuki City, Japan
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Bashir K, Whitaker JN. Importance of paraclinical and CSF studies in the diagnosis of MS in patients presenting with partial cervical transverse myelopathy and negative cranial MRI. Mult Scler 2000; 6:312-6. [PMID: 11064439 DOI: 10.1177/135245850000600503] [Citation(s) in RCA: 18] [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] [Indexed: 11/15/2022]
Abstract
Patients presenting with isolated partial cervical myelopathy are at high risk for development of multiple sclerosis (MS), especially if lesions suggestive of demyelination are present on cranial magnetic resonance imaging (MRI). This risk is lower, though not precisely known, in patients whose cranial MRI is normal. This clinical issue was addressed by examining the role of paraclinical studies in establishing a diagnosis of MS at the time of initial presentation. Twelve consecutive patients, mean age of 32.2 years, seen over 6.5 years were identified prospectively and included in this study. Numbness was the presenting symptom in 11 of these patients. Symptoms completely resolved in nine patients regardless of treatment with glucocorticoids. Evoked potential (EP) and cerebrospinal fluid (CSF) examinations assisted in establishing a diagnosis of laboratory-supported definite (LSDMS) or clinically probable (CPMS) MS in six patients at the time of presentation. During a clinical follow-up period of 4.1 years, four developed recurrent neurologic deficits leading to the establishment of a diagnosis of clinically definite MS (CDMS). The presence of a solitary, non-specific lesion on cranial MRI resulted in an increased risk for the development of definite MS. In patients with a clinically isolated cervical partial transverse myelitis (TM) and normal cranial MRI, an accurate diagnosis of MS can usually be made. Revision of the diagnostic criteria for LSDMS is warranted. Multiple Sclerosis (2000) 6 312 - 316
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Affiliation(s)
- K Bashir
- Department of Neurology, University of Alabama at Birmingham, Alabama 35233-7340, USA
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25
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Abstract
Chemokines and matrix metalloproteinases (MMPs) appear to be crucial in leukocyte recruitment to the central nervous system in multiple sclerosis (MS). CCR5 delta32, a truncated allele of the CC chemokine receptor CCR5 gene encoding a non-functional receptor, did not confer protection from MS. CCR5 delta32 was, however, associated with a lower risk of recurrent clinical disease activity. High CSF levels of MMP-9 activity were also associated with recurrent disease activity. These results directly link intrathecal inflammation to disease activity in patients with MS, suggesting that treatments targeting CCR5 or treatment with MMP inhibitors may attenuate disease activity in MS.
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Affiliation(s)
- F Sellebjerg
- Department of Neurology, University of Copenhagen, Glostrup Hospital, Denmark.
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Affiliation(s)
- I C Chou
- Department of Pediatrics, China Medical College Hospital, Taichung, Taiwan, Republic of China
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28
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Gilden DH, Bennett JL, Kleinschmidt-DeMasters BK, Song DD, Yee AS, Steiner I. The value of cerebrospinal fluid antiviral antibody in the diagnosis of neurologic disease produced by varicella zoster virus. J Neurol Sci 1998; 159:140-4. [PMID: 9741397 DOI: 10.1016/s0022-510x(98)00153-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [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: 11/28/2022]
Abstract
We studied four patients with subacute to chronic varicella zoster virus (VZV) infection of the central nervous system (CNS). VZV infection was verified by detecting antibody to VZV in the cerebrospinal fluid (CSF). VZV caused myelitis in two patients and encephalitis in two patients. In one of the patients with VZV encephalitis, in addition to VZV IgM antibody, VZV DNA was found in the CSF. Among the four patients with VZV infection of the CNS, CSF antibody to VZV was the crucial diagnostic laboratory test which corroborated the clinical features, and indicated that VZV caused neurologic disease. In addition to looking for amplifiable VZV DNA in the CSF of patients with neurologic disease whose clinical and radiologic features suggest VZV infection, we also recommend a search for CSF antibody to VZV, particularly in patients with intervals of weeks to months between zoster and the onset of neurologic disease, or in those patients without rash in whom the tempo of illness is unknown.
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Affiliation(s)
- D H Gilden
- Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA.
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29
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Ito M, Nishibe Y, Inoue YK. Isolation of Inoue-Melnick virus from cerebrospinal fluid of patients with epidemic neuropathy in Cuba. Arch Pathol Lab Med 1998; 122:520-2. [PMID: 9625419] [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: 02/07/2023]
Abstract
BACKGROUND A mysterious disease spread over Cuba from 1991 to 1993, the cause of which has not been fully established. Major symptoms were the same in patients with the Cuban disease as in patients with subacute myelo-optico-neuropathy (SMON), which had occurred in Japan nearly 30 years ago and from which Inoue-Melnick virus (IMV) type 1 was first isolated. We investigated the presence of IMV in cerebrospinal fluid samples of patients with this epidemic neuropathy in Cuba. METHODS The established method for detecting IMV in MRC-5 fibroblasts was used throughout the study, which was conducted in two independent laboratories, one in Buffalo, NY, and the other in Kyoto, Japan. The cerebrospinal fluid samples of 20 patients and four controls were provided by Cuban researchers. RESULTS All cerebrospinal fluid specimens from 20 Cuban patients tested were positive for IMV type 2 (100%), and four cerebrospinal fluid specimens from Cuban controls were negative for IMV (0%). These clear-cut results were identical in both laboratories. CONCLUSION Our study indicates an important association of IMV type 2 with patients of this Cuban epidemic. The etiologic role of IMV type 2 in the epidemic neuropathy in Cuba, along with weak cytopathic effect viruses isolated by the Cuban group, remains to be elucidated.
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Affiliation(s)
- M Ito
- Roswell Park Cancer Institute, Buffalo, NY, USA
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Abstract
We report a patient presenting with myelitis after respiratory symptoms. A high level of antibodies to influenza A virus was measured in serum and cerebrospinal fluid (CSF), and the serum/CSF antibody ratio was 1.7, suggesting specific antibody production in the central nervous system. Magnetic resonance imaging of the spinal canal showed a contrast-enhanced swelling on the cervical medulla. Such a case would have warranted the use of antiviral therapy and calls to mind the neurotropic potential of influenza A viruses.
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Affiliation(s)
- O Salonen
- Department of Radiology, Helsinki University Central Hospital, Finland
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31
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Abstract
We evaluated creatine kinase (CK) activity in the cerebrospinal fluid (CSF) of 128 horses with various neurological disorders. No association was found between CSF CK activity and CSF red blood cell count, CSF nucleated cell count, CSF total protein concentration, or serum CK activity. The sensitivity and specificity of CSF CK activity as a diagnostic test for protozoal myelitis in horses (61% and 56%, respectively) was higher than for cervical stenotic myelopathy, degenerative myelopathy, or motor neuron disease, but was considered to be inadequate to be of use diagnostically. Contamination of CSF with whole blood, hemolyzed red blood cells, or serum did not substantially contribute to increases in CSF CK activity. Addition of epidural fat or dura to CSF significantly increased CSF CK activity in all cases. We suggest that the use of CSF CK activity as a diagnostic indicator of neurological disease in the horse in unreliable, and that CSF CK activity may be falsely increased by contamination of CSF with epidural fat or dura during CSF collection.
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Affiliation(s)
- C Jackson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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32
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Jacobs A, Bamborschke S, Szelies B, Lanfermann H, Schröder R, Heiss WD. [Varicella-zoster-virus myelitis without herpes. An important differential diagnosis of the radicular syndrome]. Dtsch Med Wochenschr 1996; 121:331-5. [PMID: 8681722 DOI: 10.1055/s-2008-1043009] [Citation(s) in RCA: 2] [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: 02/01/2023]
Abstract
HISTORY AND CLINICAL FINDINGS A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion. INVESTIGATIONS Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease. TREATMENT AND COURSE With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days). CONCLUSION VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.
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Affiliation(s)
- A Jacobs
- Klinik und Poliklinik für Neurologie und Psychiatrie der Universität, Köln
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33
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Kuntzer T, Ochsner F. Evidence of axonal reinnervation in two arthropod-borne viral encephalomyelitis patients. Eur Neurol 1996; 36:57-9. [PMID: 8719656 DOI: 10.1159/000117205] [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] [Indexed: 02/01/2023]
Affiliation(s)
- T Kuntzer
- Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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34
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Tsutsumi H, Kamazaki H, Nakata S, Chiba S, Imai S, Osato T. Sequential development of acute meningoencephalitis and transverse myelitis caused by Epstein-Barr virus during infectious mononucleosis. Pediatr Infect Dis J 1994; 13:665-7. [PMID: 7970962] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- H Tsutsumi
- Department of Pediatrics, School of Medicine, Sapporo Medical University, Japan
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35
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Gómez-Tortosa E, Gadea I, Gegúndez MI, Esteban A, Rábano J, Fernández-Guerrero ML, Soriano F. Development of myelopathy before herpes zoster rash in a patient with AIDS. Clin Infect Dis 1994; 18:810-2. [PMID: 8075278 DOI: 10.1093/clinids/18.5.810] [Citation(s) in RCA: 10] [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: 01/28/2023] Open
Abstract
We describe the case of a patient with AIDS who developed progressive myelopathy due to varicella-zoster virus 2 months before the appearance of skin lesions typical of herpes zoster. Varicella-zoster virus was isolated from his CSF. Therapy with acyclovir failed to control his neurological complications despite its in vitro efficacy against the isolates.
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Affiliation(s)
- E Gómez-Tortosa
- Department of Neurology, Fundación Jimenez Díaz, Madrid, Spain
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36
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Landgren M, Kyllerman M, Bergström T, Dotevall L, Ljungström L, Ricksten A. Diagnosis of Epstein-Barr virus-induced central nervous system infections by DNA amplification from cerebrospinal fluid. Ann Neurol 1994; 35:631-5. [PMID: 8179310 DOI: 10.1002/ana.410350522] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [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: 01/29/2023]
Abstract
A nested polymerase chain reaction was used for the detection of Epstein-Barr virus DNA in 1 patient with encephalitis, and in 1 patient with myelitis. Epstein-Barr virus DNA was detected in cerebrospinal fluid samples obtained at the onset of neurological symptoms in both patients, and serological findings indicated ongoing Epstein-Barr virus infection. In the patient with encephalitis, herpes simplex virus type 1 DNA was transiently detected in the cerebrospinal fluid, while Epstein-Barr virus DNA was still present on day 44 after admittance. Single-photon emission computed tomography in this patient indicated a frontal bilateral hypoperfusion. The diagnostic value of polymerase chain reaction on cerebrospinal fluid and serum samples for Epstein-Barr virus infections of the central nervous system is emphasized.
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Affiliation(s)
- M Landgren
- Department of Pediatrics II, University of Göteborg, Sweden
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37
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Abstract
All cases of neurological infections virologically verified as due to herpes simplex virus (HSV) during a 2-year period in the Helsinki University Hospital area were studied. Altogether 10 cases were divided clinically into two forms: encephalitis 5 cases, polyradiculomyelitis, meningitis and miscellaneous 5 cases. All the cases of encephalitis were treated with acyclovir. None of the severe cases of herpes radiculomyelitis received this drug, because of lack of a rapid virological diagnosis. Besides encephalitis HSV was associated with other types of severe diseases and those need attention for proper therapy.
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Affiliation(s)
- M Färkkilä
- Department of Neurology, University of Helsinki, Finland
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38
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Siddiqui AA, Khan N, Waqar MA. Evaluation of creatine kinase in the cerebrospinal fluid of patients with various neurological diseases. Biochem Soc Trans 1990; 18:1257-8. [PMID: 2088902 DOI: 10.1042/bst0181257] [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] [Indexed: 12/30/2022]
Affiliation(s)
- A A Siddiqui
- Department of Biochemistry, Aga Khan University Medical College, Karachi, Pakistan
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39
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Abstract
Eight weeks after a tick bite, a 33-year-old male patient presented with stiffness of one leg together with spasmodic painful jerks resembling stiff man syndrome. Isolated myelitis of lumbosacral segments of the spinal cord, apparently confined to the grey matter, was diagnosed and its spirochaetal aetiology confirmed by serology and CSF findings. Oligoclonal IgG bands in CSF specific for Borrelia burgdorferi were found. Thus, there is evidence that B. burgdorferi ist able to cause a localized myelitis, probably of spinal interneurons, presenting as a partial stiff man syndrome.
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Affiliation(s)
- R Martin
- Department of Neurology, University of Würzburg, Federal Republic of Germany
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40
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Martin R, Ortlauf J, Sticht-Groh V, Mertens HG. Isolation and characterization of Borrelia burgdorferi-specific and autoreactive T-cell lines from the cerebrospinal fluid of patients with Lyme meningoradiculomyelitis. Ann N Y Acad Sci 1988; 540:449-51. [PMID: 2462820 DOI: 10.1111/j.1749-6632.1988.tb27130.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- R Martin
- Department of Neurology, University of Würzburg, FRG
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41
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Denning DW, Anderson J, Rudge P, Smith H. Acute myelopathy associated with primary infection with human immunodeficiency virus. Br Med J (Clin Res Ed) 1987; 294:143-4. [PMID: 2885058 PMCID: PMC1245159 DOI: 10.1136/bmj.294.6565.143] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 29 year old white homosexual man presented with a two and a half week history of severe sore throat, fever, and extreme fatigue. His symptoms did not respond to antibiotics. He had mild bilateral conjunctivitis, a rash over his chest and back, and enlarged lymph nodes, but examination of the nervous system yielded normal results. He had low total white cell and platelet counts. The results of enzyme linked immunosorbent assay for human immunodeficiency virus (HIV) were equivocal when HIV IgM was detected in serum. Despite treatment with ampicillin his temperature remained high and he developed abnormal neurological signs, including a paraparesis and hyperreflexia of the arms. HIV was isolated from lymphocytes from blood and cerebrospinal fluid. Over the next six weeks the patient improved and was discharged. Two months later abnormal neurological signs persisted in his legs. Although various neurological syndromes associated with seroconversion to HIV have been described, this is probably the first report of a patient with myelopathy at the time of seroconversion.
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Abstract
We present a case of herpes zoster (HZ) with some uncommon features, namely lumbar localization and muscle weakness with a distribution different from the site of cutaneous eruptions and sensory deficits. Spread of HZ virus from sensory ganglion to anterior horn cells seems the only possible explanation of these clinical features. Urinary retention and CSF data confirm the hypothesis of HZ myelitis.
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Chopra A, Rana PV, Narayanaswamy AS, Bajpai CP, Madan VS. Neurological complications following acute viral conjunctivitis: a new profile. Trop Geogr Med 1986; 38:197-202. [PMID: 3750388] [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: 01/07/2023]
Abstract
A study of eleven patients presenting with neurological complications following acute viral conjunctivitis, mostly haemorrhagic, is reported and the literature reviewed. A Guillain-Barre syndrome-like profile was seen in six patients while the remaining had features of radiculomyelitis. Besides asymmetrical neurological deficits, protein cell reaction and residual muscle wasting, the occurrence of dysautonomias was the striking feature noted in the patients with a Guillain-Barre syndrome-like profile. The dysautonomic features included fatal paroxysmal hypertensive and hypotensive crises in one patient and self limiting tachycardias, episodic profuse sweating, abnormal expiration-inspiration ratio and valsalva ratio in four patients. High antibody titers to EV-70 virus were seen in five patients. A follow up of one and a half year revealed poor neurologic recovery in patients with radiculomyelitis as compared to good functional recovery in others. The importance of early recognition and appropriate treatment of dysautonomias is emphasised. The probable aetiopathogenesis of the neurological complications including dysautonomias is discussed.
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Abstract
Inoue-Melnick virus (IMV) was isolated from the cerebrospinal fluid of patients with chronic neurologic disorders. The effect of acyclovir (ACV), 9-(2-hydroxyethoxymethyl)-guanine, on the growth of IMV was studied in human diploid cell cultures. ACV markedly inhibited the multiplication of all three IMV serotypes in vitro with the same inhibitory effect. By passage of IMV in the presence of ACV in the medium, ACV-resistant mutants of three IMV serotypes were easily isolated.
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45
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Bhattacharyya K. Lymphocytoma cutis with meningeal involvement. J Indian Med Assoc 1984; 82:210-1. [PMID: 6491321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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46
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Mayhew IG, Brewer BD, Reinhard MK, Greiner EC. Verminous (Strongylus vulgaris) myelitis in a donkey. Cornell Vet 1984; 74:30-37. [PMID: 6705537] [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: 05/21/2023]
Abstract
A fifth stage Strongylus vulgaris migrated through the spinal cord of a 2-year-old, male donkey resulting in progressive paraparesis and then tetraplegia. A profound neutrophilic pleocytosis was detected on analysis of cerebrospinal fluid. The parasite appeared to have entered the mid-lumbar spinal cord, migrated to the cranial thoracic segments, exited, then re-entered the spinal cord a few segments craniad. It then traveled further cranially and was found in the third cervical spinal cord segment. Some parts of the lesion were remarkably free from tissue necrosis, hemorrhage and inflammation. Severe granulomatous myelitis with hemorrhage and necrosis were seen at other sites. The latter were quite similar to lesions seen in equine protozoal myeloencephalitis.
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47
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Mokuno K, Kato K, Kawai K, Matsuoka Y, Yanagi T, Sobue I. Neuron-specific enolase and S-100 protein levels in cerebrospinal fluid of patients with various neurological diseases. J Neurol Sci 1983; 60:443-51. [PMID: 6355398 DOI: 10.1016/0022-510x(83)90155-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Neuron-specific enolase (NSE) and S-100 protein (S-100) levels in cerebrospinal fluid (CSF) were determined in 129 patients with various neurological diseases. The chronological changes of these nervous system-specific proteins in CSF were also examined in 3 patients with acute disorders. NSE and S-100 levels were elevated in many cases with acute conditions. These specific proteins did not increase simultaneously but independently. These results suggested that NSE and S-100 in CSF would be useful markers for damage of the nervous system and that measurement of both NSE and S-100 might positively indicate whether the damage was neuronal, glial or mixed in origin. Moreover, from the serial determination of these substances, they would be better markers than cell counts and total protein in CSF for the active injury for the nervous tissues.
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48
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Deuskar NJ, Thakare JP, Gore MM, Wadia RS, Ghosh SN. Cerebrospinal fluid immunoglobulins in acute transverse myelitis. Indian J Med Res 1983; 77:854-60. [PMID: 6642583] [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: 01/21/2023] Open
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49
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Kohler J, Schröter E, Cramer H. Somatostatin-like immunoreactivity in the cerebrospinal fluid of neurological patients. Arch Psychiatr Nervenkr (1970) 1982; 231:503-8. [PMID: 6127989 DOI: 10.1007/bf00343993] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Using a specific radioimmunoassay we have measured somatostatin-like immunoreactivity (SLIR) of CSF in patients with brain atrophy, spinal spasticity, seizures, brain tumors and inflammatory disorders. Patients with marked brain atrophy had significantly decreased somatostatin levels in CSF. In patients with spinal spasticity significantly higher levels were observed. Seizure patients had reduced levels but the difference was not significant. In patients with inflammatory disorders and malignant brain tumors SLIR levels were significantly elevated but not in patients with benign brain tumors. A possible pathophysiologic meaning of SLIR in spasticity and seizures is discussed. The altered levels in brain atrophy, tumors and inflammatory disorders are probably indirect signs of altered somatostatin turnover or increased somatostatin leakage from damaged CNS.
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50
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Kauerz U, Weisner B, Bernhardt W, Rehpenning W. [C.S.F. and blood glucose levels as an indicator of functioning of the blood-brain barrier (author's transl)]. Nervenarzt 1982; 53:91-7. [PMID: 7063093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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