Aquaporin-4 autoantibody: a neurogenic cause of anorexia and weight loss.

Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disease often associated with a highly specific autoantibody, aquaporin-4 antibody. Although the classic syndrome involves the optic nerves and spinal cord, aquaporin-4 antibody has been important in defining the true spectrum of NMO, which now includes brain lesions in areas of high aquaporin-4 expression. Brainstem involvement, specifically area postrema involvement in the medulla, has been associated with intractable vomiting in some patients with NMO. We describe a 14-year-old female with positive aquaporin-4 antibody whose clinical course was dominated by severe anorexia with associated weight loss (from 68-41kg; body mass index 25.2-15.6). Magnetic resonance imaging showed lesions in the medulla, pons, and thalami. Although she had asymptomatic radiological longitudinally extensive transverse myelitis, she never had symptoms or signs referable to the spinal cord or the optic nerves. We propose that anorexia and weight loss should be considered part of the NMO spectrum, probably related to area postrema involvement.

Mielitis transversa asociada a lupus eritematoso sistémico / Transverse myelitis associated with systemic lupus erythematosus

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Myelopathy: a report of two cases.

OBJECTIVE: To present diagnostic imaging findings of two cases of cervical myelopathy, with different etiologies, presenting to a chiropractic office. CLINICAL FEATURES: The patient with acute transverse myelitis had neck and upper back pain and nonspecific headaches for 40 years. The patient with posttraumatic syringomyelia experienced intermittent left arm pain starting in the anterolateral shoulder and radiating down the arm into the third, fourth, and fifth digits. Neither of these patients presented with typical myelopathic symptoms. INTERVENTION AND OUTCOME: Chiropractic spinal manipulative therapy using high-velocity low-amplitude thrusts and concomitant medical management were used for the patient with posttraumatic syringomyelia. The patient with acute transverse myelitis was not treated. CONCLUSION: Practitioners should be aware of the etiology, pathophysiology, clinical features, laboratory, diagnostic imaging findings, and treatment options pertaining to patients with cervical myelopathy.

[A case of transverse myelopathy caused by acupuncture].

A 54-year-old man received insertion of an acupuncture needle into the region extending from the posterior neck to the back on two occasions for the treatment of shoulder stiffness. Two weeks after the second acupuncture, he developed fever, dysarthria and mictionary disturbance, finally reaching the condition of tetraplegia. He was immediately admitted to an emergency room in our hospital, and was diagnosed as sepsis with DIC, ARDS, heart failure, renal failure, liver failure, and myelitis. After one month, he recovered with transverse myelopathy as a residual deficit. Neurological findings showed transverse myelopathy below the level of Th2 at that time. Cervical CT revealed an irregular low density at the periphery of the cervical vertebra from the C2 to C4 level. Cervical MRI revealed an irregular swelling of his spinal cord from the C2 to C7 level. We explained the mechanism of transverse myelopathy in this case as follows. After the acupuncture, he suffered a focal infection of the region of needle insertion, and then the infection expanded to the cervical vertebra, thus causing osteomyelitis, sepsis, and finally cervical myelitis. Direct injury of the spinal cord and nerve roots as a complication of acupuncture was previously reported, but indirect injury of the spinal cord due to myelitis had not been reported except our present case. Careful attentions should be paid to the complications of acupuncture.