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1.
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
2.
J Assoc Physicians India ; 67(3): 93-95, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304721

RESUMO

EBV associated nervous system complications includes encephalitis, meningitis, cerebellitis, polyradiculomyelitis, transverse myelitis, cranial and peripheral neuropathies, and psychiatric abnormalities are usually more commonly seen in immunocompromised patients and rarely in immunocompetent patients. Here we are reporting a 13 years old boy developed headache, malaise, sore throat and low back pain with radiation to both lower limbs. Next day he felt numbness below umbilicus followed by acute onset weakness in both lower limbs and urinary retention. Motor exam revealed proximal muscle power MRC grade 4/5 and distal power 1/5 in right lower limb and proximal power 4-/5 and distal power 0/5 in left lower limb with normal power in both upper limbs. Deep tendon reflexes were bilaterally normal except absent ankle reflexes. Both plantars were mute. All the modalities of sensation including pain, touch, temperature, joint position and vibration were impaired below umbilicus. Routine investigations were normal. The magnetic resonance imaging (MRI) of thoracic spine showed intramedullary lesion in conus, which was iso-hyperintense on T1-weighted and hyperintense on T2- weighted images extending from D12thoracic vertebral level to L1 with cord expansion (Figures 1, 2). The MRI features were suggestive of conus myelitis. Cerebrospinal fluid (CSF) analysis revealed increased protein, normal cells, glucose and Chloride. CSF Polymerase chain reaction (PCR) was positive for Epstein Barr virus . The clinical and imaging findings were consistent with the diagnosis of myelitis and responded well to steroid plus acyclovir treatment. The clinicians should be aware of such uncommon etiology of a common disease.


Assuntos
Encefalite , Infecções por Vírus Epstein-Barr/diagnóstico , Mielite Transversa/diagnóstico , Aciclovir , Adolescente , Infecções por Vírus Epstein-Barr/terapia , Herpesvirus Humano 4 , Humanos , Imagem por Ressonância Magnética , Masculino , Mielite Transversa/terapia
3.
Continuum (Minneap Minn) ; 25(3): 815-844, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31162318

RESUMO

PURPOSE OF REVIEW: This article reviews the clinical features, diagnostic approach, treatment, and prognosis of central nervous system inflammatory diseases that mimic multiple sclerosis (MS), including those defined by recently discovered autoantibody biomarkers. RECENT FINDINGS: The discovery of autoantibody biomarkers of inflammatory demyelinating diseases of the central nervous system (aquaporin-4 IgG and myelin oligodendrocyte glycoprotein IgG) and the recognition that, despite some overlap, their clinical phenotypes are distinct from MS have revolutionized this field of neurology. These autoantibody biomarkers assist in diagnosis and have improved our understanding of the underlying disease pathogenesis. This has allowed targeted treatments to be translated into clinical trials, three of which are now under way in aquaporin-4 IgG-seropositive neuromyelitis optica (NMO) spectrum disorder. SUMMARY: Knowledge of the clinical attributes, MRI findings, CSF parameters, and accompanying autoantibody biomarkers can help neurologists distinguish MS from its inflammatory mimics. These antibody biomarkers provide critical diagnostic and prognostic information and guide treatment decisions. Better recognition of the clinical, radiologic, and laboratory features of other inflammatory MS mimics that lack autoantibody biomarkers has allowed us to diagnose these disorders faster and initiate disease-specific treatments more expeditiously.


Assuntos
Fatores Imunológicos/administração & dosagem , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/terapia , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/terapia , Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Doenças do Sistema Nervoso Central/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/terapia , Mielite Transversa/líquido cefalorraquidiano , Neuromielite Óptica/líquido cefalorraquidiano , Troca Plasmática/métodos , Rituximab/administração & dosagem
5.
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
6.
BMJ Case Rep ; 12(4)2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31028050

RESUMO

We present a 47-year-old woman with recently diagnosed systemic lupus erythematosus who developed progressive numbness and tingling of her upper and lower extremities, followed by weakness and difficulty ambulating. She was diagnosed with longitudinal extensive transverse myelitis involving her entire cervical and thoracic spinal cord. Infectious workup was unrevealing. She failed to respond to pulse-dose intravenous steroids, but slowly improved with the addition of plasmapheresis and cyclophosphamide. Following maintenance treatment with mycophenolate mofetil and slow tapering of oral steroids, she has maintained complete remission with significant recovery of neurological function.


Assuntos
Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Imagem por Ressonância Magnética , Mielite Transversa/diagnóstico , Indução de Remissão/métodos , Medula Espinal/patologia , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/terapia , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Mielite Transversa/fisiopatologia , Mielite Transversa/terapia , Plasmaferese/métodos , Resultado do Tratamento
7.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936344

RESUMO

Heroin-related myelopathy is an uncommon but often devastating complication of heroin intake. It is usually reported in individuals exposed to intravenous heroin after a variable drug-free period, leading to acute and complete spinal cord injury with poor long-term outcome. We describe an original case of acute longitudinally extensive transverse myelopathy following single heroin and cocaine intravenous exposure after a long period of abstinence confirmed by toxicological hair and retrospective urine drug analysis. This case could provide new insights in the understanding of this rare neurological complication.


Assuntos
Cocaína/administração & dosagem , Incontinência Fecal/fisiopatologia , Cabelo/química , Heroína/efeitos adversos , Mielite Transversa/diagnóstico , Paraplegia/fisiopatologia , Abuso de Substâncias por Via Intravenosa/complicações , Anti-Inflamatórios/uso terapêutico , Cocaína/efeitos adversos , Extinção Psicológica , Incontinência Fecal/etiologia , Feminino , Heroína/administração & dosagem , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/complicações , Mielite Transversa/fisiopatologia , Mielite Transversa/terapia , Paraplegia/etiologia , Índice de Gravidade de Doença , Punção Espinal , Detecção do Abuso de Substâncias/métodos , Resultado do Tratamento
8.
Neurol Sci ; 40(7): 1383-1391, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30903415

RESUMO

OBJECTIVES: We compared the clinical, laboratory, and radiological features of different subgroups of acute transverse myelitis (ATM) diagnosed according to the criteria established by the Transverse Myelitis Consortium Working Group (TMCWG) as well as of non-inflammatory acute transverse myelopathies (NIATM) to identify possible short- and long-term prognostic factors. METHODS: A multicenter and retrospective study comprising 110 patients with ATM and 15 NIATM admitted to five Italian neurological units between January 2010 and December 2014 was carried out. RESULTS: A significantly higher frequency of isolated sensory disturbances at onset in ATM than in NIATM patients (chi-square = 14. 7; P = 0.005) and a significantly higher frequency of motor symptoms in NIATM than ATM (chi-square = 12.4; P = 0.014) was found. ATM patients with high disability at discharge had more motor-sensory symptoms without (OR = 3.87; P = 0.04) and with sphincter dysfunction at onset (OR = 7.4; P = 0.0009) compared to those with low disability. Higher age (OR = 1.08; P = 0.001) and motor-sensory-sphincter involvement at onset (OR = 9.52; P = 0.002) were significantly associated with a high disability score at discharge and after a median 1-year follow-up. CONCLUSIONS: The diagnosis of ATM may prevail respect to that of NIATM when a sensory symptomatology at onset occurs. In ATM, patients older and with motor-sensory involvement with or without sphincter impairment at admission could experience a major risk of poor prognosis both at discharge and at longer time requiring a timely and more appropriate treatment.


Assuntos
Mielite Transversa/diagnóstico , Adulto , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Encéfalo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Itália , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite Transversa/terapia , Exame Neurológico , Prognóstico , Estudos Retrospectivos , Medula Espinal/diagnóstico por imagem
9.
Mult Scler Relat Disord ; 30: 42-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30738277

RESUMO

IMPORTANCE: Patients afflicted with rare diseases often have a delay in diagnosis and treatment. Understanding the prevalence and impact of delayed diagnosis in transverse myelitis could trigger directed educational initiatives to increase clinician awareness and improve care. OBJECTIVE: To determine if symptoms at onset or care provider initially approached was associated with time to diagnosis, treatment or outcome in patients with transverse myelitis. DESIGN: This was an online patient and caregiver standardized survey to collect data about the initial medical experience. Patients were recruited through social media to complete a survey about initial symptoms, care provider approached for diagnosis, first events (hospital admission, testing, sent home, etc.), first diagnosis, time to treatment and outcomes. The data was collected by an independent, non-profit patient advocacy organization (The Transverse Myelitis Association) and provided to researchers for analysis. SETTING: This was an online survey of a prevalent cohort of individuals diagnosis with transverse myelitis. PARTICIPANTS: Patients with various autoimmune disorders responded to the survey. These included patients with multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis and idiopathic transverse myelitis. Only data about patients, greater than a year of age, with a diagnosis of transverse myelitis were included in the study.


Assuntos
Diagnóstico Tardio , Erros de Diagnóstico , Mielite Transversa/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mielite Transversa/epidemiologia , Mielite Transversa/fisiopatologia , Mielite Transversa/terapia , Mídias Sociais , Adulto Jovem
10.
J Clin Apher ; 34(4): 499-502, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30592528

RESUMO

We report the impact of measuring the hematocrit (HCT) of blood prime units (BPUs) on postprocedure patient HCT values in a small child with transverse myelitis undergoing therapeutic plasma exchange (TPE). Initially, the BPU HCT values were not measured, according to our apheresis policy of using our blood center's estimated HCT value. This approach resulted in unexpected increasing elevations of our patient's post-TPE HCT after the first two TPE procedures. Subsequent measurement of the BPU HCT prior to use stabilized the patient's post-TPE HCT. To our knowledge, this is the first case report describing the impact of using the measured BPU HCT vs the estimated HCT for very small children undergoing therapeutic apheresis. Our standard operating procedure for very small children has been updated after this patient's case to include measurements of the HCT values of BPUs for children who weigh 10 kg or less.


Assuntos
Hematócrito , Pediatria/métodos , Troca Plasmática/métodos , Peso Corporal , Criança , Humanos , Mielite Transversa/terapia
11.
Mult Scler Relat Disord ; 26: 207-210, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30268997

RESUMO

Longitudinally extensive transverse myelitis (LETM) is defined as a spinal cord lesion that extends over three or more vertebrae. LETM very rarely occurs in patients with the systemic malignancy. We report a 38-year old woman with adenocarcinoma of the cervix and LETM. Cervical and thoracic spine MRI showed hyperintense signal on T2W involving predominantly central spinal cord from the C4 level distally, including conus medullaris. In this patient corticosteroid therapy and therapeutic plasma exchange (TPE) courses were performed. On discharge, five weeks after TPE initiation, patient could walk with bilateral assistance. After a 16-month follow-up, her neurological finding was almost normal and MRI lesions disappeared. Thus, we present our patient as one of the rare cases of paraneoplastic LETM with excellent treatment response.


Assuntos
Adenocarcinoma/complicações , Mielite Transversa/etiologia , Mielite Transversa/patologia , Neoplasias do Colo do Útero/complicações , Corticosteroides/farmacologia , Adulto , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/terapia , Troca Plasmática
12.
J Neurol Sci ; 395: 47-53, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30292020

RESUMO

We review post-infectious and post-vaccination neurological syndromes involving peripheral and central nervous system (CNS) and report an illustrative case of simultaneous occurrence of Guillain-Barré syndrome (GBS), confirmed by nerve conduction velocities, plus MRI-demonstrated transverse myelitis (TM) and acute encephalitis [acute disseminated encephalomyelitis] (ADEM+GBS) affecting a 24-year-old woman from Cúcuta, Colombia, who developed acute Zika virus (ZIKV) infection confirmed by serum reverse transcriptase-polymerase chain reaction (RT-PCR) and convalescent ZIKV IgG antibodies. With intensive care treatment, respiratory support, steroids, and intravenous immunoglobulin (IVIg), patient survived with residual flaccid paraparesis. She had preexisting immunity against Chikungunya virus (CHIKV) and Dengue virus (DENV) acquired before the arrival of ZIKV in Colombia. From reports in the Caribbean, Central and South America we review 19 cases of ZIKV-associated TM, encephalitis and ADEM occurring after a mean latent period of 10.5 days (range 1-96) post-infection. Although GBS and ADEM are usually considered post-infectious and associated with development of antibodies against peripheral nerve and CNS epitopes, we postulate that our case of ADEM+GBS is para-infectious, induced by acute ZIKV neurotropism boosted by active immunity against other arboviruses. Animal models of ZIKV demonstrated strong viral neurotropism enhanced by passive immunity with antibodies against arboviruses such as West Nile virus, CHIKV, or DENV. These considerations are relevant to prevent potential ZIKV vaccine-induced reactions involving central and peripheral nervous system.


Assuntos
Encefalite/complicações , Síndrome de Guillain-Barré/complicações , Mielite Transversa/complicações , Infecção por Zika virus/complicações , Encefalite/diagnóstico por imagem , Encefalite/imunologia , Encefalite/terapia , Feminino , Síndrome de Guillain-Barré/diagnóstico por imagem , Síndrome de Guillain-Barré/imunologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunidade Ativa , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/imunologia , Mielite Transversa/terapia , Adulto Jovem , Infecção por Zika virus/diagnóstico por imagem , Infecção por Zika virus/imunologia , Infecção por Zika virus/terapia
13.
Pediatr Neurol ; 86: 42-45, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30077551

RESUMO

BACKGROUND: Anti-myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders frequently manifest as optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis. While their clinical phenotypes overlap with relapsing inflammatory Central nervous system (CNS) conditions such as multiple sclerosis and neuromyelitis optica spectrum disorder, MOG-related syndromes frequently occur in a younger age group. In children, longitudinally extensive transverse myelitis (LETM) is less specific for anti-aquaporin-4 associated neuromyelitis optica spectrum disorder, and has also been reported in pediatric multiple sclerosis, idiopathic transverse myelitis, and acute flaccid myelitis. METHODS: We summarize two patients with positive MOG antibodies and myelitis. RESULTS: We identified two individuals with anti-MOG associated LETM that demonstrate primarily gray matter involvement. Clinically these patients exhibited hyperreflexia and had rapid improvement with immunotherapies. CONCLUSIONS: Anti-MOG diseases can cause LETM with gray matter predominance mimicking acute flaccid myelitis, but clinically these patients can have retained reflexes and respond favorably to immunotherapies.


Assuntos
Autoanticorpos/imunologia , Substância Cinzenta/diagnóstico por imagem , Glicoproteína Mielina-Oligodendrócito/imunologia , Mielite Transversa/diagnóstico , Mielite Transversa/imunologia , Adolescente , Diagnóstico Diferencial , Substância Cinzenta/imunologia , Humanos , Imunoterapia , Masculino , Mielite Transversa/terapia , Reflexo Anormal/imunologia
14.
Acupunct Med ; 36(4): 261-266, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29909400

RESUMO

OBJECTIVE: To preliminarily explore the effect of electroacupuncture (EA) on bladder and bowel dysfunction in patients with transverse myelitis. METHODS: Sixteen participants were treated with EA at bilateral BL32, BL33, and BL35 once a day, five times a week for the first 4 weeks, and once every other day, three times a week for the following 4 weeks. Patients were then followed up for 6 months. Bladder and bowel function, and the safety of EA, were assessed. RESULTS: After 8 weeks of treatment, five (5/16, 31%) patients resumed normal voiding, three (6/16, 38%) regained partially normal voiding, and five (5/16, 31%) had no change. After treatment, the residual urine volume decreased by 100 mL (IQR 53-393 mL; P<0.05) in nine patients with bladder voiding dysfunction; in 11 patients with urinary incontinence, the number of weekly urinary incontinence episodes, 24-hour urinary episodes, and nocturia episodes per night diminished by 14 (95% CI 5 to 22), 5 (95% CI 1 to 9), and 4 (95% CI 0 to 7) episodes, respectively (all P<0.05). After 8 weeks of treatment in eight patients with faecal retention, four (4/8, 50%) resumed normal bowel movements, three (3/8, 38%) regained partially normal bowel movements, and one (1/8, 13%) had no change. CONCLUSIONS: EA might be a promising alternative for the management of bladder and bowel dysfunction in patients with transverse myelitis. Randomised controlled trials are needed to confirm the effectiveness and safety of EA for this condition.


Assuntos
Eletroacupuntura , Mielite Transversa/terapia , Bexiga Urinária/fisiopatologia , Pontos de Acupuntura , Adulto , Defecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/fisiopatologia , Estudos Prospectivos , Micção , Adulto Jovem
17.
Handb Clin Neurol ; 152: 213-227, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29604979

RESUMO

The epidemiology of spinal cord disease in human immunodeficiency virus (HIV) infection is largely unknown due to a paucity of data since combination antiretroviral therapy (cART). HIV mediates spinal cord injury indirectly, by immune modulation, degeneration, or associated infections and neoplasms. The pathologies vary and range from cytotoxic necrosis to demyelination and vasculitis. Control of HIV determines the differential for all neurologic presentations in infected individuals. Primary HIV-associated acute transverse myelitis, an acute inflammatory condition with pathologic similarities to HIV encephalitis, arises in early infection and at seroconversion. In contrast, HIV vacuolar myelopathy and opportunistic infections predominate in uncontrolled disease. There is systemic immune dysregulation as early as primary infection due to initial depletion of gut-associated lymphoid tissue CD4 cells and allowance of microbial translocation across the gut that never fully recovers throughout the course of HIV infection, regardless of how well controlled. The subsequent proinflammatory state may contribute to spinal cord diseases observed even after cART initiation. This chapter will highlight an array of spinal cord pathologies classified by stage of HIV infection and immune status.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/terapia , Animais , Antirretrovirais/uso terapêutico , Humanos , Mielite Transversa/diagnóstico , Mielite Transversa/epidemiologia , Mielite Transversa/terapia , Doenças da Medula Espinal/terapia
18.
J Clin Neurosci ; 50: 152-154, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29396069

RESUMO

Cytomegalovirus can cause severe disease in immunocompromised patients including encephalomyelitis, hepatitis, pneumonitis, colitis and retinitis. CMV induced myelitis and hepatitis are rare in immunocompetent patients. Following a thorough search on the literature using pubmed, there were only 10 well documented CMV-induced transverse myelitis cases reported worldwide. We report a healthy young male who developed longitudinal extensive transverse myelitis and acute hepatitis secondary to CMV infection. Our case is different from the other cases as our patient had concurrent acute hepatitis and received plasma exchange therapy (PLEX) in addition to pulsed steroids and antivirals. The patient recovered well and had an excellent outcome.


Assuntos
Infecções por Citomegalovirus/complicações , Hepatite/virologia , Mielite Transversa/virologia , Doença Aguda , Adulto , Antivirais/uso terapêutico , Citomegalovirus , Hepatite/terapia , Humanos , Masculino , Mielite Transversa/terapia , Troca Plasmática , Plasmaferese
19.
Am J Case Rep ; 19: 114-117, 2018 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-29382812

RESUMO

BACKGROUND Isolated spinal artery subarachnoid hemorrhage is a rare occurrence in the general population, but occurs more commonly as one of many neurologic sequela of systemic lupus erythematosus (SLE). The etiology of a neurologic deficit in an SLE patient is often multifactorial. Comorbid conditions, such as antiphospholipid antibody syndrome, predispose to stroke. Other diagnoses, including transverse myelitis, may also be attributed to local inflammation. CASE REPORT A 37-year-old woman with SLE and antiphospholipid antibody syndrome experienced severe back pain followed by sudden paralysis and sensory loss below the T2 level. She remained alert and oriented on examination, with neurologic exam positive for diminished strength in the arms and with total loss of sensation and strength in the legs. Diagnostic workup was limited due to a contrast allergy and severe lupus nephritis; however, initial imaging showed increased cervical-thoracic spinal cord signal and concern for acute blood in the subarachnoid space. No neurosurgical intervention occurred, and the patient was treated with high-dose steroids and plasmapheresis for a possible transverse myelitis and non-aneurysmal subarachnoid hemorrhage. The patient received further neurologic and rheumatologic workup and remained neurologically stable, with improvement in proximal arm strength on physical exam. CONCLUSIONS We highlight the diagnostic challenges in treating a patient with SLE with acute paralysis and sensory loss. In this case, aggressive early treatment of the patient's myelitis and myelopathy were successful in leading to mild neurological improvement.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/etiologia , Hemorragia Subaracnóidea/etiologia , Vasculite/etiologia , Adulto , Feminino , Humanos , Mielite Transversa/diagnóstico , Mielite Transversa/terapia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/terapia , Vasculite/diagnóstico , Vasculite/terapia
20.
Mult Scler Relat Disord ; 21: 9-10, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29438836

RESUMO

INTRODUCTION: Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) associated disorders present with a spectrum of clinical pictures including brainstem involvement. CASE REPORT: A patient with the sudden onset of a post-partum severe rhombencephalitis causing respiratory failure (12 years after a mild transverse myelitis). Despite the aggressive clinical course, she had an impressive recovery after plasmapheresis, and no further relapses on immunosuppression. CONCLUSION: MOG-IgG disorders could relapse several years after onset and involve brainstem. Good prognosis is possible after treatment.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/imunologia , Encefalite/imunologia , Imunoglobulina G/sangue , Glicoproteína Mielina-Oligodendrócito/imunologia , Mielite Transversa/imunologia , Adulto , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/complicações , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/diagnóstico por imagem , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/terapia , Encefalite/complicações , Encefalite/diagnóstico por imagem , Encefalite/terapia , Feminino , Humanos , Mielite Transversa/complicações , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/terapia , Período Pós-Parto , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/imunologia , Insuficiência Respiratória/terapia , Rombencéfalo/diagnóstico por imagem , Rombencéfalo/imunologia
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