RESUMO
We reported four patients with coronavirus disease 2019 (COVID-19)-associated myelopathies, highlighting the delayed and atypical spinal cord magnetic resonance imaging (MRI) features and the literature review. All four patients were males, aged 37 to 72 years old. The latencies from COVID-19 to the onset of myelitis were 5, 15, 30, and 80 days. The initial symptoms were numbness and weakness of lower limbs in three cases, and back pain with weakness of lower limbs in one case. The peak symptoms included paraplegia, sphincter dysfunction, sensory disturbance level, and spastic gait. The EDSS scores were 7.5, 9.0, 9.0, and 7.5, respectively. Magnetic resonance imaging (MRI) showed delayed atypical spinal cord lesions at onset, i.e., two cases without lesions, one with linear spinal meningeal enhancement, and one with punctate lesions on T2-weighted imaging (T2WI). During the follow-up period, punctate, linear, and cloudy lesions in the lateral and posterior funiculus were seen on T2WI in the peak stage. The prominent features of spinal cord lesions were linear spinal meningeal enhancement, the mismatch of deteriorated clinical symptoms, and inapparent MRI findings. All four patients were left with an obvious disability, with two patients completely bedridden and two who could stand with support. This report highlights the recognition of COVID-19-associated myelopathy even months after initial infection, especially in patients with delayed and atypical spinal cord findings on MRI.
Assuntos
COVID-19 , Mielite , Doenças da Medula Espinal , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , COVID-19/complicações , COVID-19/patologia , Imageamento por Ressonância Magnética/métodos , Mielite/diagnóstico por imagem , Mielite/etiologia , Mielite/patologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagemRESUMO
BACKGROUND: Lymphomas are malignant tumors of the immune system that arise in lymphoid organs and can impact the central nervous system. However, lymphomas with acute myelitis as the first manifestation are exceedingly rare, and most of them are symptoms of spinal cord damage due to the lack of specificity in their clinical manifestations. The rate of early misdiagnosis is exceedingly high, and the prognosis is dire. Here, we report a case of mature B-cell lymphoma with acute myelitis as the first presentation and review the related literature. CASE PRESENTATION: In this study, We report a case of a 70-year-old male patient with bilateral lower extremity weakness, bowel and bladder dysfunction, and recurrent fever. A paraureteral mass was seen beneath the right kidney on imaging, and the final pathological biopsy revealed: CD20 ( +), mature B-cell tumor, The patient refused to undergo additional tests to ascertain the type of lymphoma and subsequent therapy and asked to be discharged. In mid-November 2020, the patient died. CONCLUSIONS: This case report shows that patients with lymphoma can present with acute myelitis as the first symptom, especially if they have recurrent fever, that conventional treatment for myelitis is ineffective, and that tumors are considered after other causes of myelitis have been ruled out. Furthermore, a focused search for tumor-related evidence, as well as early identification and therapy, may help patients live longer lives.
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Linfoma de Células B , Linfoma , Mielite , Masculino , Humanos , Idoso , Mielite/diagnóstico por imagem , Mielite/etiologia , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico , Linfoma/patologiaRESUMO
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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Viroses do Sistema Nervoso Central/diagnóstico por imagem , Viroses do Sistema Nervoso Central/reabilitação , Infecções por Enterovirus/epidemiologia , Hipotonia Muscular , Debilidade Muscular , Mielite/diagnóstico por imagem , Mielite/reabilitação , Doenças Neuromusculares/diagnóstico por imagem , Doenças Neuromusculares/reabilitação , Viroses do Sistema Nervoso Central/líquido cefalorraquidiano , Viroses do Sistema Nervoso Central/virologia , Criança , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/complicações , Saúde Global , Humanos , Imageamento por Ressonância Magnética , Hipotonia Muscular/etiologia , Debilidade Muscular/etiologia , Mielite/líquido cefalorraquidiano , Mielite/virologia , Doenças Neuromusculares/líquido cefalorraquidiano , Doenças Neuromusculares/virologia , Avaliação de Resultados da Assistência ao PacienteRESUMO
BACKGROUND: Varicella zoster virus (VZV) can remain lifelong in the latent state in ganglionic neurons and adrenal glands after the initial infection. However, it can be reactivated anytime and can trigger several severe neurological manifestations such as encephalitis, meningitis, Ramsay-Hunt syndrome, cerebellitis, myelitis, and stroke. In addition, due to the diversity of clinical manifestations, clinical diagnosis of VZV can be difficult, especially in the absence of varicella. Here, we describe the case of a 52-year-old male who presented with symptoms of acute myelitis as well as polycranial neuritis, and was finally diagnosed with VZV infection through metagenomic next-generation sequencing (mNGS). CASE PRESENTATION: A 52-year-old male came to our hospital with complaint of headache, fever, weakness of right lower limb, abdominal distension, and hearing loss. T2-weighted MRI revealed a hyperintense lesion in the spinal cord extending from T8 to T11. In addition, enhanced MRI showed small patches and strips hyperintensities in both the spinal cord and meninges. Plain abdominal radiographs and abdominal computed tomography (CT) scan displayed air-fluid levels and incomplete bowel obstruction. Moreover, electrophysiological evaluation of the peripheral neuropathy in the extremities was found to be normal. Finally, by using metagenomic next-generation sequencing (mNGS) we found that the copy number of VZV DNA in cerebrospinal fluid (CSF) was significantly increased and IgG antibody against VZV in CSF was also noted to be positive. Hence, VZV infection was identified in patient's central neuron system. Finally, after a few days of low dose steroid treatment, the patient's symptoms were found to be significantly improved. CONCLUSIONS: The findings indicate that we should pay proper attention to the various symptoms caused by VZV infection due to the clinical heterogeneity, especially in the absence of cutaneous lesions.
Assuntos
Herpes Zoster da Orelha Externa , Herpes Zoster , Mielite , Neurite (Inflamação) , Herpesvirus Humano 3/genética , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite/diagnóstico por imagemRESUMO
INTRODUCTION: As acquired immunodeficiency syndrome (AIDS) becomes more widespread, there will be an increasing need for diagnostic AIDS-related neurological syndromes. AIDS-related myelitis is easy to be ignored, and AIDS-related longitudinal myelitis has not yet been reported. CASE PRESENTATION: A 45-year-old male patient was admitted to our hospital after 3 days of progressive slurred speech and limb weakness. Neurologic examination revealed near-complete four-limb paralysis with dyspnea, dysarthria, and neck rigidity. Contrast-enhanced T2-weighted magnetic resonance imaging showed hyperintensities within the entire spinal cord. Cerebrospinal fluid analysis showed elevated white blood cell count and protein level. He was administered high-dose immunoglobulin and methylprednisolone. There was rapid regression in his symptoms after a month of therapy. CONCLUSIONS: This unique presentation of AIDS with longitudinal myelitis involving the entire spinal cord enriches our understanding of the clinical spectrum of this condition. Our case provides essential information for the diagnosis and treatment of longitudinal myelitis in AIDS patients.
Assuntos
Síndrome da Imunodeficiência Adquirida , Mielite , Síndrome da Imunodeficiência Adquirida/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite/diagnóstico por imagem , Mielite/tratamento farmacológico , Paralisia , Medula Espinal/diagnóstico por imagemRESUMO
BACKGROUND: Prospective studies regarding tuberculous myelitis are lacking. We aimed to prospectively evaluate patients with tuberculous myelitis to identify the features that distinguish tuberculous myelitis from other myelitis. METHODS: This was a prospective study. Patients presenting with paraparesis/quadriparesis, and MRI showing myelitis were included. All patients were subjected to clinical, neuroimaging, and laboratory evaluation. Diagnosis of definite tuberculous myelitis was made if GeneXpert test in CSF was positive. Probable tuberculous myelitis was diagnosed if there was evidence of tuberculosis elsewhere in the body. Patients were treated with methylprednisolone and antituberculosis treatment. Patients were followed for 6 months. We compared the clinical, laboratory, and neuroimaging parameters and response to treatment of tuberculous myelitis with other myelitis. P values were adjusted using the Benjamini-Hochberg (BH) procedure to control false discovery rate. RESULTS: We enrolled 52 patients. Eighteen (34.6%) patients had tuberculous myelitis. Headache (P = 0.018) was significantly more common in tuberculous myelitis. The CSF protein (P < 0.001), and CSF cell count (P < 0.001) were significantly higher in tuberculous myelitis. On neuroimaging, a LETM was common in tuberculous myelitis. Spinal meningeal enhancement (14; 77.8%), extra-axial collection, and CSF loculation (6; 33.4%), arachnoiditis (3;16.7%), and concomitant spinal tuberculoma (2;11.1%) were other common imaging features of tuberculous myelitis. Tuberculous myelitis patients showed a better response (P = 0.025) to treatment. CONCLUSION: Tuberculous myelitis was seen in approximately 35% of all myelitis cases, in a high tuberculosis endemic zone. Headache, markedly elevated CSF protein and spinal meningeal enhancement were distinguishing features. Tuberculous myelitis patients responded well to corticosteroids.
Assuntos
Mielite , Tuberculose Meníngea , Seguimentos , Cefaleia/complicações , Humanos , Imageamento por Ressonância Magnética , Mielite/diagnóstico por imagem , Mielite/tratamento farmacológico , Estudos Prospectivos , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/diagnóstico por imagemRESUMO
Patients with acute abdominal pain typically undergo urgent clinical assessment to exclude serious underlying surgical diagnoses. However, a diverse range of less common medical conditions may also present with abdominal pain and their severity can range from benign to life threatening. Here we present a case of myelitis (inflammation of the spinal cord) presenting with acute abdominal pain that was initially diagnosed clinically as biliary pathology. We review the canonical differential diagnosis for medical causes of acute abdominal pain and highlight the clinical features that raise the suspicion of spinal pathology. We argue that awareness of the basic clinical features of structural and inflammatory spinal lesions could improve early recognition of these potentially overlooked diseases.
Assuntos
Mielite , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Diagnóstico Diferencial , Humanos , Mielite/diagnóstico por imagem , Mielite/etiologiaRESUMO
Chikungunya fever is an arbovirus infection transmitted by the same mosquito vector of dengue and Zika virus. Besides high fever, common clinical symptoms include articular pain and general malaise. Neurological involvement is unusual, but some patients may develop peripheral and central nervous system involvement, including meningoencephalitis, myelitis, Guillain-Barré syndrome, and acute disseminated encephalomyelitis. We present three cases of Chikungunya fever complicated with extensive myelitis. The spinal cord magnetic resonance imaging (MRI) pattern is characterized by multiple dotted-like and longitudinal hyperintense lesions, with contrast enhancement, mostly distributed in the peripheral regions of the spinal cord. It seems that these lesions are mostly located in the perivascular spaces (PVS), related or not to virus attack. Involvement of brain PVS can also be demonstrated, as shown in two of the cases described. Considering the MRI pattern, extensive spinal cord lesion should include Chikungunya as a differential diagnosis, especially during an outbreak.
Assuntos
Febre de Chikungunya/complicações , Mielite/diagnóstico por imagem , Mielite/patologia , Mielite/virologia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Myelitis accompanied by a negative spinal cord MRI may lead to diagnostic uncertainty. OBJECTIVE AND METHODS: We retrospectively investigated the frequency of negative spinal cord MRI (performed <6 weeks from onset) in Mayo Clinic patients with myelin oligodendrocyte glycoprotein (MOG)-IgG-associated myelitis (2000-2019). RESULTS: The initial spinal cord MRI was negative in 7/73 (10%) patients, despite severe acute disability (median EDSS, 7 (range, 4.5-8)); myelitis symptoms/signs were frequent (paraparesis, neurogenic bladder, sensory level, Lhermitte's phenomenon). Myelitis lesions became overt at follow-up MRI in three patients. CONCLUSIONS: A negative spinal cord MRI should not dissuade from MOG-IgG testing in patients with acute/subacute myelitis.
Assuntos
Mielite , Neuromielite Óptica , Aquaporina 4 , Autoanticorpos , Humanos , Imageamento por Ressonância Magnética , Glicoproteína Mielina-Oligodendrócito , Mielite/diagnóstico por imagem , Estudos RetrospectivosRESUMO
A middle-aged woman with idiopathic longitudinally extensive myelitis underwent repeat MR scan of cervical spine at 5-month follow-up, which showed new non-enhancing T2 hyperintensities, initially reported as myelitis recurrence. However, the hyperintensities involved both lateral corticospinal tracts caudal to the initial lesion and both dorsal columns rostral to the initial lesion and were therefore compatible with Wallerian degeneration. This radiological mimic should be considered in the differential of recurrence of myelitis.
Assuntos
Mielite , Degeneração Walleriana , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mielite/diagnóstico por imagem , Radiografia , Recidiva , Degeneração Walleriana/diagnóstico por imagemRESUMO
BACKGROUND: Acute flaccid myelitis (AFM) are reported to be associated with enterovirus D68 infection. Though an increasing number of AFM cases were reported with EV-D68 infection in the US, few such cases have been found in China. CASE PRESENTATION: A 6-year-old boy presented with acute flaccid myelitis (AFM) involving left arm after fever and respiratory symptoms for 6 days. Computed Tomography (CT) revealed inflammation in both lungs and magnetic resonance imaging (MRI) of the brain and spine showed swelling in the left frontal lobe and brain stem. The patient was diagnosed with meningomyelitis. EV-D68 was detected from pharyngeal samples 36 days after the onset of the disease. CONCLUSION: We report the first EV-D68 infection in case of AFM in mainland China. AFM surveillance systems is recommended to be established in China to guide diagnosis, case reporting, and specimen collection and testing for better understanding its etiologies.
Assuntos
Viroses do Sistema Nervoso Central/virologia , Enterovirus Humano D/patogenicidade , Infecções por Enterovirus/etiologia , Mielite/virologia , Doenças Neuromusculares/virologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/virologia , Viroses do Sistema Nervoso Central/diagnóstico por imagem , Viroses do Sistema Nervoso Central/etiologia , Viroses do Sistema Nervoso Central/terapia , Criança , China , Encefalite Viral/diagnóstico por imagem , Encefalite Viral/virologia , Enterovirus Humano D/genética , Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/diagnóstico por imagem , Infecções por Enterovirus/terapia , Infecções por Enterovirus/virologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielite/diagnóstico por imagem , Mielite/etiologia , Mielite/terapia , Doenças Neuromusculares/diagnóstico por imagem , Doenças Neuromusculares/etiologia , Doenças Neuromusculares/terapia , Faringe/virologia , Filogenia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/virologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Coluna Vertebral/virologia , Tomografia Computadorizada por Raios XRESUMO
Acute myelitis is a common neurological manifestation due to different causes, but in about 15-30% of cases its etiology remains unknown (idiopathic myelitis). Myelitis represents the most common manifestation of neurotoxocariasis, the infection of the human nervous system by larvae of the nematode Toxocara spp.; however, despite the high seroprevalence worldwide, its contribution to the burden of disease has not been assessed. We evaluated the presence of antibodies against Toxocara spp. in cerebrospinal fluid (CSF) from a sample of 28 patients with a diagnosis of idiopathic myelitis (N = 20) or encephalomyelitis (N = 8) who attended the Neurological Unit of the University Hospital of Catania, Sicily. Antibodies against Toxocara spp. were measured using a multiplex bead-based assay and Toxocara immunoblot using Toxocara canis excretory secretory antigens. All samples tested negative for the presence of anti-T. canis IgG antibodies. In this series, we found no evidence of a contribution of neurotoxocariasis to the burden of myelitis.
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Mielite/líquido cefalorraquidiano , Mielite/diagnóstico por imagem , Toxocara canis , Toxocaríase/líquido cefalorraquidiano , Toxocaríase/diagnóstico por imagem , Adulto , Idoso , Animais , Autoanticorpos/líquido cefalorraquidiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mielite/epidemiologia , Estudos Retrospectivos , Sicília/epidemiologia , Toxocaríase/epidemiologiaRESUMO
IgG4-related disease (IgG4-RD) is a disorder with various clinical manifestations. Central nervous system (CNS) involvement is well recognized, with hypertrophic pachymeningitis and hypophysitis being the most common manifestations. Spinal cord involvement is an extremely rare manifestation. We present the first case of an IgG4-RD patient with spinal cord parenchymal disease and concurrent hypophysitis. We review also the current literature about CNS parenchymal involvement in the context of IgG4-RD. A young female presented with clinical symptoms of myelitis. Cervical spinal cord magnetic resonance imaging (MRI) displayed features of longitudinally extensive transverse myelitis (LETM). Brain MRI showed a small number of high-intensity lesions in the deep white matter and enlargement of hypophysis with homogeneous gadolinium enhancement (asymptomatic hypophysitis). Diagnostic workup revealed elevated IgG4 serum levels (146 mg/dL). Our patient fulfilled the organ-specific diagnostic criteria of IgG4-hypophysitis. Treatment with intravenous glucocorticoids led to rapid clinical response, and to the substantial resolution of imaging findings. Azathioprine was used as a maintenance treatment. One relapse occurred 2 years after the initial diagnosis and patient was re-treated with glucocorticoids. Three years after relapse, patient is in remission with azathioprine. We present the first case of myelitis with radiological features of LETM associated with increased IgG4 serum levels and the simultaneous presence of asymptomatic IgG4-related hypophysitis.
Assuntos
Hipofisite Autoimune/diagnóstico por imagem , Imunoglobulina G/imunologia , Mielite/diagnóstico por imagem , Adolescente , Doenças Assintomáticas , Hipofisite Autoimune/tratamento farmacológico , Hipofisite Autoimune/imunologia , Hipofisite Autoimune/fisiopatologia , Azatioprina/uso terapêutico , Vértebras Cervicais , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hipestesia/fisiopatologia , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Doença Relacionada a Imunoglobulina G4/imunologia , Doença Relacionada a Imunoglobulina G4/fisiopatologia , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Mielite/tratamento farmacológico , Mielite/imunologia , Mielite/fisiopatologia , Parestesia/fisiopatologia , Pulsoterapia , RecidivaRESUMO
Myelitis refers to inflammation of the spinal cord which can result in a spectrum of neurologic impairment. Infectious pathogens are an important etiologic category, and can result in myelitis through direct pathogenic effect or through immune-mediated parainfection; this review focuses on the former category. The spectrum of clinical manifestations is summarized and a diagnostic workup provided to aid clinicians in developing an approach to patients presenting with symptoms suggestive of infectious myelitis. This is followed by an overview of the important viral, bacterial, parasitic, and fungal causes of infectious myelitis. The typical presentations, diagnostic modalities, and treatment approaches are outlined for key pathogens culprit in infectious myelitis to allow clinicians to promptly recognize and diagnose specific infectious etiologies of myelitis.
Assuntos
Mielite/diagnóstico por imagem , Mielite/epidemiologia , Medula Espinal/diagnóstico por imagem , Antirretrovirais/uso terapêutico , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico por imagem , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecções Bacterianas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico por imagem , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções por HIV/diagnóstico por imagem , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Mielite/tratamento farmacológico , Medula Espinal/microbiologia , Medula Espinal/parasitologiaRESUMO
AIM: To quantify characteristics in acute flaccid myelitis (AFM) at acute and convalescent stages. METHOD: This was a retrospective case series of children with AFM evaluated at a single institution in the USA (2014-2017). Acute inflammatory/ischemic myelopathies were excluded. Neurological assessments and segmental quantitative analysis of signal abnormalities on magnetic resonance imaging (MRI) of the brain and spinal cord were performed. RESULTS: Sixteen patients (11 males, five females) were evaluated. Median age at onset was 4 years (interquartile range [IQR] 3-6y). All had parainfectious acute-onset limb weakness, lower motor neuron examination, and spinal fluid pleocytosis. On acute spinal cord MRI, longitudinally extensive T2 hyperintensities were identified throughout the spinal cord mostly within grey matter; five out of 12 patients had dorsal brainstem T2 hyperintensities. At a median of 2 months follow-up (IQR 2-3mo), spinal cord MRI improved in seven out of nine patients although focal T2 hyperintensities persisted in cervical and lumbar grey matter. At a median follow-up of 4 months (IQR 2-6mo), Medical Research Council sum score rose from a median of 29 to 32; distal muscle groups improved more than proximal ones; four out of 16 patients were ventilator-dependent; and two out of 16 patients were quadriplegic. INTERPRETATION: While patients may show marked improvement on neuroimaging from acute to convalescent stages, the majority of children with AFM have limited motor recovery and continued disability. Clinicians should consider the timing of clinical and neuroimaging exams when assessing diagnosis and prognosis. WHAT THIS PAPER ADDS: During the 2014 to 2017 acute flaccid myelitis outbreak in the USA, clinical recovery was better in distal than proximal muscle groups. Lumbar spinal cord showed more residual abnormalities at convalescence.
Assuntos
Mielite/diagnóstico por imagem , Mielite/fisiopatologia , Doença Aguda , Criança , Pré-Escolar , Convalescença , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielite/complicações , Neuroimagem , Prognóstico , Recuperação de Função Fisiológica , Estudos RetrospectivosRESUMO
AIM: We used magnetic resonance imaging (MRI) to compare the neuroimaging of children with their first episode of clinical enterovirus 71-associated transverse myelitis (EV71-TM), myelin oligodendrocyte glycoprotein antibody positive transverse myelitis (MOG-TM), aquaporin-4 antibody positive transverse myelitis (AQP4-TM), transverse myelitis in multiple sclerosis (MS-TM), and unclassified transverse myelitis (UNC-TM). METHOD: We performed a retrospective blinded radiological assessment and compared the neuroimaging of 52 children (32 females, 20 males; mean age 9y 8mo, SD 5y 5mo, range 5mo-17y) presenting with their first episode of myelitis caused by EV71-TM (n=11), MOG-TM (n=10), AQP4-TM (n=9), MS-TM (n=13), and UNC-TM (n=9). RESULTS: In the EV71-TM group, lesions were distributed throughout the cord and enhancement of nerve roots (ventral and dorsal) was common. The MOG-TM group had lesions distributed throughout the cord and most commonly longitudinally extensive transverse myelitis and lesions involving the grey matter alone on axial scans. The AQP4-TM group had lesions distributed in the cervicothoracic spine, cavitation, and contrast enhancing lesions. All patients with AQP4-TM had an abnormal brain MRI scan. The MS-TM group characteristically had multiple short segment lesions of the cord involving the cervicothoracic spine. The UNC-TM group did not have distinctive spinal MRI findings but had a relative paucity of lesions on their brain MRI scans. INTERPRETATION: There are neuroimaging findings that are helpful in differentiating between myelitis associated with EV71, MOG, AQP4, and multiple sclerosis in children. These features may be useful early in the presentation of transverse myelitis while awaiting infectious/immunological testing, and/or further demyelinating events. WHAT THIS PAPER ADDS: Magnetic resonance imaging can help identify aetiologies for children presenting with a first episode of myelitis. Entervirus-71-associated myelitis lesions are distributed throughout the cord and enhancement of nerve roots is common. Lesions distributed throughout the cord are commonly seen in myelin oligodendrocyte-associated myelitis. Aquaporin-4-associated myelitis lesions are distributed in the cervicothoracic spine, cavitation and contrast enhancing lesions are common. Short segment lesions in the cervicothoracic spine are commonly seen in multiple sclerosis-associated myelitis.
IMÁGENES DE RESONANCIA MAGNÉTICA EN ENTEROVIRUS-71, ANTICUERPOS DE GLICOPROTEÍNA DE LA MIELINA DEL OLIGODENDROCITO, ANTICUERPOS AQUAPORIN-4, Y ESCLEROSIS MÚLTIPLE-ASOCIADA A MIELITIS EN NIÑOS: OBJETIVO: Utilizamos imágenes de resonancia magnética (IRM) para comparar la neuroimagen de los niños con su primer episodio clínico de enterovirus 71-asociado a mielitis transversa (EV71-TM), mielitis transversa con anticuerpos de glicoproteína de la mielina del oligodendrocito positivos (MOG-TM), mielitis transversa con anticuerpos aquaporin-4 positivos (AQP4-TM), mielitis transversa en esclerosis múltiple (MS-TM) y mielitis transversa no clasificada (UNC-TM). MÉTODO: Se realizó un análisis radiológico, ciego, retrospectivo y se comparó la neuroimagen de 52 niños (32 mujeres, 20 varones; con edad promedio 9 años 8 meses, La DS 5 años 5 meses, el rango de 5 meses -17 años) que presentaron su primer episodio de mielitis causada por EV71-TM (n= 11), MOG-TM (n= 10), AQP4-TM (n= 9), MS-TM (n= 13) y UNC-TM (n= 9). RESULTADOS: En el grupo de EV71-TM, fue común observar lesiones distribuidas a través de la medula con realce de las raíces de nervio (ventrales y dorsales). El grupo de MOG-TM tenía lesiones distribuidas a través de la médula, más comúnmente mielitis transversa longitudinalmente extensa y lesiones que implican solamente la sustancia gris en exploraciones axiales. El grupo AQP4-TM tenía lesiones distribuidas en la medula cervicodorsal, cavitación y lesiones con realce en el contraste. Todos Pacientes con AQP4-TM tenían una IRM cerebral anormal. El grupo de MS-TM característicamente tenía lesiones múltiples de segmentos pequeños de la medula que involucran las regiones cervical y dorsal. El grupo UNC-TM no tenía hallazgos de IRM distintivos en la medula espinal, pero tenía una relativa escasez de lesiones cerebrales IRM. INTERPRETACIÓN: Hay hallazgos de neuroimagen en niños que son útiles en diferenciar entre mielitis asociada a EV71, a MOG, a AQP4, y esclerosis múltiple. Estas características pueden ser útiles al inicio de la presentación de la mielitis transversa mientras se espera la prueba infecciosa/inmunológica y/u otros acontecimientos desmielinizantes.
IMAGEM POR RESSONÂNCIA MAGNÉTICA EM ENTEROVÍRUS-71, ANTICORPO DA GLICOPROTEÍNA DE OLIGODENDRÓCITO DA MIELINA, ANTICORPO AQUAPORINA-4, E MIELITE ASSOCIADA A ESCLEROSE MÚLTIPLA EM CRIANÇAS: OBJETIVO: Usamos imagens de ressonância funcional (IRM) para comparar as neuroimagens de crianças com o primeiro episósio de mielite transversa clínica associada a enterovírus-71 (MT-EV71), mielite transversa positiva para anticorpo da glicoproteína de oligodendrócit oda mielina (MT-GOM), mielite transversa positiva para anticorpo aquaporina-4 (MT-AQP4), mielite transversa em esclerose múltipla (MT-EM), e mielite transversa não classificada (MT-NC). MÉTODO: Realizamos uma avaliação radiológica retrospectiva cega, e comparamos a neuroimagem de 52 crianças (32 do sexo feminino, 20 do sexo masculino; média de idade 9a 8m, DP 5a 5m, variação 5m-17a) apresentando seu primeiro episódio de mielite causada por MT-EV71 (n=11), MT-GOM (n=10), MT-AQP4 (n=9), MT-EM (n=13), e MT-NC (n=9). RESULTADOS: No grupo MT-EV71, as lesões se distribuíram por toda a medula, e realces das raízes nervosas (ventrais e dorsais) eram comuns. O grupo MT-GOM teve lesões distribuídas por toda a medula, e mais comumente mielite transversa extensiva longitudinalmente e lesões envolvendo apenas a substância cinzenta nas imagens axiais. O grupo MT-AQP4 teve lesões distribuídas na coluna cérvico-torácica, cavitação, e lesões realçadas pelo contraste. Todos os pacientes com MT-AQP4 -tiveram uma IRM cerebral anormal. O grupo MT-EM caracteristicamente teve múltiplas lesões de segmentos curtos da medula envolvendo a região cérvico-torácica. O grupo MT-NC não teve achados distintivos de IRM espinhal, mas tiveram relativamente menos lesões nas imagens cerebrais. INTERPRETAÇÃO: Há achados de neuroimagem úteis para diferenciar a mielite associada com EV71, GOM, AQP4 e esclerose múltipla em crianças. Estes aspectos podem ser úteis na apresentação precoce da mielite transversa, enquanto se aguarda testes infecciosos/imunológicos, e e/ou outros eventos desmielinizantes.
Assuntos
Aquaporina 4/imunologia , Encéfalo/diagnóstico por imagem , Enterovirus Humano A/imunologia , Esclerose Múltipla/diagnóstico por imagem , Glicoproteína Mielina-Oligodendrócito/imunologia , Mielite/diagnóstico por imagem , Adolescente , Autoanticorpos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla/imunologia , Mielite/imunologia , Estudos RetrospectivosRESUMO
The spectrum of Myelin Oligodendrocytes Glycoprotein (MOG) antibody disease constitutes a recently described challenging entity, referring to a relatively new spectrum of autoimmune disorders with antibodies against MOG predominantly involving the optic nerve and spinal cord. The purpose of this article is to describe MRI features of MOG-AD involvement in the optic nerves, spinal cord and the brain of adults.
Assuntos
Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/patologia , Imageamento por Ressonância Magnética , Adolescente , Adulto , Autoanticorpos , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Doenças Desmielinizantes/imunologia , Encefalite/diagnóstico por imagem , Encefalite/imunologia , Encefalite/patologia , Feminino , Humanos , Masculino , Glicoproteína Mielina-Oligodendrócito/imunologia , Mielite/diagnóstico por imagem , Mielite/imunologia , Mielite/patologia , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Neurite Óptica/diagnóstico por imagem , Neurite Óptica/imunologia , Neurite Óptica/patologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Adulto JovemRESUMO
AIM: Occipital neuralgia is a common form of headache that is characterized by paroxysmal severe lancinating pain in the occipital nerve distribution. METHODS: The exact pathophysiology is still not fully understood and occipital neuralgia often develops spontaneously. There are no specific guidelines for evaluation of patients with occipital neuralgia. RESULT: Cervical spine, spinal cord and posterior neck muscle lesions can induce occipital neuralgia. Brain and spine imaging may be necessary in some cases, according to the nature of the headache or response to treatment. DISCUSSION: We report a case of cervical myelitis presenting as occipital neuralgia.
Assuntos
Mielite/diagnóstico por imagem , Mielite/fisiopatologia , Neuralgia/fisiopatologia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Mielite/tratamento farmacológico , Esteroides/uso terapêutico , Escala Visual AnalógicaRESUMO
Glial fibrillary acidic protein antibody-positive meningoencephalomyelitis is a newly described, possibly under-recognised, severe inflammatory condition of the nervous system. The clinical presentation is variable but most commonly is a combination of meningitis, encephalitis and myelitis; other manifestations may include seizures, psychiatric symptoms and tremor. There is a significant association with malignancies, often occult, and with other autoimmune conditions. Although the disease responds well to corticosteroids acutely, it typically relapses when these are tapered, and so patients need long-term immunosuppression. We report a young man presenting with subacute meningoencephalitis and subsequent myelitis, and discuss the typical presentation and management of this severe but treatable condition.