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1.
Mult Scler Relat Disord ; 48: 102723, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33388559

RESUMO

Corona Virus Disease 2019 (COVID-19) is a new illness caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With the increasing number of confirmed cases and the accumulating clinical data, a broad spectrum of neurological complications has been reported in the literature, including encephalopathy, stroke, Guillain-Barré syndrome, meningo-encephalitis, acute necrotizing hemorrhagic encephalopathy, and inflammatory central nervous system syndromes. Here, we describe the case of a 38-year-old woman presenting with longitudinally extensive transverse myelitis, revealed by bilateral lower limb weakness, decreased sensation below the Th4 level and urinary retention, and occuring 15 days after she had been diagnosed with COVID-19.


Assuntos
/complicações , Mielite Transversa/etiologia , Mielite Transversa/fisiopatologia , Adulto , Feminino , Humanos
4.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784242

RESUMO

A 60-year-old man presented to hospital with bilateral lower limb weakness, urinary retention and constipation. He had been diagnosed with COVID-19 10 days prior. Clinical examination revealed global weakness, increased tone, hyperreflexia and patchy paresthesia in his lower limbs bilaterally. Preliminary blood tests performed revealed a mildly elevated C reactive protein and erythrocyte sedimentation rate but was otherwise unremarkable. MRI scan of his whole spine demonstrated hyperintense T2 signal centrally from T7 to T10, suggestive of acute transverse myelitis. A lumbar puncture showed elevated protein count but normal glucose and white blood cell count. Serological testing for other viruses was negative. His neurological symptoms improved significantly after treatment with intravenous methylprednisone. This case highlights a potential neurological complication of COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/etiologia , Pneumonia Viral/complicações , Doença Aguda , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Pandemias , Coluna Vertebral/diagnóstico por imagem
8.
Neurocrit Care ; 32(3): 667-671, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32346843

RESUMO

The magnitude of the COVID-19 pandemic will result in substantial neurological disease, whether through direct infection (rare), para-infectious complications (less rare), or critical illness more generally (common). Here, we raise the importance of stringent diagnosis and data collection regarding neurological complications of COVID-19; we urge caution in the over-diagnosis of neurological disease where it does not exist, but equally strongly encourage the concerted surveillance for such conditions. Additional to the direct neurological complications of COVID-19 infection, neurological patients are at risk of harm from both structural limitations (such as number of intensive care beds), and a hesitancy to treat with certain necessary medications given risk of nosocomial COVID-19 infection. We therefore also outline the specific management of patients with neuroinflammatory diseases in the context of the pandemic. This article describes the implications of COVID-19 on neurological disease and advertises the Neurocritical Care Society's international data collection collaborative that seeks to align data elements.


Assuntos
Infecções por Coronavirus/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Pneumonia Viral/fisiopatologia , Betacoronavirus , Disfunção Cognitiva/etiologia , Infecções por Coronavirus/complicações , Cuidados Críticos , Estado Terminal , Infecção Hospitalar/prevenção & controle , Coleta de Dados , Encefalomielite Aguda Disseminada/etiologia , Síndrome de Guillain-Barré/etiologia , Humanos , Imunossupressores/efeitos adversos , Controle de Infecções , Cooperação Internacional , Mielite Transversa/etiologia , Doenças do Sistema Nervoso/tratamento farmacológico , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações
9.
J Neuroimmunol ; 343: 577229, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32247876

RESUMO

Chronic granulomatous disease (CGD) is an uncommon genetic immunodeficiency disorder affecting neutrophil function, characterized by recurrent bacterial and fungal infections. X-linked carriers of CGD have an increased risk of autoimmune disorders, in particular lupus like disorders. We describe the case of a 37 years old female carrier of X-linked CGD, who presented with clinical features and serology consistent with a definite diagnosis of Systemic lupus erythematosus (SLE), with rare immune mediated neurological manifestations including secondary central nervous system (CNS) vasculitis and Longitudinally extensive transverse myelitis (LETM), responsive to immunomodulation. These neurological manifestations have not been described previously in carriers of CGD. We recommend early diagnosis of these immune mechanisms, especially in X-linked carriers of CGD, and appropriate immunomodulation in order to improve life expectancy and improve neurological outcome.


Assuntos
Doença Granulomatosa Crônica/complicações , Lúpus Eritematoso Sistêmico/complicações , Adulto , Anti-Inflamatórios/uso terapêutico , Feminino , Doença Granulomatosa Crônica/tratamento farmacológico , Doença Granulomatosa Crônica/genética , Heterozigoto , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Mielite Transversa/etiologia , Vasculite do Sistema Nervoso Central/etiologia
10.
J Neurol ; 267(3): 823-829, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31776719

RESUMO

Leber hereditary optic neuropathy (LHON) typically presents as painless central or centrocecal scotoma and is due to maternally inherited mitochondrial DNA (mtDNA) mutations. Over 95% of LHON cases are caused by one of three mtDNA "common" point mutations: m.3460G>A, m.11778G>A, or m.14484T>C, which are all in genes encoding structural subunits of complex I of the respiratory chain. Intriguing features of LHON include: incomplete penetrance, tissue specificity, and male predominance, indicating that additional genetic or environmental factors are modulating the phenotypic expression of the pathogenic mtDNA mutations. However, since its original description as a purely ophthalmological disorder, LHON has also been linked to multisystemic conditions with variable neurological, cardiac, and skeletal abnormalities. Although double "common" mutations have been reported to cause LHON and LHON-plus, they are extremely rare. Here, we present a patient with an unusual double point mutation (m.11778 G>A and m.14484T>C) with a multisystemic LHON-plus phenotype characterized by: optic neuropathy, ptosis, ataxia, dystonia, dysarthria, and recurrent extensive transverse myelitis.


Assuntos
Distonia/genética , Distonia/patologia , Mielite Transversa/patologia , NADH Desidrogenase/genética , Atrofia Óptica Hereditária de Leber/genética , Atrofia Óptica Hereditária de Leber/patologia , Adulto , Humanos , Masculino , Mielite Transversa/etiologia , Mutação Puntual
11.
Mult Scler Relat Disord ; 37: 101455, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670207

RESUMO

We describe a 50-year-old male patient who was admitted to the emergency department with complaints of fever and fatigue that had suddenly started two weeks ago. In the laboratory evaluation, a white blood cell count of 131.000/mm3 was detected. The patient was hospitalized and developed fecal incontinence on the first day of hospitalization. Detailed neurological examination revealed the patient had tetraparesis. Long segment high signal intensity was observed on spinal MRI. Flow cytometry examination of the CSF and biopsy findings of the bone marrow were compatible with Chronic Lymphocytic Leukemia (CLL). The patient's MRI appearances resolved after treatment. The tetraparesis resolved partially. There was no motor deficit in upper extremities and the patient was able to walk without aid or rest for 100 m. Clinical manifestation of central nervous system (CNS) involvement in CLL is heterogeneous and therefore may be difficult to pinpoint. We have described an uncommon occurrence of CNS involvement in CLL.


Assuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Mielite Transversa/diagnóstico , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite Transversa/etiologia
12.
BMC Neurol ; 19(1): 234, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31607267

RESUMO

BACKGROUND: This article reports a case diagnosis of a 44-year-old female who presented with intractable hiccups and vomit complicated with an acute onset of paraplegia. Transverse myelitis was evident on MRI and serological studies were consistent with Neuromyelitis Optica (NMO) based on NMO-IgG sero-positivity. Further studies revealed positive ANA, anti-RNA polymerase III autoantibodies, and Scl-70, leading to a concurrent diagnosis of systemic sclerosis (SSc). The coexistence of these two disease processes and their underlying clinical manifestations and therapeutic interventions are seldom reported in literature and are worth reporting. CASE PRESENTATION: The patient was treated with high dose steroids, and subsequently developed malignant hypertension and acute renal failure, later identified on biopsy as steroids-induced scleroderma renal crisis. Although Neuromyelitis Optica spectrum disorder (NMOSD) has often been associated with various collagen and autoimmune diseases, the coexistence of NMOSD and SSc presented a challenge where the patient underwent aggressive physical therapy and necessitated an intervention with Rituximab to achieve an appropriate clinical response. We have received a written consent forms from the participant in our study, and we have them on file in case they are requested. We have also received the patient's written consent for the data and images presented in this article. CONCLUSION: This article expands on NMOSD associated autoimmune diseases. Systemic Sclerosis is an insidious disease that is often diagnosed late as not all patients often report skin manifestation. The finding suggests that patients presenting with acute neurological manifestations get tested for NMO-IgG/AQP-4 antibodies and other immunological studies based on clinical findings.


Assuntos
Mielite Transversa/etiologia , Neuromielite Óptica/complicações , Escleroderma Sistêmico/complicações , Adulto , Autoanticorpos/sangue , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Imagem por Ressonância Magnética , Mielite Transversa/tratamento farmacológico , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/tratamento farmacológico , Rituximab/uso terapêutico , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/tratamento farmacológico , Síndrome
13.
Neurol India ; 67(4): 1087-1089, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512641

RESUMO

The occurrence of longitudinally extensive transverse myelitis (LETM) in an elderly patient should evoke search for underlying systemic malignancy. Intramedullary spinal cord metastases and paraneoplastic myelopathy are the most common etiology for LETM in patients with systemic malignancy. The occurrence of LETM in association with renal cell carcinoma with aquaporin-4 (AQP4) antibody positivity has not been reported. We report an elderly woman who presented with acute paraplegia and was diagnosed as having LETM with AQP4 positivity and renal cell carcinoma.


Assuntos
Aquaporina 4/imunologia , Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Mielite Transversa/diagnóstico , Paraplegia/diagnóstico , Idoso , Carcinoma de Células Renais/complicações , Feminino , Humanos , Neoplasias Renais/complicações , Mielite Transversa/etiologia , Mielite Transversa/imunologia , Paraplegia/etiologia
14.
Rinsho Shinkeigaku ; 59(9): 579-583, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474644

RESUMO

Many cases of acute flaccid paralysis occurred during an enterovirus D68 (EV-D68) outbreak in North America in the fall of 2014, and this epidemic has been newly defined as a distinct disease entity named acute flaccid myelitis (AFM). This disease entity is relatively popular among pediatricians, whereas it remains little-known among neurologists in Japan. We reported a 7-year-old girl with AFM, in whom severe limb weakness and respiratory failure developed five days after appearance of respiratory symptoms. Clinical features of our case were mimicked by those of acute axonal motor neuropathy at early stage of the disease, and this resulted in delayed diagnosis of AFM. DNA of EV-D68 was not detected. There are few reported cases of severe AFM, in which artificial ventilation is needed for a long time including both acute and recovery phases of the illness, and functional prognosis of AFM is discussed by literature.


Assuntos
Mielite Transversa/terapia , Insuficiência Respiratória/terapia , Doença Aguda , Criança , Diagnóstico Tardio , Enterovirus Humano D , Infecções por Enterovirus/complicações , Extremidades , Feminino , Humanos , Debilidade Muscular/etiologia , Mielite Transversa/diagnóstico , Mielite Transversa/etiologia , Respiração Artificial , Insuficiência Respiratória/etiologia , Índice de Gravidade de Doença
16.
Rev Neurol ; 69(3): 113-122, 2019 Aug 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31310001

RESUMO

INTRODUCTION: Dengue is an arboviral infection caused by the dengue virus. The neurological complications associated with this infection are reviewed. DEVELOPMENT: The neurotropic nature of dengue virus has been confirmed in epidemiological studies, case series and histopathological studies. The range of neurological complications is 5.6-14.6%, and they are more frequent in serotypes 1 and 3. Encephalopathy is the most common neurological syndrome (0.5-6%) and its prevalence is higher in children and adolescents. The detection of the viral antigen in brain tissue and the presence of pleocytosis or RNA in cerebrospinal fluid are evidence of the neurotropic nature of dengue virus, which manifests itself in the form of encephalitis. Neurological syndromes during convalescence (disseminated acute cerebellitis, opsoclonus-myoclonus syndrome, mononeuritis, poly-radiculoneuritis and plexitis) appear to be immunomediated. Myelitis can occur during acute dengue virus infection and through an immunomediated mechanism in the convalescence phase. Myalgias, myositis, rhabdomyolysis and hypokalemic paralysis are examples of muscular dysfunction associated with the dengue virus. The incidence of stroke is 0.26%, and may be ischaemic or haemorrhagic. Ophthalmological complications include maculopathy, retinal haemorrhage, optic neuropathy and vitritis. CONCLUSIONS: The spectrum of neurological complications from dengue virus is broad. There are no reliable data on its real incidence because most of the studies published to date are isolated series or cases.


Assuntos
Dengue/complicações , Doenças do Sistema Nervoso/etiologia , Dengue/diagnóstico , Dengue/terapia , Vacinas contra Dengue/uso terapêutico , Diagnóstico Precoce , Encefalite Viral/etiologia , Oftalmopatias/etiologia , Hidratação , Síndrome de Guillain-Barré/etiologia , Humanos , Mielite Transversa/etiologia , Doenças Neuromusculares/etiologia , Hemorragia Retiniana/etiologia , Acidente Vascular Cerebral/etiologia
17.
AJNR Am J Neuroradiol ; 40(8): 1427-1432, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31296526

RESUMO

BACKGROUND AND PURPOSE: The early prediction of recurrence after an initial event of transverse myelitis helps to guide preventive treatment and optimize outcomes. Our aim was to identify MR imaging findings predictive of relapse and poor outcome in patients with acute transverse myelitis of unidentified etiology. MATERIALS AND METHODS: Spinal MRIs of 77 patients (mean age, 36.3 ± 20 years) diagnosed with acute transverse myelitis were evaluated retrospectively. Only the patients for whom an underlying cause of myelitis could not be identified within 3 months of symptom onset were included. Initial spinal MR images of patients were examined in terms of lesion extent, location and distribution, brain stem extension, cord expansion, T1 signal, contrast enhancement, and the presence of bright spotty lesions and the owl's eyes sign. The relapse rates and Kurtzke Expanded Disability Status Scale scores at least 1 year (range, 1-14 years) after a myelitis attack were also recorded. Associations of MR imaging findings with clinical variables were studied with univariate associations and binary log-linear regression. Differences were considered significant for P values < .05. RESULTS: Twenty-seven patients (35.1%) eventually developed recurrent disease. Binary logistic regression revealed 3 main significant predictors of recurrence: cord expansion (OR, 5.30; 95% CI, 1.33-21.11), contrast enhancement (OR, 5.05; 95% CI, 1.25-20.34), and bright spotty lesions (OR, 3.63; 95% CI, 1.06-12.43). None of the imaging variables showed significant correlation with the disability scores. CONCLUSIONS: Cord expansion, contrast enhancement, and the presence of bright spotty lesions could be used as early MR imaging predictors of relapse in patients with acute transverse myelitis of unidentified etiology. Collaborative studies with a larger number of patients are required to validate these findings.


Assuntos
Imagem por Ressonância Magnética/métodos , Mielite Transversa/diagnóstico por imagem , Adolescente , Adulto , Criança , Meios de Contraste , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/etiologia , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Lupus ; 28(10): 1243-1249, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31213132

RESUMO

OBJECTIVE: The aim of this study was to: (a) screen a large group of unselected patients with juvenile systemic lupus erythematosus for anti-aquaporin 4 antibodies (AQP4-Ab); (b) identify clinical and laboratory predictors of the presence of AQP4-Ab positivity in juvenile systemic lupus erythematosus. METHODS: Sera from 90 patients with juvenile systemic lupus erythematosus were tested for the presence of AQP4-Ab using a cell-based assay. Demographics, clinical and immunological features, treatment received were summarized. Fisher's exact test was used to identify clinical predictors of positivity for AQP4-Ab. RESULTS: Five of 90 (5.5%) patients tested positive for AQP4-Ab, all of which had neurological involvement, mainly transverse myelitis and optic neuritis. AQP4-Ab-positive patients were more likely to have neurological symptoms (P = 0.002), less likely to experience dermatological manifestations (P = 0.045), and less likely to have detectable anti-dsDNA antibodies (P = 0.022). These patients were also more likely to have received anti-epileptic (P = 0.023) and anti-coagulant (P = 0.007) drugs. CONCLUSIONS: The findings of this study indicate that some patients with juvenile systemic lupus erythematosus develop antibodies against aquaporin-4 and may be at risk of developing a neurological clinical phenotype. We suggest that all juvenile systemic lupus erythematosus patients should be systematically screened for the presence of AQP4-Ab and this may help identify a high risk for neurological involvement in juvenile systemic lupus erythematosus.


Assuntos
Aquaporina 4/sangue , Imunoglobulina G/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Adolescente , Adulto , Aquaporina 4/imunologia , Criança , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Mielite Transversa/diagnóstico , Mielite Transversa/etiologia , Neurite Óptica/diagnóstico , Neurite Óptica/etiologia , Estudos Retrospectivos , Adulto Jovem
20.
Transfus Apher Sci ; 58(3): 341-343, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31113744

RESUMO

Transverse myelitis is a quite rare complication of hematopoietic stem cell transplantation. The case is here reported of a 49 year old male with diffuse large B cell lymphoma in complete remission who developed transverse myelitis after autologous stem cell transplantation. The patient presented with numbness and sensory loss of the bilateral lower extremities and difficulty in urinating on the 20th day after cell transplantation. Millimetric hyperintensity was detected in the C5-C6 and T2-T5 segments of the spinal cord on cervical and thoracic vertebral magnetic resonance imaging. Treatment was initiated of pulse steroid and intravenous immunoglubulin followed by plasmapheresis and cyclophosphamide due to inadequate response. The patient then started a rehabilitation program and was discharged in the 9th month after stem cell transplantation when most of the symptoms were relieved. To the best of our knowledge, this is the first case reported in literature of TM development after autologous stem cell transplantation.


Assuntos
Ciclofosfamida/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Linfoma Difuso de Grandes Células B , Imagem por Ressonância Magnética , Mielite Transversa , Plasmaferese , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/etiologia , Mielite Transversa/terapia , Transplante Autólogo
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