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1.
Medicina (B Aires) ; 79 Suppl 3: 66-70, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603847

RESUMO

The two main demyelinating diseases in children are reviewed. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). For its physiopathological characteristics, probable etiologies, clinical manifestations, diagnosis, treatment, prognosis, evolution, as well as atypical alterations that complicate its diagnosis, the smaller the child is, more study is needed before reaching the diagnosis. The International Study Group of Multiple Pediatric Sclerosis, published the operating definitions for demyelinating diseases acquired from the central nervous system in children: the ADEM is monophasic, polysymptomatic and with encephalopathy. Its duration is up to 3 months, with fluctuating symptoms and magnetic resonance findings. MS is an isolated monofocal or polyfocal syndrome, without encephalopathy. Currently, two different and distinguishable diseases are considered from the onset of symptoms.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Criança , Quimioterapia Combinada , Encefalomielite Aguda Disseminada/tratamento farmacológico , Humanos , Imunoterapia , Imagem por Ressonância Magnética , Esclerose Múltipla/tratamento farmacológico , Esteroides/uso terapêutico , Síndrome
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(2. Vyp. 2): 36-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31156239

RESUMO

AIM: To analyze clinical, neuroimaging and laboratory characteristics of acute disseminated encephalomyelitis (ODEM) in adults with an analysis of the frequency of diagnostic errors at the initial examination stage. MATERIAL AND METHODS: The study included 23 patients hospitalized with a diagnosis of ODEM. The analysis of clinical characteristics, MRI results and cerebrospinal fluid (CSF) was performed. The diagnosis of the disease in each case was specified after a full examination and dynamic observation. RESULTS: The diagnosis of ODEM was confirmed only in 16 cases. In 6 cases, the final diagnosis of multiple sclerosis (MS) was made, and one case of Susak syndrome, primary CNS lymphoma and levamisole-associated multifocal inflammatory leukoencephalopathy was also detected. It has been shown that ODEM in adults is characterized by the acute development of multifocal brain lesions in combination with clinical manifestations of encephalopathy, which in half of cases is preceded by an infectious disease. There were no specific clinical, neuroimaging and laboratory features, which could allow differentiation of ODEM from onset of MS. CONCLUSION: To make a correct diagnosis in the first episode of acute multifocal brain lesion, a dynamic observation, including repeated MRI, is needed. The development of specific biomarkers may be of great importance for the early differential diagnosis of demyelinating diseases.


Assuntos
Encefalomielite Aguda Disseminada , Esclerose Múltipla , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem
3.
Rev. chil. radiol ; 25(1): 5-18, mar. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1003745

RESUMO

Resumen: La esclerosis múltiple (EM) es la enfermedad inflamatorio-desmielinizante del Sistema nervioso central más prevalente en adultos. La resonancia magnética (RM) juega un rol cada vez más importante en el estudio de esta patología, en especial en su diagnóstico precoz, por lo que la diferenciación imagenológica de variantes frecuentes e infrecuentes de EM con otras patologías de sustancia blanca que comprometen encéfalo y médula espinal es esencial. Mediante una revisión pictórica se ilustrarán características típicas en RM del compromiso por EM y de variantes menos habituales de lesión desmielinizante, y se ilustrarán hallazgos característicos de lesiones relacionadas a vasculopatías inflamatorias y no inflamatorias, encefalomielitis diseminada aguda (ADEM), neuromielitis óptica (NMO) y enfermedades vasculares de la médula espinal que pueden simular EM, con énfasis en el diagnóstico diferencial radiológico.


Abstract:Multiple sclerosis (MS) is the most prevalent inflammatory-demyelinating disease of the central nervous system in adult population. Magnetic resonance imaging (MRI) has an increasingly important role, especially in early diagnosis, so the imaging differentiation of frequent and infrequent variants of MS with other white matter diseases of brain and spinal cord is essential. Through a pictorial essay we show typical MR features of MS and more infrequent variants of demyelinating lesions and illustrate characteristic imaging findings of inflammatory and non-inflammatory vasculopathies, acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO) and vascular diseases of spinal cord that may simulate MS, with emphasis on imaging differential diagnosis.


Assuntos
Radiografia/métodos , Diagnóstico Diferencial , Esclerose Múltipla/diagnóstico , Espectroscopia de Ressonância Magnética/métodos , Doenças do Nervo Óptico/diagnóstico por imagem , Neuromielite Óptica/diagnóstico por imagem , Doenças Vasculares da Medula Espinal/diagnóstico por imagem , Encefalomielite Aguda Disseminada/diagnóstico por imagem
4.
Acta Med Port ; 32(1): 81-85, 2019 Feb 01.
Artigo em Português | MEDLINE | ID: mdl-30753808

RESUMO

Acute disseminated encephalomyelitis is a rare inflammatory demyelinating multifocal disease of the central nervous system that typically occurs in children following vaccination or exanthematous viral infections and conveys an elevated risk of neurological sequelae unless promptly recognized and treated. We describe an adult case of acute disseminated encephalomyelitis following vaccination against Mumps, Measles and Rubella, presenting with fever and progressive neurological deficits which improved under systemic corticosteroid therapy. Considering the ongoing public debate regarding universal vaccination and the surge of previously controlled infectious diseases, we aim not only to underline the need for a rigorous assessment of vaccination safety on adult patients in order to prevent misguidance of public opinion, but also to alert clinicians for an early diagnosis of acute disseminated encephalomyelitis in these patients, the incidence of which we speculate may be rising.


Assuntos
Corticosteroides/uso terapêutico , Encefalomielite Aguda Disseminada/etiologia , Vacina contra Sarampo-Caxumba-Rubéola/efeitos adversos , Doença Aguda , Adulto , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/tratamento farmacológico , Humanos , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem
5.
Jpn J Radiol ; 37(4): 277-282, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30671706

RESUMO

PURPOSE: To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM). MATERIALS AND METHODS: Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated. RESULTS: Five ADEM patients were included in this study. Linear (n = 2) or nodular (n = 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (n = 1), subcortical region alone (n = 1), and internal capsule (n = 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14-43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients. CONCLUSION: T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Criança , Pré-Escolar , Meios de Contraste , Progressão da Doença , Encefalomielite Aguda Disseminada/patologia , Feminino , Humanos , Aumento da Imagem , Masculino , Estudos Retrospectivos , Adulto Jovem
6.
BMJ Case Rep ; 11(1)2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30593525

RESUMO

Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory-demyelinating disease of central nervous system. Several viral infections and vaccines act as precipitating factor for ADEM. We report an 8-year-old girl presenting with acute-onset flaccid paraparesis and bilateral painless vision loss. MRI brain showed extensive multifocal patchy demyelination and she made good clinical recovery with steroids and intravenous immunoglobulin therapy. She had history of bilateral parotid swelling before the onset of neurological symptoms and diagnosis of mumps was confirmed by positive ELISA in serum. Mumps, usually a benign and self-limited viral infection, rarely can cause severe neurological complications. Hence, we report this case to emphasise the importance of mumps vaccination and the need to strengthen the health policy system for the prevention of disease.


Assuntos
Encefalomielite Aguda Disseminada/etiologia , Caxumba/complicações , Encéfalo/diagnóstico por imagem , Criança , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Imagem por Ressonância Magnética , Metilprednisolona/uso terapêutico , Vacina contra Caxumba/uso terapêutico , Medula Espinal/diagnóstico por imagem
7.
Pan Afr Med J ; 29: 138, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050602

RESUMO

Acute disseminated encephalomyelitis is a rare disease of central nervous system, which can present with a variety of clinical manifestations. That is why first attack of ADEM, in particular remains a diagnostic puzzle. Early anticipation and diagnosis is important for better outcomes. We present a case of acute disseminated encephalomyelitis which initially had atypical clinical features with cough, expectoration, fever and later manifested strange neurological features, diagnosed to be a case of acute disseminated encephalomyelitis based on radio-imaging.


Assuntos
Tosse/etiologia , Encefalomielite Aguda Disseminada/diagnóstico , Febre/etiologia , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Rinsho Shinkeigaku ; 58(5): 297-301, 2018 May 25.
Artigo em Japonês | MEDLINE | ID: mdl-29710023

RESUMO

We report a case of acute disseminated encephalomyelitis (ADEM) concomitant with polyneuropathy associated with anti-lactosylceramide antibody. A 68-year-old man was admitted to our hospital with ophthalmoparesis, bulbar palsy, tetraplegia after suffering from upper respiratory infection and headache. Subsequently, he developed respiratory failure requiring mechanical ventilation. Fluid-attenuated inversion recovery (FLAIR) MRI showed high intensities in the pons and medulla, and a nerve conduction study revealed motor-dominant axonal polyneuropathy. Although the laboratory tests revealed the presence of anti-lactosylceramide antibody in his serum, he was diagnosed with acute disseminated encephalomyelitis concomitant with polyneuropathy. Whereas the intensive treatment with corticosteroids, plasmapharesis, and high-dose intravenous immunoglobulin (IVIg) brought a moderate improvement, his tetraparesis continued to exist.


Assuntos
Autoanticorpos/sangue , Encefalomielite Aguda Disseminada/complicações , Encefalomielite Aguda Disseminada/diagnóstico , Lactosilceramidas/imunologia , Polineuropatias/complicações , Polineuropatias/diagnóstico , Idoso , Biomarcadores/sangue , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/terapia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/administração & dosagem , Troca Plasmática , Polineuropatias/diagnóstico por imagem , Polineuropatias/terapia , Pulsoterapia , Resultado do Tratamento
9.
Brain Dev ; 40(7): 607-611, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29661590

RESUMO

BACKGROUND: The effect of rituximab on acute disseminated encephalomyelitis (ADEM) followed by recurrent optic neuritis (ON) is not yet known. PATIENT: We are reporting the case of a 4-year-old Japanese girl who was diagnosed with anti-myelin oligodendrocyte glycoprotein (MOG) antibody positive ADEM followed by recurrent ON. She developed altered mental status, left facial paralysis, left paresis, and experienced three episodes of ON. She was treated with rituximab and azathioprine (AZA) as prevention for recurrent ON. She relapsed under treatment with AZA when CD19 cells reappeared 6 months after the first rituximab infusion. However, she has not relapsed since her CD19 count was reduced and kept low with rituximab infusion. CONCLUSIONS: It is conceivable that anti-MOG antibodies are involved in the pathology of "ADEM followed by recurrent ON," and that the early introduction of rituximab, which is involved in the suppression of antibody production and has effects on CD20 T lymphocytes, may be a feasible treatment for ON. Due to the small number of patients, additional reports on prospectively followed patients are needed.


Assuntos
Autoanticorpos/metabolismo , Encefalomielite Aguda Disseminada/terapia , Fatores Imunológicos/uso terapêutico , Glicoproteína Mielina-Oligodendrócito/imunologia , Neurite Óptica/terapia , Rituximab/uso terapêutico , Encéfalo/diagnóstico por imagem , Criança , Progressão da Doença , Encefalomielite Aguda Disseminada/complicações , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/imunologia , Feminino , Humanos , Neurite Óptica/diagnóstico por imagem , Neurite Óptica/etiologia , Neurite Óptica/imunologia
10.
Hinyokika Kiyo ; 64(1): 17-20, 2018 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-29471599

RESUMO

An 11-year-old boy was referred to our department with the chief complaint of acute urinary retention. He had had a history of viral enteritis a few days before the onset of dysuria. He presented with a slight fever, mild headache and weakness of the extremities. A cerebrospinal fluid examination showed the elevation of cell number (cell number : 158/3, polynuclear cells : 29/3, and mononuclear cells : 129/3). Although spinal magnetic resonance imaging (MRI) did not show abnormal findings, fluid attenuated inversion recovery (FLAIR) image of the brain MRI showed a high signal area on the cerebral cortex. Acute disseminated encephalomyelitis (ADEM) was suspected from the clinical course, the cerebrospinal fluid examination, and brain MRI findings. A urethral catheter was indwelled for urinary retention, and steroid pulse therapy was promptly started. After removal of the urethral catheter seven days after the therapy initiation, normal urination without residual urine was observed. Findings of a cerebrospinal fluid test and brain MRI also showed improvement.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Retenção Urinária/complicações , Criança , Encefalomielite Aguda Disseminada/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Retenção Urinária/terapia
11.
Neuropediatrics ; 49(1): 3-11, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28859212

RESUMO

Myelin oligodendrocyte glycoprotein (MOG) antibodies (abs) are present in one third of all children with an acute demyelinating syndrome (ADS). MOG-abs can be found in acute disseminated encephalomyelitis (ADEM), transverse myelitis, isolated optic neuritis (ON), or recurrent demyelinating diseases, such as multiphasic neuromyelitis optica spectrum disorders (NMOSD) without aquaporin-4 (AQP4) abs or multiphasic ADEM (MDEM), but rarely in children who subsequently develop multiple sclerosis (MS). The presence of MOG-abs is age dependent with the highest seropositivity rates found in young children and an episode of ADEM, whereas older children with MOG-abs present with ON, myelitis, or brainstem symptoms. MOG-abs, initially thought to be associated with a benign disease course, are found in a substantial proportion of children with relapsing episodes associated with high and persisting MOG-ab titers. This review describes, in particular, the increasing spectrum of phenotypes associated with MOG-abs with a focus on clinical characteristics, radiological features, and therapeutic aspects.


Assuntos
Autoanticorpos/sangue , Encefalomielite Aguda Disseminada/sangue , Encefalomielite Aguda Disseminada/terapia , Glicoproteína Mielina-Oligodendrócito/imunologia , Criança , Pré-Escolar , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/imunologia , Humanos
12.
Australas J Dermatol ; 59(2): e123-e126, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28524368

RESUMO

Pemphigoid gestationis is a skin-specific autoimmune disorder that can sometimes present as the cutaneous manifestation of a multiorgan disease due to potentially common pathogenic mechanisms. We report a severe form of pemphigoid gestationis in a 32-year-old primigravida woman, who presented at 22 weeks of gestation with headaches and blurred vision, later developing encephalitis, intrauterine fetal demise and dilated cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada/etiologia , Encefalomielite Aguda Disseminada/etiologia , Morte Fetal/etiologia , Penfigoide Gestacional/diagnóstico , Adulto , Cardiomiopatia Dilatada/diagnóstico , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Penfigoide Gestacional/patologia , Gravidez
14.
Neurology ; 89(9): 900-908, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28768844

RESUMO

OBJECTIVE: To assess the prognostic value of MOG antibodies (abs) in the differential diagnosis of acquired demyelinating syndromes (ADS). METHODS: Clinical course, MRI, MOG-abs, AQP4-abs, and CSF cells and oligoclonal bands (OCB) in children with ADS and 24 months of follow-up were reviewed in this observational prospective multicenter hospital-based study. RESULTS: Two hundred ten children with ADS were included and diagnosed with acute disseminated encephalomyelitis (ADEM) (n = 60), neuromyelitis optica spectrum disorder (NMOSD) (n = 12), clinically isolated syndrome (CIS) (n = 101), and multiple sclerosis (MS) (n = 37) after the first episode. MOG-abs were predominantly found in ADEM (57%) and less frequently in NMOSD (25%), CIS (25%), or MS (8%). Increased MOG-ab titers were associated with younger age (p = 0.0001), diagnosis of ADEM (p = 0.005), increased CSF cell counts (p = 0.011), and negative OCB (p = 0.012). At 24-month follow-up, 96 children had no further relapses. Thirty-five children developed recurrent non-MS episodes (63% MOG-, 17% AQP4-abs at onset). Seventy-nine children developed MS (4% MOG-abs at onset). Recurrent non-MS episodes were associated with high MOG-ab titers (p = 0.0003) and older age at onset (p = 0.024). MS was predicted by MS-like MRI (p < 0.0001) and OCB (p = 0.007). An MOG-ab cutoff titer ≥1:1,280 predicted a non-MS course with a sensitivity of 47% and a specificity of 100% and a recurrent non-MS course with a sensitivity of 46% and a specificity of 86%. CONCLUSIONS: Our results show that the presence of MOG-abs strongly depends on the age at disease onset and that high MOG-ab titers were associated with a recurrent non-MS disease course.


Assuntos
Encefalomielite Aguda Disseminada/imunologia , Esclerose Múltipla/imunologia , Glicoproteína Mielina-Oligodendrócito/sangue , Glicoproteína Mielina-Oligodendrócito/imunologia , Neuromielite Óptica/imunologia , Adolescente , Autoanticorpos , Biomarcadores/metabolismo , Criança , Pré-Escolar , Diagnóstico Diferencial , Progressão da Doença , Encefalomielite Aguda Disseminada/sangue , Encefalomielite Aguda Disseminada/líquido cefalorraquidiano , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Esclerose Múltipla/sangue , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/diagnóstico por imagem , Neuromielite Óptica/sangue , Neuromielite Óptica/líquido cefalorraquidiano , Neuromielite Óptica/diagnóstico por imagem , Bandas Oligoclonais , Prognóstico , Estudos Prospectivos
15.
J Neurol ; 264(8): 1754-1762, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28695361

RESUMO

Patients with acute disseminated encephalomyelitis (ADEM) are presumed to have radiological monophasic disease, but this is uncertain since follow-up brain MRI is not routinely performed. We aimed to ascertain combined radiological and clinical monophasic disease in ADEM patients and to assess whether performing early (<6 months) follow-up brain MRI has prognostic value for subsequent multiphasic disease. We retrospectively studied the medical records of patients initially diagnosed with ADEM (years 2000-2014) at the Massachusetts General Hospital, USA. A neuroimaging specialist, masked to clinical events, reviewed all available brain MRIs. We included 62 patients (25 male; 30 pediatric; median clinical follow-up 3 years) and classified them into two subgroups: (1) clinically monophasic (no new, recurrent or worsening neurological symptoms >3 months after onset) (n = 45), and (2) clinically multiphasic (clinical relapse >3 months after onset) (n = 17). All clinically monophasic patients with brain MRI follow-up (n = 30) also had radiological monophasic disease a median of 2 years after ADEM onset. New lesions (58 vs. 14%) and persistent lesions (100 vs. 18%) on early brain MRI [available in 40 patients (65%)], as well as clinical flares (53 vs. 20%), were more common in clinically multiphasic versus monophasic patients. These early follow-up data allowed us to predict multiphasic disease with reasonable accuracy in a multivariable model (AUC = 0.73). We conclude that performing early follow-up brain MRI routinely in ADEM patients would aid clinicians in predicting multiphasic disease and may stratify patients who would benefit from initiation of disease-modifying therapy for multiple sclerosis.


Assuntos
Encéfalo/diagnóstico por imagem , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Imagem por Ressonância Magnética , Adolescente , Adulto , Encefalomielite Aguda Disseminada/líquido cefalorraquidiano , Encefalomielite Aguda Disseminada/tratamento farmacológico , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Neuroimagem , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Medula Espinal/diagnóstico por imagem , Fatores de Tempo , Adulto Jovem
18.
Mult Scler Relat Disord ; 13: 21-24, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28427695

RESUMO

We describe a man recently diagnosed with multiple myeloma who presented with progressive spastic paraparesis, encephalopathy and multifocal MRI lesions with haemorrhage. Brain histopathology was consistent with acute disseminated encephalomyelitis (ADEM) with no new clinicoradiological findings on follow-up. This case emphasises the growing paraneoplastic spectrum, including non-classical but treatable disorders such as ADEM.


Assuntos
Encefalomielite Aguda Disseminada/complicações , Encefalomielite Aguda Disseminada/patologia , Mieloma Múltiplo/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/patologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/patologia , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico por imagem , Paraparesia Espástica/complicações
19.
BMJ Case Rep ; 20172017 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-28433979

RESUMO

A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid (black mamba) 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid NM2201, technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.


Assuntos
Canabinoides/toxicidade , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto , Encefalomielite Aguda Disseminada/induzido quimicamente , Encefalomielite Aguda Disseminada/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
20.
Jpn J Radiol ; 35(7): 341-349, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28447317

RESUMO

Zika virus (ZIKV) is a mosquito-borne arbovirus from the Flaviviridae family, first discovered in 1947. There has been no report of severe complications caused by this virus in humans until recently. However, it is confirmed now that prenatally acquired ZIKV infection may cause severe congenital brain abnormalities in the infected fetuses. In addition, there has been an increasing number of reports during recent years about the causal relationship between postnatally acquired ZIKV infection and severe neurologic complications (mostly immune-mediated ones). Hence, ZIKV should not be considered as benign as it was initially thought, but it might be seen as a serious global threat to human health that may severely affect not only fetuses. In this pictorial essay, we aim to describe and illustrate the currently recognized spectrum of neuroimaging findings in postnatally acquired ZIKV infection. Although neurologic complications do not frequently occur in postnatal ZIKV infection, it is important to be aware of them because they may cause high morbidity and mortality in the affected patients. In addition to clinical and laboratory findings, neuroimaging may help in the diagnostic work-up to make the correct diagnosis, determine the extent of the disease, and follow the clinical course.


Assuntos
Neuroimagem/métodos , Infecção por Zika virus/diagnóstico por imagem , Diagnóstico Diferencial , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/virologia , Síndrome de Guillain-Barré/diagnóstico por imagem , Síndrome de Guillain-Barré/virologia , Humanos , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/virologia , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/virologia
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