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1.
MMWR Morb Mortal Wkly Rep ; 70(44): 1534-1538, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34735423

RESUMO

Acute flaccid myelitis (AFM), a recognized complication of certain viral infections, is a serious neurologic condition that predominantly affects previously healthy children and can progress rapidly, leading to respiratory insufficiency and permanent paralysis. After national AFM surveillance began in 2014, peaks in AFM cases were observed in the United States in 2014, 2016, and 2018 (1). On the basis of this biennial pattern, an increase in AFM was anticipated in 2020. To describe the epidemiology of confirmed AFM cases since 2018, demographic, clinical, and laboratory information collected as part of national AFM surveillance was reviewed. In 2018, a total of 238 confirmed AFM cases were reported to CDC, compared with 47 cases in 2019 and 32 in 2020. Enterovirus D68 (EV-D68) was detected in specimens from 37 cases reported in 2018, one case in 2019 and none in 2020. Compared with 2018, cases reported during 2019-2020 occurred in older children and were less frequently associated with upper limb involvement, febrile or respiratory prodromal illness, or cerebrospinal fluid (CSF) pleocytosis. These findings suggest that the etiologies of AFM in 2019 and 2020 differed from those in 2018. The absence of an increase in cases in 2020 reflects a deviation from the previously observed biennial pattern, and it is unclear when the next increase in AFM should be expected. Clinicians should continue to maintain vigilance and suspect AFM in any child with acute flaccid limb weakness, particularly in the setting of recent febrile or respiratory illness.


Assuntos
Viroses do Sistema Nervoso Central/epidemiologia , Mielite/epidemiologia , Doenças Neuromusculares/epidemiologia , Vigilância da População , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia
2.
Euro Surveill ; 26(45)2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34763750

RESUMO

We report a rapid increase in enterovirus D68 (EV-D68) infections, with 139 cases reported from eight European countries between 31 July and 14 October 2021. This upsurge is in line with the seasonality of EV-D68 and was presumably stimulated by the widespread reopening after COVID-19 lockdown. Most cases were identified in September, but more are to be expected in the coming months. Reinforcement of clinical awareness, diagnostic capacities and surveillance of EV-D68 is urgently needed in Europe.


Assuntos
COVID-19 , Enterovirus Humano D , Infecções por Enterovirus , Enterovirus , Mielite , Infecções Respiratórias , Controle de Doenças Transmissíveis , Surtos de Doenças , Enterovirus Humano D/genética , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Mielite/epidemiologia , SARS-CoV-2
3.
J Med Microbiol ; 70(10)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34672918

RESUMO

Introduction. Global poliovirus eradication is a public health emergency of international concern. The acute flaccid paralysis (AFP) surveillance programme in South Africa has been instrumental in eliminating polioviruses and keeping the country poliovirus free.Gap statement. The sensitivity of surveillance for polioviruses by every African country is of global interest in the effort to ensure global health security from poliovirus re-emergence.Aim. To describe the epidemiology of polioviruses from AFP cases and environmental samples in South Africa and to report the performance of the AFP surveillance system for the years 2016-2019 against targets established by the World Health Organization (WHO).Methods. Stool specimens from AFP or suspected AFP cases were received and tested as per WHO guidelines. Environmental samples were gathered from sites across the Gauteng province using the grab collection method. Concentration was effected by the two-phase polyethylene glycol method approved by the WHO. Suspected polioviruses were isolated in RD and/or L20B cell cultures through identification of typical cytopathic effects. The presence of polioviruses was confirmed by intratypic differentiation PCR. All polioviruses were sequenced using the Sanger method, and their VP1 gene analysed for mutations.Results. Data from 4597 samples (2385 cases) were analysed from the years 2016-2019. Two cases of immunodeficiency-associated vaccine-derived poliovirus (iVDPV) type 3 were detected in 2017 and 2018. A further 24 Sabin type 1 or type 3 polioviruses were detected for the 4 years. The national surveillance programme detected an average of 3.1 cases of AFP/100 000 individuals under 15 years old (2.8/100 000-3.5/100 000). The stool adequacy of the samples received was 53.0 % (47.0-55.0%), well below the WHO target of 80 % adequacy. More than 90 % of results were released from the laboratory within the turnaround time (96.6 %) and non-polio enteroviruses were detected in 11.6 % of all samples. Environmental surveillance detected non-polio enterovirus in 87.5 % of sewage samples and Sabin polioviruses in 12.5 % of samples.Conclusion. The AFP surveillance programme in South Africa is sensitive to detect polioviruses in South Africa and provided no evidence of wild poliovirus or VDPV circulation in the country.


Assuntos
Viroses do Sistema Nervoso Central/epidemiologia , Mielite/epidemiologia , Doenças Neuromusculares/epidemiologia , Poliomielite/epidemiologia , Poliovirus/isolamento & purificação , Adolescente , Viroses do Sistema Nervoso Central/prevenção & controle , Viroses do Sistema Nervoso Central/virologia , Criança , Pré-Escolar , Erradicação de Doenças/normas , Erradicação de Doenças/estatística & dados numéricos , Monitoramento Epidemiológico , Fezes/virologia , Humanos , Mielite/prevenção & controle , Mielite/virologia , Doenças Neuromusculares/prevenção & controle , Doenças Neuromusculares/virologia , Poliomielite/prevenção & controle , Poliomielite/virologia , Vacinas contra Poliovirus/isolamento & purificação , Esgotos/virologia , África do Sul/epidemiologia
4.
Pan Afr Med J ; 39: 147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527163

RESUMO

Introduction: the World health organisation (WHO) African Region reported the first confirmed COVID-19 case caused by the SARS-CoV-2 on 25th February 2020, and the first case for the East Southern Africa (ESA) sub-region was on 5th March 2020. Almost all countries in the ESA sub region implemented the WHO-recommended preventive measures variably after the notification of community transmission of the COVID-19 disease. This resulted in the disruption of the outpatient, immunization surveillance, and the related supply chain activities. Methods: a comparative analysis study design of secondary acute flaccid paralysis (AFP) surveillance data received from the East and Southern Africa sub-region countries to evaluate the effect of the COVID-19 pandemic in the AFP field surveillance for the same time period of March to December 2019 and 2020. Results: we observed that 52.4% of second stool samples were received in the laboratory within 72 hours from March to December 2019, and only 48.1% in the same period of 2020. A 4.3% decline with a p-value of <0.0001 (95% CI, ranges from 2.326% to 6.269%). Similarly, we noted a 4.7% decline in the number of reported AFP cases in the ESA sub-region for March to December 2020 compared to the same period in 2019, a p-value of less than 0.001 (95% CI ranges from 2.785 to 6.614). For the percentage of stool adequacy, we observed a 3.37% decline for April in 2020 compared to April 2019 with a p-value of less than 0.001 (95% CI ranges from 2.059 to 4.690). Conclusion: we observed a decline in the core AFP surveillance (non polio) NP-AFP rate, and percentage of stool adequacy in countries severely affected by the COVID-19 disease. These countries implemented stringent transmission prevention measures such as lock-down and international transportation restrictions.


Assuntos
COVID-19 , Viroses do Sistema Nervoso Central/diagnóstico , Fezes/virologia , Mielite/diagnóstico , Doenças Neuromusculares/diagnóstico , Vigilância da População/métodos , Adolescente , África Oriental/epidemiologia , África Austral/epidemiologia , Viroses do Sistema Nervoso Central/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mielite/epidemiologia , Doenças Neuromusculares/epidemiologia
6.
Spinal Cord Ser Cases ; 7(1): 85, 2021 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-34564705

RESUMO

INTRODUCTION: Although neurological complications are well recognized in patients with sickle cell disease, myelopathy has been rarely described, with few reported cases of compressive and ischemic myelopathy. We present the first case report of longitudinally extensive myelitis (LETM) in SCD and review the differential diagnosis of myelopathy in these patients. CASE PRESENTATION: We report the case of a 29-year-old African-Brazilian man with SCD, who experienced a subacute flaccid paraparesis, with T2 sensory level and urinary retention. Cerebrospinal fluid analysis showed a lymphocytic pleocytosis and increased protein levels. MRI disclosed a longitudinally extensive spinal cord lesion, with a high T2/STIR signal extending from C2 to T12. We searched Medline/PubMed, Embase, Scopus, and Google Scholar databases for myelopathy in SCD patients. DISCUSSION: Spinal cord compression by vertebral fractures, extramedullary hematopoietic tissue, and Salmonella epidural abscess have been reported in SCD. We found only three case reports of spinal cord infarction, which is unexpectedly infrequent compared to the prevalence of cerebral infarction in SCD. We found only one case report of varicella-zoster myelitis and no previous report of LETM in SCD patients. Specific and time-sensitive causes of myelopathy should be considered in SCD patients. In addition to compression and ischemia, LETM is a possible mechanism of spinal cord involvement in SCD patients.


Assuntos
Anemia Falciforme , Mielite , Compressão da Medula Espinal , Doenças da Medula Espinal , Adulto , Anemia Falciforme/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Mielite/diagnóstico , Mielite/etiologia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia
8.
BMJ Case Rep ; 14(8)2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462272

RESUMO

Transverse myelitis is a rare neurological complication seen with varicella-zoster virus (VZV) infection, which is common among immunocompromised hosts. It can occur during the primary VZV infection or reactivation of latent infection. It is a complication that requires prompt diagnosis and treatment. The present case is that of a 28-year-old immunocompetent man, who presented with fever, rash and acute-onset spastic paraparesis with bladder involvement. Causes such as herpes simplex 1 and 2, cytomegalovirus, enterovirus and Epstein-Barr virus infection were ruled out. On evaluation, he was diagnosed with acute primary disseminated VZV infection with parainfectious transverse myelitis, based on positive cerebrospinal fluid multiplex PCR (PCR) and serum VZV IgM antibodies. He was treated with intravenous acyclovir and steroids, with which he improved significantly.


Assuntos
Varicela , Infecções por Vírus Epstein-Barr , Herpes Zoster , Mielite Transversa , Mielite , Adulto , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Humanos , Masculino , Mielite Transversa/diagnóstico , Mielite Transversa/tratamento farmacológico , Mielite Transversa/etiologia
9.
J Neuroimmunol ; 359: 577686, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34392078

RESUMO

A 44-year-old previously healthy woman developed acute myelitis in close temporal relationship with ChAdOx1 nCoV-19 vaccine first-dose administration. The neurological involvement was mainly sensory with neuroimaging showing two mono-metameric lesions involving the posterior and lateral cord at dorsal level. Significant improvement was promptly recorded with high-dose intravenous steroids, with complete recovery within one month. The strict temporal relationship between vaccination and myelitis, together with the absence of clues pointing to alternative diagnoses, might suggest a conceivable role for anti-SARS-CoV-2 vaccine as immunological trigger, although a causal relationship has yet to be established and our preliminary observation suggests caution.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Mielite/diagnóstico por imagem , Doença Aguda , Adulto , Vacinas contra COVID-19/efeitos adversos , Feminino , Humanos , Mielite/induzido quimicamente
10.
AJNR Am J Neuroradiol ; 42(10): 1912-1917, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34413066

RESUMO

Coronavirus disease 2019 (COVID-19) myelitis is a rare condition, most commonly presenting with nonenhancing central expansile cord T2 signal changes. A single case report has also described longitudinal involvement of the dorsal columns. We present 5 cases of COVID-19-associated myelitis with tract-specific involvement of the dorsal and lateral columns and discuss potential pathophysiologic pathways for this unique pattern.


Assuntos
COVID-19 , Mielite , Substância Branca , Humanos , Imageamento por Ressonância Magnética , Mielite/diagnóstico por imagem , SARS-CoV-2 , Substância Branca/diagnóstico por imagem
11.
J Clin Microbiol ; 59(11): e0115121, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34432489

RESUMO

Enterovirus D68 (EV-D68) causes a range of clinical manifestations, including asthma-like illness, severe respiratory disease, and acute flaccid myelitis. EV-D68 has caused worldwide outbreaks since 2014 and is now recognized as a reemerging infection in many countries. EV-D68-specific PCR assays are widely used for the diagnosis of EV-D68 infection; however, assay sensitivity is a concern because of genetic changes in recently circulated EV-D68. To address this, we summarized EV-D68 sequences from previously reported world outbreaks from 2014 through 2020 on GenBank, and found several mutations at the primer and probe binding sites of the existing EV-D68-specific PCR assays. Subsequently, we designed two novel assays corresponding to the recently reported EV-D68 sequences: an EV-D68-specific real-time and seminested PCR. In an analysis of 22 EV-D68 confirmed cases during a recent EV-D68 outbreak in Japan, the new real-time PCR had higher sensitivity than the existing assay (100% versus 45%, P < 0.01) and a lower median CT value (27.8 versus 32.8, P = 0.005). Sensitivity was higher for the new nonnested PCR (91%) than for the existing seminested PCR assay (50%, P < 0.01). The specificity of the new real-time PCR was 100% using samples from non-EV-D68-infected cases (n = 135). In conclusion, our novel assays had higher sensitivity than the existing assay and might lead to more accurate diagnosis of recently circulating EV-D68. To prepare for future EV-D68 outbreaks, EV-D68-specific assays must be continuously monitored and updated.


Assuntos
Viroses do Sistema Nervoso Central , Enterovirus Humano D , Infecções por Enterovirus , Mielite , Infecções Respiratórias , Surtos de Doenças , Enterovirus Humano D/genética , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Humanos , Mielite/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia
12.
Clin Neurophysiol ; 132(10): 2456-2463, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34454273

RESUMO

OBJECTIVE: To summarize the neurophysiological properties of acute flaccid myelitis (AFM) and evaluate limb-based motor outcomes. METHODS: Nerve conduction studies (NCS) in 49 patients (21 females, 28 males; median age = 52 m) with AFM (median = 7 d after onset; range 1-122 d) were reviewed. Neurophysiological findings, together with treatment and prognosis, and neurophysiology-neuroimaging correlations were analyzed. RESULTS: The findings indicated that 64% of paralytic limbs during the acute stage (≤14 d after onset) showed diminished or absent compound muscle action potentials (CMAPs), 79% showed normal motor nerve conduction velocities, 55% showed decreased persistence or absent F-waves, and 95% showed normal sensory nerve conduction velocities. The rate of CMAP abnormalities increased from 41% on days 1-2 to 83% on days 13-14. The reduction in CMAP amplitude was correlated with weaker muscle strength at both the peak neurological deficit and the last follow-up. The baseline limb-based muscle strength at nadir and anterior horn-localized magnetic resonance imaging lesions at recovery stage (>14 d) were strong predictors of outcome at the last follow-up. CONCLUSIONS: AFM typically shows neurophysiological features of neuronopathy. SIGNIFICANCE: NCS is probably useful in the diagnosis and evaluation of AFM.


Assuntos
Potenciais de Ação/fisiologia , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/fisiopatologia , Eletromiografia/métodos , Força Muscular/fisiologia , Mielite/epidemiologia , Mielite/fisiopatologia , Condução Nervosa/fisiologia , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/fisiopatologia , Viroses do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Mielite/diagnóstico , Doenças Neuromusculares/diagnóstico
13.
Front Immunol ; 12: 671425, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220818

RESUMO

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) covers a wide spectrum of manifestations and is defined by the presence of MOG seropositivity. However, in a proportion of patients, there may be an overlap in some of the clinical and radiological manifestations between MOGAD and multiple sclerosis (MS). Being wary of this entity is critical to ensure appropriate therapy. Herein, we present a case with recurrent episodes of short-segment myelitis typical for multiple sclerosis, but later diagnosed as MOGAD by MOG antibody seropositivity. This case, along with previous reports, highlights an increasingly recognized subgroup in MOGAD with initial clinical phenotypes suggestive of MS, but later showing a disease course and therapeutic response compatible with MOGAD. Given the potential overlap of some clinical phenotypes in patients with MS and those with MOGAD, we recommend MOG antibody testing in all patients with recurrent short-segment myelitis, conus medullaris involvement, and those who demonstrated steroid dependence.


Assuntos
Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/diagnóstico , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/imunologia , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/patologia , Glicoproteína Mielina-Oligodendrócito/imunologia , Adulto , Autoanticorpos/imunologia , Autoantígenos/imunologia , Diagnóstico Diferencial , Feminino , Humanos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/patologia , Mielite/etiologia
14.
BMC Public Health ; 21(1): 1148, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130684

RESUMO

BACKGROUND: Nigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. METHODS: This retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019. RESULTS: Cumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases. CONCLUSIONS: Sokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.


Assuntos
Poliomielite , Poliovirus , Adolescente , Viroses do Sistema Nervoso Central , Criança , Análise de Dados , Humanos , Masculino , Mielite , Doenças Neuromusculares , Nigéria/epidemiologia , Paralisia/epidemiologia , Poliomielite/epidemiologia , Vigilância da População , Estudos Retrospectivos
15.
BMJ Case Rep ; 14(6)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187795

RESUMO

A 52-year-old woman with HIV and recent antiretroviral therapy non-adherence presented with a 5-day history of widespread painful vesicular skin lesions. Direct fluorescent antibody testing of the skin lesions was positive for varicella zoster virus (VZV). On day 3, she developed profound right upper extremity weakness. MRI of the brain and cervical spine was suggestive of VZV myelitis. Lumbar puncture was positive for VZV PCR in the cerebrospinal fluid (CSF) and CSF HIV viral load was detected at 1030 copies/mL, indicating 'secondary' HIV CSF escape. She was treated with intravenous acyclovir for 4 weeks and subsequent oral therapy with famciclovir then valacyclovir for 6 weeks. She also received dexamethasone. The patient had an almost full recovery at 6 months. Myelitis is a rare complication of reactivated VZV infection that can have atypical presentation in immunocompromised patients. Such 'secondary' HIV CSF escape should be considered in immunosuppressed patients with concomitant central nervous system infection.


Assuntos
Infecções do Sistema Nervoso Central , Infecções por HIV , Herpes Zoster , Mielite , Aciclovir/uso terapêutico , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Herpesvirus Humano 3 , Humanos , Pessoa de Meia-Idade , Mielite/diagnóstico , Mielite/tratamento farmacológico , Mielite/etiologia
16.
Neurosci Lett ; 759: 136040, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34118307

RESUMO

Despite a likely underestimation due to the many obstacles of the highly infectious, intensive care setting, increasing clinical reports about COVID-19 patients developing acute paralysis for polyradiculoneuritis or myelitis determine additional impact on the disease course and outcome. Different pathogenic mechanisms have been postulated basing on clinical, laboratory and neuroimaging features, and response to treatments. Here we provide an overview with insights built on the available reports. Besides direct viral pathogenicity, a crucial role seems to be represented by immune-mediated mechanisms, supporting and further characterizing the already hypothesized neurotropic potential of SARS-CoV-2 and implying specific treatments. Proper clinical and instrumental depiction of symptomatic cases, as well as screening for their early recognition is advocated.


Assuntos
COVID-19/complicações , Síndrome de Guillain-Barré/virologia , Mielite/epidemiologia , Mielite/virologia , Síndrome de Guillain-Barré/patologia , Humanos , Mielite/patologia , SARS-CoV-2
17.
Phys Med Rehabil Clin N Am ; 32(3): 477-491, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34175008

RESUMO

Acute flaccid myelitis (AFM) is an incompletely understood neurologic disorder occurring in epidemic fashion causing weakness ranging from mild paresis to devastating paralysis in children and some adults. This article reviews the case definition of AFM as well as its epidemiology and association with enteroviral infection. The clinical presentation, diagnostic investigation with particular attention to electrodiagnostics, acute management, and surgical options are described. Clinical outcomes and considerations for acute and long-term rehabilitation management are discussed extensively based on review of current literature, highlighting avenues for further study.


Assuntos
Viroses do Sistema Nervoso Central , Infecções por Enterovirus , Mielite , Doenças Neuromusculares , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/terapia , Viroses do Sistema Nervoso Central/virologia , Doenças Transmissíveis Emergentes , Diagnóstico Diferencial , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/terapia , Infecções por Enterovirus/virologia , Humanos , Mielite/diagnóstico , Mielite/epidemiologia , Mielite/terapia , Mielite/virologia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/terapia , Doenças Neuromusculares/virologia , Poliomielite/diagnóstico , Estados Unidos/epidemiologia
19.
J Clin Neuromuscul Dis ; 22(4): 228-231, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34019009

RESUMO

ABSTRACT: Elsberg syndrome is a rare cause of lumbosacral radiculitis with concomitant thoracic and lumbosacral myelitis that can be seen after an acute or reactivated viral infection. After the initial coronavirus surge in New York City, a 68-year-old man developed progressive lower extremity weakness and a defined sensory level at the lower abdomen. He had highly elevated SARS-CoV-2 IgG antibodies despite an absence of preceding COVID-19 symptoms. Serial electrodiagnostic testing revealed absent lower extremity late responses, with otherwise normal distal sensorimotor conductions. Electromyography revealed active neurogenic changes and reduced motor unit recruitment in the L3-L4 myotomes. Treatment with methylprednisolone and intravenous immunoglobulin was followed by minimal clinical improvement but re-emergence of the lower extremity late responses on electrodiagnostic testing. We report here, to the best of our knowledge, the first case of suspected COVID-19-associated Elsberg syndrome, which expands the spectrum of neuromuscular manifestations associated with SARS-CoV-2 infection and sheds light on ways to approach diagnostic and treatment options for these patients.


Assuntos
COVID-19/complicações , Mielite/etiologia , Radiculopatia/etiologia , Idoso , Anti-Inflamatórios/uso terapêutico , Eletrodiagnóstico , Eletromiografia , Humanos , Imunoglobulina G/análise , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Debilidade Muscular/etiologia , Mielite/diagnóstico , Condução Nervosa , Radiculopatia/diagnóstico , Coluna Vertebral/diagnóstico por imagem , Síndrome , Resultado do Tratamento
20.
Rev Neurol (Paris) ; 177(5): 557-566, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024334

RESUMO

Myelopathy is a term referring to any pathologic process affecting the spinal cord, and encompasses a broad spectrum of etiologies. The first step is to categorize myelopathy, according to the time to reach maximum deficit. Myelopathies are commonly classified as acute, subacute or chronic, for which the etiologies are totally different. Myelopathy is considered acute when the symptoms progress to their nadir in maximum 21 days after onset. Due to heterogeneity in pathogenesis, and the overlap in the clinical and imaging presentation among etiologies, acute myelopathy is considered as a diagnostic dilemma. A simple and efficient algorithm for timely identification of the underlying cause is thus useful. In this review, we provide a simplified approach for the differential diagnosis among all causes of acute myelopathies, and describe the principal clinical and imaging features of the main etiologies in adults, including recently characterized antibody-mediated myelitis, and its mimics.


Assuntos
Mielite Transversa , Mielite , Neuromielite Óptica , Doenças da Medula Espinal , Doença Aguda , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Medula Espinal , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia
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