RESUMO
Acute transverse myelitis as complication of systemic lupus erythematosus is a known and well-characterized although uncommon clinical entity. We report here four cases of lupic myelitis collected at our hospital in the last few years and review the available literature of the last ten years, approximately the time when NMR became generally available. The clinical picture can be very variable and therefore, when facing a picture of acute myelitis, lupus should be included in the differential diagnosis; biochemistry evaluating the lupus "activity" is of poor diagnostic value, nuclear magnetic resonance is not conclusive for the etiologic diagnosis of myelitis and its prognosis has improved with therapy including pulses of steroid and immunosuppressant agents.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/etiologia , Doença Aguda , Adulto , Criança , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Mielite Transversa/diagnóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
Three cases of sarcoidosis with spinal cord involvement are reported. The diagnosis in each case was very difficult, being mistaken with tuberculosis in two of the patients and with paraneoplasic myelopathy in the other one. Initial treatment was incorrect for this reason. MRI without contrast was normal, but showed the existence of lesions in two cases after gadolinium administration. Symptoms improved in two patients with prednisone, but they got worse after tapering dose. Spinal sarcoidosis is very rare, but its diagnosis most be considered and MRI with gadolinium should be performed in subacute or chronic myelopathies. Treatment with prednisone should be prolonged.
Assuntos
Sarcoidose , Doenças da Medula Espinal , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoidose/diagnóstico , Sarcoidose/terapia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/terapiaRESUMO
The objective of this investigation was to know the features of acute nontraumatic myelopathies in our area, given the paucity of reported data. Therefore, 36 episodes of myelitis observed during a 15-year period at Hospital Nacional de Parapléjicos were retrospectively reviewed. Cases associated with multiple sclerosis were excluded. On etiological basis these disorders were classified in vascular (in its turn subclassified in surgical and non-surgical) and inflammatory myelopathies. The functional prognosis was poor. Two patients with non-surgical vascular myelitis suffered a second episode of spinal ischemia which deteriorated their conditions. The usefulness of NMR seems to be limited.
Assuntos
Mielite , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite/diagnóstico , Mielite/etiologia , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
The case of a 39 years old woman with acute transverse myelitis manifested as a syndrome of the anterior spinal artery is presented. Etiologic investigation diagnosed a primary antiphospholipid syndrome because of the finding of significantly high titers of anticardiolipin antibodies discarding the presence of systemic lupus erythematosus for the lack of sufficient diagnostic criteria. The association between both clinical pictures is infrequent.
