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Poorthuis MHF, Battjes S, Dorigo-Zetsma JW, de Kruijk JR. Primary Epstein-Barr virus infection in immunocompetent patients with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome as neurological manifestations. BMJ Case Rep 2018; 2018:bcr-2018-225333. [PMID: 30158264 PMCID: PMC6119397 DOI: 10.1136/bcr-2018-225333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2018] [Indexed: 11/04/2022] Open
Abstract
Neurological manifestations of a primary Epstein-Barr virus (EBV) infection are rare. We describe a case with acute transverse myelitis and another case with a combination of polyradiculitis and anterior horn syndrome as manifestations of a primary EBV infection.The first case is a 50-year-old immunocompetent male diagnosed with acute transverse myelitis, 2 weeks after he was clinically diagnosed with infectious mononucleosis. The second case is an 18-year-old immunocompetent male diagnosed with a combination of polyradiculitis and anterior horn syndrome while he had infectious mononucleosis. The first patient was treated with methylprednisolone. After 1 year, he was able to stop performing clean intermittent self-catheterisation. The second patient completely recovered within 6 weeks without treatment.Primary EBV infection should be considered in immunocompetent patients presenting with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome. Antiviral treatment and steroids are controversial, and the prognosis of neurological sequelae is largely unknown.
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Merino-Urrutia W, Villagrán-Schmidt M, Ulloa-Vásquez P, Carrasco-Moyano R, Uribe A, Stoicea N, Bergese SD. Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess: A case report. Medicine (Baltimore) 2018; 97:e0693. [PMID: 29742719 PMCID: PMC5959389 DOI: 10.1097/md.0000000000010693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Neuraxial anesthesia is a commonly used type of regional anesthesia. Cauda equina syndrome is an unusual and severe complication of neuraxial anesthesia, and is caused by damage to the sacral roots of the neural canal. We present a case of cauda equina syndrome following spinal anesthesia in a patient who underwent Bartholin abscess drainage. PATIENT CONCERNS A 23-year old female scheduled to undergo surgical drainage of Bartholin abscess. Spinal anesthesia was performed with bupivacaine and fentanyl. There were no perioperative adverse events reported. On postoperative day 1, the patient went to the emergency department describing bilateral weakness and pain of the lower extremities (LE). DIAGNOSES Lumbar magnetic resonance imaging showed increased gadolinium accumulation in the neural sheath at the level of the cauda equina tracts, consistent with the diagnosis of arachnoiditis and the diagnosis of cauda equina was established. INTERVENTIONS The patient received the following emergent treatment: 75 mg pregabalin (oral) every 12 hours, 20 mg (8 drops) tramadol (oral) every 8 hours, and 4 mg dexamethasone (intravenous) every 6 hours. On postoperative day 4, the patient still experienced bilateral flaccid paraparesis (accentuated in the left side), neuropathic pain in low extremities, and left brachial monoparesis. Hence, dexamethasone was instantly replaced with 1 g methylprednisolone (intravenous) for 5 days. OUTCOMES After completing 5 days of methylprednisolone, on postoperative day 9, the patient experienced less pain in left extremities, osteotendinous reflexes were slightly diminished, and she was able to walk with difficulty for 3 to 5 minutes. Greater mobility was evidenced, with right proximal and distal low extremities Medical Research Council Scale grades of 2 and 3 and left proximal and distal low extremities Medical Research Council Scale grades 1 and 2, respectively. Oral prednisone was restarted. Consequently, she was discharged home in stable conditions on postoperative day 25 with a prescription for sertraline, clonazepam, pregabalin, paracetamol, and prednisone. LESSON The early detection and treatment of complications after neuraxial anesthesia is essential to minimize the risk of permanent damage.
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Affiliation(s)
- Waldo Merino-Urrutia
- Department of Surgery, Orthopedic and Anesthesiology, Universidad de La Frontera, Hospital Hernán Henríquez Aravena, Temuco, Chile
| | - Milca Villagrán-Schmidt
- Department of Surgery, Orthopedic and Anesthesiology, Universidad de La Frontera, Hospital Hernán Henríquez Aravena, Temuco, Chile
| | - Priscilla Ulloa-Vásquez
- Department of Surgery, Orthopedic and Anesthesiology, Universidad de La Frontera, Hospital Hernán Henríquez Aravena, Temuco, Chile
| | - Rubén Carrasco-Moyano
- Department of Surgery, Orthopedic and Anesthesiology, Universidad de La Frontera, Hospital Hernán Henríquez Aravena, Temuco, Chile
- Department of Anesthesiology
| | | | | | - Sergio D. Bergese
- Department of Anesthesiology
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Melnick SC. Treatment of the Guillain-Barre syndrome. Bibl Psychiatr Neurol 2015; 139:375-84. [PMID: 4332889 DOI: 10.1159/000385722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Polyradiculopathy (PRP) is a rare but serious neurologic complication of cytomegalovirus (CMV) in patients with acquired immunodeficiency syndrome (AIDS). We herein report three cases of CMV PRP in patients with AIDS. Although providing a prompt diagnosis and initiating anti-CMV therapy may achieve clinical improvements, administering single-drug treatment may result in virologic failure. Therefore, introducing antiretroviral therapy is a key step for improving the treatment outcomes of CMV PRP.
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Affiliation(s)
- Kazuaki Kameda
- Department of Infectious Diseases, Osaka City General Hospital, Japan
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Chang HH, Havton LA. Serotonergic 5-HT(1A) receptor agonist (8-OH-DPAT) ameliorates impaired micturition reflexes in a chronic ventral root avulsion model of incomplete cauda equina/conus medullaris injury. Exp Neurol 2012; 239:210-7. [PMID: 23099413 DOI: 10.1016/j.expneurol.2012.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Received: 09/05/2012] [Revised: 10/05/2012] [Accepted: 10/16/2012] [Indexed: 12/17/2022]
Abstract
Trauma to the thoracolumbar spine commonly results in injuries to the cauda equina and the lumbosacral portion of the spinal cord. Both complete and partial injury syndromes may follow. Here, we tested the hypothesis that serotonergic modulation may improve voiding function after an incomplete cauda equina/conus medullaris injury. For this purpose, we used a unilateral L5-S2 ventral root avulsion (VRA) injury model in the rat to mimic a partial lesion to the cauda equina and conus medullaris. Compared to a sham-operated series, comprehensive urodynamic studies demonstrated a markedly reduced voiding efficiency at 12 weeks after the VRA injury. Detailed cystometrogram studies showed injury-induced decreased peak bladder pressures indicative of reduced contractile properties. Concurrent external urethral sphincter (EUS) electromyography demonstrated shortened burst and prolonged silent periods associated with the elimination phase. Next, a 5-HT(1A) receptor agonist, 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT), was administered intravenously at 12 weeks after the unilateral L5-S2 VRA injury. Both voiding efficiency and maximum intravesical pressure were significantly improved by 8-OH-DPAT (0.3-1.0 mg/kg). 8-OH-DPAT also enhanced the amplitude of EUS tonic and bursting activity as well as duration of EUS bursting and silent period during EUS bursting. The results indicate that 8-OH-DPAT improves voiding efficiency and enhances EUS bursting in rats with unilateral VRA injury. We conclude that serotonergic modulation of the 5-HT(1A) receptor may represent a new strategy to improve lower urinary tract function after incomplete cauda equina/conus medullaris injuries in experimental studies.
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Affiliation(s)
- Huiyi H Chang
- Department of Anesthesiology and Perioperative Care, UC Irvine, Irvine, CA 92697, USA
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6
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Hoelzer BC, Weingarten TN, Hooten WM, Wright RS, Wilson WR, Wilson PR. Paraspinal abscess complicated by endocarditis following a facet joint injection⋆. Eur J Pain 2012; 12:261-5. [PMID: 17606390 DOI: 10.1016/j.ejpain.2007.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 03/29/2007] [Accepted: 05/13/2007] [Indexed: 12/17/2022]
Abstract
Infectious complications secondary to lumbar facet injections are exceedingly rare, follow an indolent course, and local sequelae include abscess spread or infections of the central nervous system. We present the case of the development of a facet abscess and infective endocarditis, which developed shortly after a lumbar facet injection. With the increase in interventional pain procedures, physicians must be aware of potential infectious complications.
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Affiliation(s)
- Bryan C Hoelzer
- Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street, S.W., Rochester, MN 55905, USA
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Czell D, Rodic B, Imoberdorf R. [Neuroborreliosis--a disease with many faces]. Praxis (Bern 1994) 2011; 100:607-612. [PMID: 21563099 DOI: 10.1024/1661-8157/a000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Borreliosis has been widely recognized in Switzerland and is often used in unclear cases with non-specific symptoms. Two illustrative cases should emphasize the current options for diagnosis and therapy of neuroborreliosis. The keystones of the diagnostic instruments are a history with typical symptoms and analysis of the cerebrospinal fluid with determination of appropriate antibodies. Therapy deals with ceftriaxon with intravenous and doxycyclin with oral application making ambulatory treatment possible.
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Affiliation(s)
- D Czell
- Muskelzentrum/ALS Clinic, Kantonsspital St. Gallen.
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8
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Ea HK, Lot G, Bardin T. Lumboperitoneal shunting of cerebrospinal fluid versus anti-tumor necrosis factor treatment of cauda equina syndrome in ankylosing spondylitis: comment on the article by Cornec et al. ACTA ACUST UNITED AC 2010; 62:1559-60; author reply 1560-1. [PMID: 20178129 DOI: 10.1002/art.27413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Prommer EE. Cauda equina syndrome and decreasing opioid requirements. J Pain Symptom Manage 2009; 37:e8-9. [PMID: 19345296 DOI: 10.1016/j.jpainsymman.2008.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 11/07/2008] [Indexed: 11/22/2022]
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Baumann J. Results of treatment of certain diseases of the central nervous system with ACTH and corticosteroids. Acta Neurol Scand Suppl 2009; 13 Pt 2:453-61. [PMID: 4284452 DOI: 10.1111/j.1600-0404.1965.tb01914.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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13
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Kytömäki O, Rinne UK. Adrenocortical secretion capacity during long-term corticotrophin treatment of neurological patients. Acta Neurol Scand 2009; 46:263-4. [PMID: 4318676 DOI: 10.1111/j.1600-0404.1970.tb02220.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Lai WWL, Ubogu EE. Chronic inflammatory demyelinating polyradiculoneuropathy presenting as cauda equina syndrome in a diabetic. J Neurol Sci 2007; 260:267-70. [PMID: 17521674 DOI: 10.1016/j.jns.2007.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 04/15/2007] [Accepted: 04/17/2007] [Indexed: 10/23/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) may occur in association with diabetes mellitus (DM). We report a case of a poorly controlled diabetic patient who presented with rapid onset of bilateral lower extremity weakness and sensory loss associated with sacral and posterior thigh paresthesias and urinary and bowel incontinence, indicative of cauda equina syndrome (CES). Subsequent evaluation was consistent with CIDP. Monthly infusions with intravenous immunoglobulins (IVIg) with strict glycemic control using insulin resulted in remarkable clinical and electrophysiological recovery. This case report describes a rare presentation of CIDP and emphasizes the importance of early utility of electrodiagnostic (EDX) studies in the clinical evaluation of diabetic patients presenting with rapidly progressive lower extremity weakness and sensory loss associated with diminished reflexes.
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Affiliation(s)
- Wayne W L Lai
- Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106-1703, United States
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Ito T, Ohtori S, Hata K, Inoue G, Moriya H, Takahashi K, Yamashita T. Rho kinase inhibitor improves motor dysfunction and hypoalgesia in a rat model of lumbar spinal canal stenosis. Spine (Phila Pa 1976) 2007; 32:2070-5. [PMID: 17762807 DOI: 10.1097/brs.0b013e318145a502] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Immunohistochemical and behavioral study using a rat cauda equina compression model. OBJECTIVE To investigate, after cauda equina compression by spinal canal stenosis (SCS), Rho activation in the spinal cord and cauda equina, and the effect of intrathecal administration of a Rho kinase inhibitor on hypoalgesia and motor dysfunction. SUMMARY OF BACKGROUND DATA Compression of the cauda equina caused by SCS is a common clinical disorder associated with sensory disturbance and intermittent claudication. Cauda equina compression is thought to reduce blood flow and result in nerve degeneration caused by various cytokines. Rho, a member of the small GTPases, is a signal transmitter. It promotes Wallerian degeneration, decreases blood flow in the spinal cord and brain, and increases expression of several cytokines. Currently, Rho kinase inhibitor is used clinically to treat progressive nerve damage due to cerebrovascular disorders. However, its effect for SCS has not been evaluated. METHODS Forty-two 6-week-old male Sprague-Dawley rats (200-250 g) were used. For the SCS model (n = 27), a small piece of silicon was placed under the lamina of the fourth lumbar vertebra. In the sham-operated group, laminectomies were performed at L5 only (n = 15). We examined mechanical sensitivity and motor function using von Frey hairs and a treadmill, and immunohistochemically localized Rho in the spinal ventral neurons, axons, and Schwann cells in the cauda equina. We also examined the effects of intrathecally administered Rho kinase inhibitor for hypoalgesia or motor dysfunction caused by SCS. RESULTS We observed motor dysfunction and hypoalgesia and activated Rho-immunoreactive cells in spinal ventral neuroreported to induce neurite and axonal outgrowth in the spinal cord and brain after nervous system injury. In addition, 1 report showed that Rho kinase was involved in Wallerian degeneration that was rescued by Rho kinase inhibitor. Furthermore, it is thought that Rho is involved in TNF-alpha and interleukin (IL) production in the central nervous system, and the production was inhibited by administering Rho kinase inhibitor in the central nervous system. Regardns, axons, and Schwann cells in the cauda equina. Intrathecal administration of Rho kinase inhibitor improved mechanical hypoalgesia and motor dysfunction caused by SCS. CONCLUSION Activated Rho may play an important role in nerve damage in the cauda equina in SCS. Rho kinase inhibitor may be a useful tool in determining the pathomechanism of cauda equina syndrome caused by SCS.
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Affiliation(s)
- Toshinori Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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16
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Abstract
A 67-year-old woman was diagnosed with inflammatory polyradiculoneuropathy. The intravenously administered immunoglobulin (IVIG) treatment that she received several times over a 3-year period relieved her clinical symptoms of muscle weakness and sensory disturbances, but these symptoms had worsened thereafter despite further IVIG treatment. MRI detected a solid tumor involving the cauda equina and pathological examinations confirmed this to be malignant lymphoma. The clinical and radiological findings for the malignant lymphoma of the cauda equina in this patient were quite similar to those for the inflammatory polyradiculoneuropathy.
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Affiliation(s)
- Yasutaka Tajima
- Department of Neurology, Sapporo City General Hospital, Sapporo.
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17
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Douthwaite ST, Taegtmeyer M, Stow R, Mwandumba HC, Hart IJ, Beeching NJ. Cidofovir treatment of HIV-associated cytomegalovirus polyradiculopathy. AIDS 2006; 20:632-4. [PMID: 16470133 DOI: 10.1097/01.aids.0000210623.98577.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Neurosarcoidosis is a rare manifestation of sarcoidosis. Involvement of the nervous system in sarcoidosis can range from peripheral or cranial neuropathy to central nervous system disease. Cauda equina sarcoidosis is distinctly rare. REVIEW SUMMARY The authors present a 58-year-old patient with systemic sarcoidosis who developed cauda equina and conus medullaris syndrome. Seventeen previous published cases of cauda equina sarcoidosis are reviewed. The history of systemic sarcoidosis, cerebrospinal fluid characteristics of lymphocytic pleocytosis with elevated protein, and evidence of acute denervation by needle electromyography are helpful in the diagnosis of this condition. Early diagnosis and treatment of cauda equina sarcoidosis usually provide a rapid recovery and yield a good prognosis. CONCLUSION Although rare, sarcoidosis should be considered in the differential diagnosis of cauda equina syndrome, particularly in patients with unclear etiology.
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Affiliation(s)
- Kitti Kaiboriboon
- Department of Neurology and the Department of Internal Medicine, Saint Louis University, St. Louis, MO 63110, USA
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19
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Maugars Y, Glémarec J. [Radiculopathy and carpal tunnel syndrome]. Rev Prat 2005; 55:81-90. [PMID: 15801403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Yves Maugars
- Service de rhumatologie, CHU hôpital Saint-Jacques, 77093 Nantes Cedex 01.
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Bersano A, Carpo M, Cappellari A, Bresolin N, Nobile-Orazio E. Transient response to immune therapies in post-irradiation lumbosacral radiculoplexopathy. J Neurol 2004; 251:488-90. [PMID: 15083301 DOI: 10.1007/s00415-004-0405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Revised: 01/08/2004] [Accepted: 01/19/2004] [Indexed: 11/25/2022]
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Singh NN, Verma R, Pankaj BK, Misra S. Cauda-conus syndrome resulting from neurocysticercosis. Neurol India 2003; 51:118-20. [PMID: 12865544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
A 60-year-old male, presented with insidious onset, gradually progressive, burning paresthesia over the saddle area, sphincteric disturbance, impotence and paraparesis. Investigations revealed a ring-enhancing lesion in the conus medullaris suggestive of neurocysticercosis. This was supported by quantitative enzyme-linked immunosorbant assay from purified cell fraction of taenia solium cysticerci. On treatment with steroids he showed marked improvement.
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Affiliation(s)
- N N Singh
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India.
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Bjørn AMB, Lebech AMK. [Extrapulmonary complications of Mycoplasma pneumoniae infections]. Ugeskr Laeger 2002; 164:1805-9. [PMID: 11957438] [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: 02/24/2023]
Abstract
INTRODUCTION Mycoplasma pneumoniae is a common cause of atypical pneumonia in children and young adults. The infection is generally mild and only a very few patients are admitted to hospital. However, extrapulmonary complications are well recognised--mostly as manifestations from the central nervous system (CNS). MATERIAL AND METHODS We describe 21 patients with M. pneumoniae infection seen at Rigshospitalet, Copenhagen, from 1994 to 2000. RESULTS The patients had fever, headache, myalgia, and cough. Biochemically, they were characterised by leucocytosis, an increased level of C-reactive protein, and infiltrations on the chest x-ray. A total of seven patients developed extrapulmonary complications to the infection in the form of encephalitis (3), polyradiculitis (1), transversel myelitis (1), erythema multiforme (3), cardial arrhythmia (1), and haemolytic anaemia (2). Three patients had more than one complication at the same time. DISCUSSION The incidence of patients with complications to M. pneumoniae infection was higher than that reported in the literature, probably because these patients are typically submitted to the Department of Infectious Diseases, Rigshospitalet. The pathogenesis of extrapulmonary complications to M. pneumoniae infection is unknown.
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MESH Headings
- Adolescent
- Adult
- Aged
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/drug therapy
- Anemia, Hemolytic/microbiology
- Anti-Bacterial Agents/administration & dosage
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/microbiology
- Child
- Encephalitis/diagnosis
- Encephalitis/drug therapy
- Encephalitis/microbiology
- Erythema Multiforme/diagnosis
- Erythema Multiforme/drug therapy
- Erythema Multiforme/microbiology
- Female
- Humans
- Male
- Middle Aged
- Mycoplasma pneumoniae/genetics
- Mycoplasma pneumoniae/immunology
- Mycoplasma pneumoniae/isolation & purification
- Myelitis, Transverse/diagnosis
- Myelitis, Transverse/drug therapy
- Myelitis, Transverse/microbiology
- Pneumonia, Mycoplasma/complications
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/drug therapy
- Polyradiculopathy/diagnosis
- Polyradiculopathy/drug therapy
- Polyradiculopathy/microbiology
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Ahn NU, Ahn UM, Nallamshetty L, Springer BD, Buchowski JM, Funches L, Garrett ES, Kostuik JP, Kebaish KM, Sponseller PD. Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): meta-analysis of outcomes after medical and surgical treatments. J Spinal Disord 2001; 14:427-33. [PMID: 11586143 DOI: 10.1097/00002517-200110000-00009] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome) is marked by slow, insidious progression and a high incidence of dural ectasia in the lumbosacral spine. A high index of suspicion for this problem must be maintained when evaluating the patient with ankylosing spondylitis with a history of incontinence and neurologic deficit on examination. There has been disagreement in the literature as to whether surgical treatment is warranted for this condition. A meta-analysis was thus performed comparing outcomes with treatment regimens. Our results suggest that leaving these patients untreated or treating with steroids alone is inappropriate. Nonsteroidal antiinflammatory drugs may improve back pain but do not improve neurologic deficit. Surgical treatment of the dural ectasia, either by lumboperitoneal shunting or laminectomy, may improve neurologic dysfunction or halt the progression of neurologic deficit.
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Affiliation(s)
- N U Ahn
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Lasso M, Pérez J, Noriega LM, Albert F, González P, Malebrán A. [Polyradiculopathy caused by cytomegalovirus in AIDS patients: successful treatment with highly active antiretroviral therapy (HAART)]. Rev Med Chil 2001; 129:1061-4. [PMID: 11725471] [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: 02/22/2023]
Abstract
We report two male patients with AIDS, aged 23 and 30 years old respectively. One was admitted due to a progressive weakness of the left leg and urinary and fecal incontinence. The other was admitted due to a progressive paraparesia without incontinence, but with a severe lumbar pain. In both patients polymerase chain reactions for cytomegalovirus in cerebrospinal fluid were positive. Treatment with ganciclovir, for 21 and 14 days respectively and highly active antiretroviral therapy was started. Both patients experienced recovery of their neurological deficits after 98 and 88 days of therapy, respectively.
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Abstract
A 7-year-old castrated male Rottweiler was evaluated for an 18-month history of bilateral hind limb lameness, signs of pain on rising, and mild ataxia. A gas-filled lumbosacral disk space (vacuum disk phenomenon) was revealed by use of computed tomography. Additional smaller gas bubbles were in the periphery of the disk and between the degenerated L5-L6 dorsal articular facets (vacuum facet phenomenon). Vacuum disk and facet phenomena have been described in humans with degenerative disk and vertebral articular facet joint disease; gas attracted from surrounding tissues accumulates within clefts of the degenerated disk or in unstable facet joints. Vacuum disk phenomenon has been reported in dogs and indicates degenerative disk disease. The phenomenon is more commonly observed by use of computed tomography, compared with conventional radiography, and can be elicited by hyperextension of the vertebral column.
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Affiliation(s)
- T Schwarz
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, University of Glasgow, Scotland
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Cianciulli P, di Toritto TC, Sorrentino F, Sergiacomi L, Massa A, Amadori S. Hydroxyurea therapy in paraparesis and cauda equina syndrome due to extramedullary haematopoiesis in thalassaemia: improvement of clinical and haematological parameters. Eur J Haematol 2000; 64:426-9. [PMID: 10901597 DOI: 10.1034/j.1600-0609.2000.9c165.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with beta-globin disorders show amelioration of clinical condition by sustained synthesis of fetal haemoglobin in adult life. We report data on a patient with beta(o)-thalassaemia genotype and thalassaemia intermedia clinical phenotype. He received therapy with hydroxyurea (20 mg/kg/d) because of the presence of extramedullary masses causing paraparesis, neurogenic bladder and impotence. During therapy, the patient showed an improved clinical picture and a significant increase in total Hb (from 71.8 to 103.2 g/L) and a gamma/alpha globin synthetic ratio (from 0.39 to 0.68). The myelosuppressive effect of hydroxyurea was revealed by a decrease in CFU-GEMM, BFU-E, and CFU-GM. Therefore hydroxyurea can be effective in the treatment of patients with extramedullary haematopoiesis (EMH) who are not transfusion-dependent and cannot be treated with radiotherapy.
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Affiliation(s)
- P Cianciulli
- Department of Haematology, St. Eugenio Hospital, Rome, Italy
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Parra Ródenas JV, Riera Ayora M, Ronda Gasulla A, Herrera Ballester A. [Lumbosacral and meningeal polyradicular disease in a patient with HIV infection]. An Med Interna 1999; 16:435-6. [PMID: 10507175] [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: 02/14/2023]
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Ahearn GS, Bedlack RS, Price DT, Robertson CN, Morgenlander JC. Transient lumbosacral polyradiculopathy after prostatectomy: association with spinal stenosis. South Med J 1999; 92:809-11. [PMID: 10456722 DOI: 10.1097/00007611-199908000-00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mononeuropathies are common after pelvic surgery. They are usually the result of unnatural positioning during surgery or faulty restraining devices. Polyneuropathy in the postoperative setting is rare. We report two cases of polyradiculopathy after radical prostatectomy using two different patient positions. Both patients complained of paresthesias and weakness in their lower extremities on postoperative day 1. Neurologic examination in each case was consistent with a polyradiculopathy. Significant spinal stenosis of the lumbosacral spine was found in both patients by magnetic resonance imaging. We propose that spinal stenosis is a risk factor for this type of neurologic injury.
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Affiliation(s)
- G S Ahearn
- Division of Neurology, Duke University Medical Center, Durham, NC 27710, USA
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Miguélez M, Correa-Nazco VJ, Linares M, Laynez P, González M, Martínez A. [Lumbosacral polyradiculomyelitis caused by herpes simplex virus (HSV) in a patient with AIDS]. An Med Interna 1999; 16:417-9. [PMID: 10507169] [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: 02/14/2023]
Abstract
To our knowledge this is the first description of lumbosacral polyradiculopathy produced by herpes simplex virus (HSV) without coinfection by cytomegalovirus (CMV) in a patient with HIV infection. The acute lumbosacral polyradiculomyelitis (ALP) in patients with AIDS is a well defined nosologic entity and classically associated to CMV infection. However, this pathology can be due to others etiologies as toxoplasmosis, syphilis, lymphoma, tuberculosis, cryptococcus, varicella-zoster virus fVZV), Epstein-Barr virus (EBT) and HSV associated CMV. The case report was documented with findings in cerebrospinal fluid, magnetic resonance imaging and was confirmed by detection of HSV DNA by polymerase chain reaction. CMV DNA was not detected and no clinical features of CMV disease was seen. Therapy with foscarnet was successful. This drug without gancyclovir associated has rarely been employed in the treatment of ALP. We believe that foscarnet may be a valuable alternative therapy for cases of ALP of suspected acyclovir-resistant herpes virus infection.
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Affiliation(s)
- M Miguélez
- Servicio de Medicina Interna, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife
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Abstract
INTRODUCTION Radicular manifestations of ankylosing spondylitis are rare and observed in the course of long-term ankylosing spondylitis. EXEGESIS The case of a young man who presented with bilateral and multiple radicular involvement is reported. Neurological symptoms occur a few weeks before ankylosing spondylitis was diagnosed. CONCLUSION This suggests that nerve root lesions might take place during initial stages of the disease. The role of inflammatory changes in the region of the intervertebral foramina is discussed. Disease evolution is marked by relief of neurological disorders in response to anti-inflammatory treatment.
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Affiliation(s)
- L Guilloton
- Service de neurologie, hôpital d'instruction des armées Desgenettes, Lyon, France
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Landete L, Blasco R. [Sjögren syndrome and subacute demyelinating polyradiculopathy: an unusual association]. Rev Neurol 1998; 27:995-7. [PMID: 9951023] [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: 02/10/2023]
Abstract
INTRODUCTION Sjögren's syndrome is a chronic inflammatory condition of unknown aetiology and autoimmune pathology. The defining feature is the dry syndrome, expressed as xerophthalmia and xerostomia. Extra-glandular involvement at many other levels may also occur. Neurological involvement is not unusual. The peripheral nervous system is most frequently involved, and a predominantly sensitive symmetrical distal polyneuropathy may be the first sign of the condition. Other patterns of peripheral involvement are also associated with the syndrome. We present a case of subacute demyelinating polyradiculopathy associated with primary Sjögren's syndrome. CLINICAL CASE A 28 year old woman with dry syndrome presented with paraesthesia in her hands and feet, distal weakness, which had progressed proximally in the muscles of her arms and legs, and bilateral facial weakness. The condition progressed for eight weeks. When complementary tests were done, alterations typical of this condition (FR, ANA, anti-Ro and anti-La) were seen and also others typical of the dry syndrome (Schirmer's test). Therefore, in view of these findings and the clinical features, after other conditions had been ruled out, a diagnosis of primary Sjögren's syndrome was made. The type of neuropathy was determined by the clinical features, electromyography and CSF findings. Treatment with corticosteroids gave good results. CONCLUSIONS Demyelinating polyradiculopathy is a form of peripheral nervous system involvement which is rarely seen in this disorder. In the differential diagnosis Sjögren's syndrome should be considered, an orientative history taken, autoantibodies determined and an ophthalmological examination made.
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Affiliation(s)
- L Landete
- Servicio de Neurología, Hospital Universitario La Fe, Valencia, España
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Jayaweera DT, Cassetti LI, Espinoza L, Lopardo GD, Hansman-Whiteman ML, Scerpella EG. [Cytomegalovirus polyradiculomyelopathy in AIDS]. Medicina (B Aires) 1998; 58:135-40. [PMID: 9706245] [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: 02/08/2023] Open
Abstract
To evaluate the efficacy of ganciclovir, foscarnet, or the combination of both for the treatment of cytomegalovirus polyradiculomyelopathy (CMV-PRAM), we reviewed the records of seven patients with AIDS, diagnosed with CMV-PRAM. Muscle strength was graded according to the Medical Research Council (MRC) scale. Response to treatment was also classified according to MRC scale, based on the degree of improvement in muscle strength. Six of 7 patients had a good response to treatment, reaching the MRC scale of 4, or improving at least 3 degrees in the same scale. CMV-PRAM may be treated with ganciclovir alone or in combination with foscarnet.
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Affiliation(s)
- D T Jayaweera
- Department of Medicine, University of Miami School of Medicine, Florida, USA
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Abstract
Using the MEDLINE database, we evaluated 103 cases of AIDS-related cytomegalovirus (CMV) polyradiculopathy (PRP). In 13% of cases, PRP was the initial manifestation of AIDS. Hyporeflexia was present in 100% of cases; lower limb weakness, in 100%; urinary retention, in 94%; paresthesia, in 79%; sensory loss, in 80%; and a Babinski's sign, in 16%. Mean cerebrospinal fluid (CSF) parameters +/- SD were as follows: white blood cell count, 651 +/- 1,053 x 10(6)/L; protein level, 2.28 +/- 1.78 g/L; and CSF/serum glucose ratio, 0.48 +/- 0.17. Gadolinium enhancement of meninges on a magnetic resonance image and abnormalities on a myelogram were noted in 31% and 17% of cases, respectively. Mean survival time +/- SD was 5.4 +/- 1.8 weeks for untreated patients and 14.6 +/- 9.4 weeks for patients treated with ganciclovir (P < .0001), but it was only 7.2 +/- 3.0 weeks for patients receiving ganciclovir treatment at the onset of PRP. CMV-related PRP is an uncommon but distinctive complication of AIDS. Early diagnosis is possible, and other causes can be excluded by lumbar magnetic resonance imaging and by the presence of typical CSF changes, as shown by polymerase chain reaction of CMV. Retrospectively, survival time for naive patients was increased by ganciclovir therapy and may even be underestimated in this evaluation of historical reports.
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Affiliation(s)
- H J Anders
- Medizinische Poliklinik, Ludwig-Maximilian University, Munich, Germany
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Hayashi N, Weinstein JN, Meller ST, Lee HM, Spratt KF, Gebhart GF. The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy. Spine (Phila Pa 1976) 1998; 23:877-85. [PMID: 9580954 DOI: 10.1097/00007632-199804150-00008] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [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: 02/07/2023]
Abstract
STUDY DESIGN The effect of epidural injection of betamethasone or bupivacaine was investigated in an animal model of lumbar radiculopathy. OBJECTIVE To investigate the effects of an epidural steroid (betamethasone) or a local anesthetic (bupivacaine) in an animal model of radiculopathy produced by nerve root irritation. SUMMARY OF BACKGROUND DATA Epidural injections are commonly used for the treatment of low back pain and sciatica. However, efficacy remains controversial, and there is a paucity of basic information to support clinical use or the injections. METHODS Fifty-one rats were used. The left L4 and L5 nerve roots were loosely ligated with chromic gut, and either betamethasone, bupivacaine, betamethasone in combination with bupivacaine, or saline was injected using an epidurally placed catheter. The effects of epidural injection were evaluated using response to noxious stimuli and immunohistochemical methods. RESULTS In betamethasone-treated rats (either alone or in combination with bupivacaine), thermal hyperalgesia was significantly less (P < 0.010 after surgery than that in saline- or bupivacaine-treated groups, in which the hyperalgesia was maximum at 2-3 postoperative weeks before resolving 5 weeks after surgery. Immunohistochemical analysis did not correlate with these results. CONCLUSIONS Epidural steroid injection has a significant effect on the thermal hyperalgesia produced in a model of radiculopathy, which may provide clinical support for advocates of epidural steroids.
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Affiliation(s)
- N Hayashi
- Department of Orthopedic Surgery, Wakayama Medical College, Japan
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Drake WM, Monson JP, Trainer PJ, Sharief M, Dick JP, Kelsey SM. Acute polyneuropathy with chronic lymphocytic leukaemia and paraproteinaemia: response to chlorambucil and prednisolone. J Neurol Neurosurg Psychiatry 1998; 64:564. [PMID: 9576561 PMCID: PMC2170025 DOI: 10.1136/jnnp.64.4.564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Flood J, Drew WL, Miner R, Jekic-McMullen D, Shen LP, Kolberg J, Garvey J, Follansbee S, Poscher M. Diagnosis of cytomegalovirus (CMV) polyradiculopathy and documentation of in vivo anti-CMV activity in cerebrospinal fluid by using branched DNA signal amplification and antigen assays. J Infect Dis 1997; 176:348-52. [PMID: 9237699 DOI: 10.1086/514051] [Citation(s) in RCA: 21] [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: 02/04/2023] Open
Abstract
Branched chain DNA assay (bDNA), cytomegalovirus (CMV) antigen assay, and cerebrospinal fluid (CSF) viral culture were studied for their utility in the diagnosis of CMV polyradiculopathy and for documenting in vivo antiviral effects. CMV was demonstrated in 15 of 16 patients by bDNA assay, 15 of 16 by CMV antigen assay, and 11 of 15 by CSF culture. When clinical criteria and results of the other two assays were used as reference standards, the sensitivity of bDNA was 94% and 100% and the specificity 95.2% and 100%; the CMV antigen assay sensitivity was 94% and 100% and specificity was 85.7% and 100%. Nine (90%) of 10 patients with polyradiculopathy and follow-up CSF culture showed a drop in CMV DNA after treatment; however, only 2 (20%) improved clinically. These results suggest that bDNA and antigen assays may be useful methods for the diagnosis of CMV polyradiculopathy, but treatment failures may not be due to inadequate antiviral activity.
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Affiliation(s)
- J Flood
- University of California, San Francisco/Mt. Zion Medical Center, Division of Infectious Diseases, 94115, USA
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Masjuan J, Corral I, Fernández-Ruiz LC. Mycobacterial acute lumbosacral polyradiculopathy as the initial manifestation of AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 15:175. [PMID: 9241120 DOI: 10.1097/00042560-199706010-00014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
A rare case of mixed connective tissue disease (MCTD) with acute polyradiculoneuropathy is reported. A 23-year-old woman presented with high body temperature, arthralgia and a headache, and developed gait disturbance two weeks later. She had many clinical features common to patients with MCTD. Her neurological manifestations were diagnosed as acute polyradiculoneuropathy based on the clinical picture, combined with supportive ancillary data, including cerebrospinal fluid (CSF) analysis, electrophysiological evaluation, sural nerve biopsy, peroneus brevis muscle biopsy, and magnetic resonance imaging (MRI). Her neurologic deficits, as well as associated laboratory findings, were improved by corticosteroid therapy.
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Affiliation(s)
- E Katada
- Second Department of Internal Medicine, Nagoya City University Medical School
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Corral I, Quereda C, Cobo J, Casado JL, Guerrero A. Cytomegalovirus polyradiculopathy treated successfully with foscarnet. Eur J Clin Microbiol Infect Dis 1996; 15:428-9. [PMID: 8793410 DOI: 10.1007/bf01690108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wehling P, Cleveland SJ, Heininger K, Schulitz KP, Reinecke J, Evans CH. Neurophysiologic changes in lumbar nerve root inflammation in the rat after treatment with cytokine inhibitors. Evidence for a role of interleukin-1. Spine (Phila Pa 1976) 1996; 21:931-5. [PMID: 8726195 DOI: 10.1097/00007632-199604150-00005] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The present study was designed to evaluate the effect of cytokine inhibitors in experimental allergic radiculitis. OBJECTIVE Evaluation of the effect of cytokine inhibitors in experimental allergic radiculitis. SUMMARY OF BACKGROUND DATA A number of cytokines are known to be involved in hyperalgesia and may play a role in radiculitis. Corticosteroids and other cytokine inhibitors antagonize their effects. METHODS Experimental allergic radiculitis was induced in rats by injection of bovine myelin from the peripheral nervous system. The sham group subsequently received saline injections; the treatment groups received either prednisolone or interleukin-1 receptor antagonist. Treatment effect was assessed on the basis of motor performance and neurophysiologic parameters. RESULTS Treatment ameliorated the symptoms of experimental allergic radiculitis. Prednisolone appeared to be somewhat more effective than interleukin-1 receptor antagonist. CONCLUSIONS Because interleukin-1 receptor antagonist specifically blocks the effects of interleukin-1 at its receptors, the present results imply that interleukin-1 is a causal factor in the model of experimental radiculitis used. Its specificity and apparent lack of side effects make interleukin-1 receptor antagonist an attractive candidate treatment for the human disease.
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Affiliation(s)
- P Wehling
- Forschungsgruppe Neuroorthopädie, Hemrich-Heine-Universität Düsseldorf, Germany
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42
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Abstract
Cytomegalovirus polyradiculopathy, a late complication of HIV infection, is characterized by lower extremity weakness, urinary retention, and sacral dysesthesias. We describe four patients (mean CD4 T-cell count = 25 cells/mm3) who developed this "infectious cauda equina syndrome." The characteristic cerebrospinal fluid (CSF) findings, notably atypical for a viral infection, included polymorphonuclear leukocytosis (mean white blood cell count = 1512 cells/mm3, 72% polymorphonuclear leukocytes), elevated protein level (mean = 370 mg/dl), and hypoglycorrhacia (mean = 28 mg/dl). Physicians who treat patients with HIV should be familiar with this syndrome because early intervention, prior to microbiologic confirmation, provides the best hope for improving neurologic function.
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Affiliation(s)
- P A Meier
- Department of Infectious Diseases, Wilford Hall Medical Center, Lackland Air Force Base, TX 78236-5300, USA
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Karmochkine M, Molina JM, Scieux C, Welker Y, Morinet F, Decazes JM, Lagrange P, Schnell L, Modai J. Combined therapy with ganciclovir and foscarnet for cytomegalovirus polyradiculomyelitis in patients with AIDS. Am J Med 1994; 97:196-7. [PMID: 8059788 DOI: 10.1016/0002-9343(94)90032-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Domingo P, Puig M, Iranzo A, Lopez-Contreras J, Ris J. Polyradiculopathy due to cytomegalovirus infection: report of a case in which an AIDS patient responded to foscarnet therapy. Clin Infect Dis 1994; 18:1019-21. [PMID: 8086536 DOI: 10.1093/clinids/18.6.1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Abstract
Active or passive immunisation with vaccines or sera can cause lesions of immunomediated pathogenesis involving both the central (CNS) and the peripheral nervous system (PNS). Although very rare, the neurological complications described during antitetanus vaccinations almost exclusively affect the PNS, those affecting the CNS being even more rare. The authors report a case of transverse myelitis with a radicular component, which arose acutely following the administration of tetanus toxoid and had a partially favourable course.
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Affiliation(s)
- F Tezzon
- Divisione di Neurologia, Ospedale Civile Maggiore, Verona
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Abstract
Polyradiculopathy caused by cytomegalovirus (CMV) is a rare but serious neurological disorder that occurs late in the course of HIV-1 infection and is potentially treatable with antimicrobial agents active against CMV. We describe a patient with CMV infection caused by a strain that was resistant to ganciclovir. This case demonstrates one potential mechanism of therapeutic failure and illustrates the potential pathogenicity of strains that are resistant to antiviral drugs.
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Affiliation(s)
- J I Tokumoto
- Division of Infectious Disease, University of California, San Francisco 94143
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Kim YS, Hollander H. Polyradiculopathy due to cytomegalovirus: report of two cases in which improvement occurred after prolonged therapy and review of the literature. Clin Infect Dis 1993; 17:32-7. [PMID: 8394748 DOI: 10.1093/clinids/17.1.32] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.9] [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: 01/30/2023] Open
Abstract
Neurological syndromes attributed to cytomegalovirus (CMV) in patients infected with human immunodeficiency virus (HIV) include encephalitis, myelitis, and peripheral neuropathy. More recently, polyradiculopathy due to CMV has been described. We review the literature and describe two patients with CMV polyradiculopathy whose conditions improved only after prolonged therapy with ganciclovir. Patients typically are young men who are severely immunocompromised and have had other opportunistic infections. The syndrome is characterized by subacute onset of leg weakness and numbness progressing to paraparesis or paraplegia. Bladder dysfunction is common. In many patients, CMV may be identified elsewhere; concomitant retinitis is common and often subclinical. Laboratory studies commonly show an increased number of neutrophils in CSF and hypoglycorrhachia. Electromyography and nerve conduction studies support the diagnosis. Imaging studies may be most useful to exclude spinal lesions. Without treatment prognosis is poor. Survival time is improved and symptoms often abate, sometimes dramatically, with ganciclovir therapy. Improvement of conditions may be rapid but can take months, as illustrated by these two cases. Once initiated, ganciclovir should be administered indefinitely to patients with CMV polyradiculopathy.
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Affiliation(s)
- Y S Kim
- Department of Medicine, University of California, San Francisco 94143-0378
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Roelcke U, Barnett W, Wilder-Smith E, Sigmund D, Hacke W. Untreated neuroborreliosis: Bannwarth's syndrome evolving into acute schizophrenia-like psychosis. A case report. J Neurol 1992; 239:129-31. [PMID: 1573415 DOI: 10.1007/bf00833910] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [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: 12/27/2022]
Abstract
In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of neuroborreliosis) follows a predictable monophasic self-limiting course. In contrast, we report the case of a patient with an untreated meningopolyradiculitis which evolved into acute schizophrenia-like psychosis due to persistent infection with Borrelia burgdorferi. The psychosis resolved within 1 week of treatment with ceftriaxone. This case shows that the usually benign monophasic meningopolyradiculitis may progress to severe CNS complications, which may have implications on current pathophysiological beliefs.
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Affiliation(s)
- U Roelcke
- Neurologische Klinik, Universität, Heidelberg, Federal Republic of Germany
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