Showing papers on "Myelitis published in 1996"

Idiopathic transverse myelitis: MR characteristics.

Abstract: PURPOSE To describe the MR characteristics that can distinguish idiopathic transverse myelitis from other intramedullary lesions. METHODS A total of 32 initial and follow-up MR studies in 17 patients with clinically proved transverse myelitis were reviewed retrospectively. The location, size, pattern, and segmental length of areas of hyperintensity were estimated on T2-weighted axial and sagittal images. In 15 of the patients, whose neurologic abnormalities were limited to the spinal cord, the location and pattern of intramedullary contrast enhancement were evaluated on sagittal and axial T1-weighted images. Follow-up MR studies were available for 10 patients. The statistical significance of cord enhancement between the groups with and without cord expansion was calculated. RESULTS Common MR findings of idiopathic transverse myelitis included a centrally located hyperintensity occupying more than two thirds of the cross-sectional area of the cord (88%); a length of 3 to 4 vertebral segments (53%), with variable presence of cord expansion (47%); a small central area of intensity, isointense with normal cord, in the core of hyperintensity (47%); focal, peripheral cord enhancement (53%), particularly in patients with cord expansion; and a slow regression of T2 hyperintensity with an enhancing nodule. Although no linear correspondence was observed between MR findings and neurologic signs and symptoms, all but 4 patients improved clinically as MR findings improved or remained stable. CONCLUSIONS MR findings are helpful in detecting transverse myelitis and in differentiating this entity from multiple sclerosis and cord tumors, but clinical assessment and observation of MR changes over time are essential in making the diagnosis.

Zoster myelitis: improvement with antiviral therapy in two cases

Abstract: This report describes two patients with acquired immunodeficiency syndrome (AIDS) and herpes zoster myelopathy. Patient one had a T-8 myelitis that preceded the onset of T-8-distribution zoster and was followed by cervical myelopathy. Antibody to varicella zoster virus (VZV) was present in the CSF. He never received steroids or other immunosuppressive drugs, and his condition improved dramatically after treatment with intravenous acyclovir. The second patient had a rapidly progressive myelitis with paralysis of both legs. Detection of VZV DNA and antibody to VZV in his CSF led to successful treatment with famciclovir despite discontinuation of dexamethasone and earlier treatment failure with acyclovir. These cases support the idea that VZV myelopathy in the immunosuppressed host is caused by virus invasion. CSF analysis for antiviral antibody and for VZV DNA by polymerase chain reaction are helpful in establishing the diagnosis. Aggressive antiviral therapy is advised.

Idiopathic acute transverse myelitis: MR imaging findings.

Abstract: PURPOSE: To analyze the magnetic resonance (MR) imaging findings in idiopathic acute transverse myelitis (IATM) in relation to pathologic findings and MR findings in Guillain-Barre syndrome and ischemia. MATERIALS AND METHODS: The cases of 19 patients with IATM seen over a 4-year period were retrospectively reviewed. Clinical parameters and laboratory test findings were recorded for each patient independently of the MR findings. RESULTS: Ten (53%) patients experienced upper respiratory infection or vaccination within 4 weeks of symptom onset. The majority (82%) of cases occurred between December and May each year. In seven of 12 patients who underwent electromyography and nerve conduction examinations, evidence of peripheral nerve injury was seen. On T2-weighted axial images, 13 of 18 lesions were depicted with holocord abnormal signal intensity, seven (39%) had gray matter involvement similar to that seen in spinal cord ischemia, and three (16%) had isolated white matter involvement. Enhancement patterns...

Toxoplasmosis of the Spinal Cord in a Patient with AIDS: Case Report and Review

Abstract: We present the case of a patient whose acute myelopathy almost completely resolved with empirical therapy for toxoplasmosis, and we review thirteen previously reported cases of myelopathy thought to have been caused by Toxoplasma gondii in patients with AIDS. The most common symptoms and abnormal physical findings were motor loss (usually paraparesis), bilateral sensory loss, urinary bladder dysfunction, and local pain. The majority of patients had magnetic resonance images that showed abnormalities of the spinal cord and brain in association with positive serology for Toxoplasma. Therapy for toxoplasmosis, when administered soon after the onset of symptoms, has resulted in clinical and radiographic improvement in the conditions of patients with toxoplasmosis.

Myelitis Due to Varicella-Zoster Virus in Two Patients with AIDS: Successful Treatment with Acyclovir

Abstract: Only a few cases of varicella-zoster virus (VZV) myelitis have been described, and nearly all have been diagnosed post-mortem. There have been no reports in the literature of successful treatment of VZV myelitis with antiviral medications. We report on two patients with AIDS who had acute severe myelitis accompanied by herpes zoster. The presence of VZV DNA in cerebrospinal fluid (CSF) was documented by the polymerase chain reaction (PCR) technique. Early treatment with acyclovir was followed by a slow but complete recovery after a phase of initial aggravation. After a follow-up of > 1 year, the two patients remained asymptomatic. We conclude that (1) VZV should be considered a curable cause of myelitis in patients with AIDS, (2) PCR assay of CSF will assist in early diagnosis, and (3) early treatment with acyclovir should aid in recovery.

Case report: Varicella-zoster virus myelitis - Serial MR findings

Abstract: The authors describe a 32-year-old male in whom herpes zoster of the left upper extremity was complicated by the development of cervical myelitis. Contrast enhancement and abnormal signal intensity on T1 and T2 weighted images was seen at C1-C6 levels in the spinal cord and medulla. There was also slight enlargement of the cord at these levels. On serial MR imaging the degree of enhancement changed from marked to none with corresponding clinical improvement.

Acute transverse myelitis after influenza vaccination: magnetic resonance imaging findings.

Abstract: Descriptions in the literature of magnetic resonance imaging (MRI) findings in post-vaccination myelitis are scarce. Described here is a case of acute transverse myelitis that occurred after administration of an influenza vaccination. T1-weighted MRIs showed diffuse, fusiform spinal cord enlargement, extending from C-3 to rostral thoracic levels. Intramedullary lesions containing increased T2 signal were found in the areas of cord enlargement. The involvement on MRI was profound, extending far rostral to the level of the discrete clinical myelopathy. The lesions did not enhance after contrast administration. The patient had a complete long-term recovery of neurological function. This represents the first report of MRI findings in acute transverse myelitis after influenza vaccination.

Varicella-zoster ventriculo-encephalitis and spinal cord infarction in a patient with AIDS

Abstract: Varicella-zoster virus (VZV) infection is usually benign and self-limited. However, particularly in the immunosuppressed host, serious central nervous system complications may occur, including encephalitis, myelitis, and cerebral vascular occlusion. We report the case of a 57-year-old male with AIDS, who rapidly developed a sixth cranial nerve palsy and progressive myelopathy. There was no antecedent zoster rash. Autopsy revealed VZV ventriculo-encephalitis and vasculitis, as well as a transverse infarction of the spinal cord without evidence of direct infection of the cord parenchyma. Spinal cord infarction secondary to VZV vasculitis is an unusual cause of myelopathy in immunosuppressed patients.

Oppenheimer's Diagnostic Neuropathology: A Practical Manual

Abstract: The Post Mortem The Cut-up Histology Biopsies Injuries to the Head and Spinal Column Intracranial Haemorrhage Infarction, Hypoxia, Cerebral Vascular Disease Hydrocephalus, Cysts and Syrinxes Pyogenic Infections and Granulomas Encephalitis and Myelitis Space-occupying Lesions Tumours Arising in the Brain and Spinal Cord Other Tumours Affecting the Nervous System Multiple (Disseminated) Sclerosis (MS) Neuronal Decay Malformations of the Central Nervous System Dementia Epilepsy Metabolic Diseases of the Nervous System Intoxications and Nutritional Diseases of the Nervous System Neuropathology of the Very Young Diseases of Peripheral Nerves Diseases of Muscle Assorted Malfunctions Other Matters Appendices: Neurohistological Staining Methods Useful Addresses Safety precautions in the practice of neuropathology Index

Chronic recurrent transverse myelitis or multiple sclerosis.

Abstract: The simultaneous occurrence of multiple sclerosis and transverse myelitis is known in the literature. Apart from the spinal symptoms, other neurological signs of brain involvement are usually found and magnetic resonance imaging (MRI) reveals disseminated foci in the brain. The positive evoked responses, the immunological abnormalities of the cerebrospinal fluid (CSF), and the oligoclonality together prove the presence of multiple sclerosis. In these cases the symptoms of transverse myelitis can separately precede other signs of multiple sclerosis, or appear as a relapse. Recurrent transverse myelitis as an independent entity, with negative MRI and CSF immunology, is an exciting topic in terms of the etiological factors and therapeutic considerations. The view in the literature is that the occurrence of transverse myelitis as an independent entity is rather rare. The present article reports the case of a female patient with recurrent spinal cord signs, and negative MRI and CSF immunology. During a ten-year follow-up observation period, symptoms of multiple sclerosis did not develop. Further studies of such cases are needed in order to clarify the etiological factors, the pathomechanism and the therapeutic considerations relating to this relatively new and probably independent clinical entity.

Acute transverse myelitis caused by herpes simplex virus.

Abstract: Dr. med. Stephan Bamborschke, PD, Klinik und Poliklinik für Neurologie der Universität zu Köln, Joseph-Stelzmann-Strasse 9, D-50924 Köln (Germany) Case Report A 42-year-old man presented with dysesthesia and palsy of the right upper limb and developed a complete tetraplegia with sensory loss below the level of C6, bowel and bladder dysfunction within 10 days. There was no stiffness of the neck or disturbance of consciousness. The tendon reflexes were first absent and then became hyperactive. Babinski's sign was found on the right side. No herpetic cutaneous or genital lesions were found. On the basis of the PCR results (see below) the patient was treated with dexamethasone 24 mg/day i.v. and acyclovir 750 mg 3 times a day i.v. Within 10 weeks motor function of both legs and of the left arm recovered almost completely whereas the right arm remained mildly paretic. Bowel and bladder function were normal. A sensory disturbance below the level of TH8 remained.

Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus.

Abstract: A woman with systemic lupus erythematosus (SLE) presented with a zoster eruption. Transverse myelitis developed at the site of the dermatomal distribution of the rash. SLE and varicella zoster virus (VZV) can both cause myelitis, and are difficult to differentiate. The topographic association between the cutaneous and the neurological involvement suggesting VZV myelitis was confirmed by polymerase chain reaction (PCR) for VZV in the cerebrospinal fluid. This case illustrates the potential role of the selective amplification of VZV DNA in cerebrospinal fluid to diagnose central neurological complications associated with VZV. The value of magnetic resonance imaging of the spinal cord in the evaluation of patients with myelitis is emphasized.

Postural hypotension in a patient with acute myelitis.

Abstract: A case of acute transverse myelitis with severe postural hypotension is described.

A case of agammaglobulinemia with chronic enteroviral meningomyelitis

Abstract: We report a 30-year-old man with agammaglobulinemia and chronic aseptic meningomyelitis. The patient was diagnosed as having X-linked recessive agammaglobulinemia at 4 years of age and gammaglobulin supplementation was started. He had TIA-like episodes several times since 25 years of age. He developed difficulty in micturition and impotence at 29 years of age. Neurological examination revealed bilateral deafness, contracture of knee joints, slight weakness and areflexia in the lower extremities, Babinski sign and dysuria. There was sensory disturbance in the lower extremity on the left. There was not consciousness disturbance or meningeal irritation sign. The cerebrospinal fluid findings included pleocytosis and increase in protein. Enterovirus RNA was detected in the cerebrospinal fluid by the modified polymerase chain reaction (PCR) method. MRI of lower spinal cord showed syrinx formation in the lumbosacral cord and CT of the brain showed bilateral temporal lobe atrophy and temporoparietal subdural fluid collection on the left. 123I-IMP SPECT showed decrease in the cerebral blood flow in the whole brain. EEG showed diffuse slow activity, suggesting the subclinical encephalopathy. Chronic enteroviral meningoencephalitis with agammaglobulinemia (CEMA) is one of the complications of agammaglobulinemia. However, myelitis without apparent encephalopathy is very rare. To our knowledge, there have been no reports of spinal sylinx formation in CEMA.

Serial MRI findings of benign poliomyelitis

Abstract: A 14-year-old boy presented with incomplete transverse myelopathic symptoms associated with mild encephalitis. Magnetic resonance imaging (MRI) revealed involvement of the central portion of spinal cord extending from the C1 to T5 level on T2-weighted images with expansion of the cervical spinal cord. The boy made a full clinical recovery in a few weeks. Cultures of the pharyngeal exudate were positive for ECHO virus type 11. The lesion on MRI disappeared completely in a few months.

Transverse lesion of the spinal cord due to mucormycosis in an AML patient

Abstract: A 54 year old man complained exertional dyspnea and palpitation since November 1989. As he was diagnosed with marked anemia, leukocytosis and thrombocytopenia by his work place doctor, he was admitted to our hospital. Acute myelogenous leukemia was diagnosed based on laboratory findings. BHAC-DMP, BHAC-MEP and A triple V therapies were only partially effective. Fine nodular shadows in all lung fields and a semicircular mass in the right lower lobe next to the thoracic vertebra were evident on the chest X-P since the end of March 1990. He was treated with antibiotics and amphotericin B but the abnormal lung shadows did not disappear. He had sudden onset of paraplegia and loss of all sensation below Th6 on May 1. Aparavertebral mass in the right lower lobe was detected by CT and MRI, for which radiotherapy was performed but without improvement. He died of respiratory failure on May 12. Autopsy showed that the semicircular paravertebral mass continued to the main pulmonary vein and epidural area of the thoracic cord (Th6-8). Microscopically, mucormycosis was found. Necrosis due to mucor embolism was found in the thoracic cord. It is usually difficult to diagnose mucormycosis in immunocompromised patients while they are alive. It is important to suspect mucormycosis if any infarction symptoms or infections resistant to antibiotics develop in immunocompromised patients.

Subacute paraneoplastic radiculomyelitis associated with Hodgkin lymphoma.

Abstract: Sirs: Spinal cord lesions associated with Hodgkin lymphoma (HL) include epidural and intramedullary tumours, ischaemic myelopathies related to paravertebral lymphoma, radiation myelopathy, toxic myelopathy due to intrathecal chemotherapy, viral myelitis and paraneoplastic myelopathy. We report a patient who developed simultaneously a HL and a probably immune-mediated paraneoplastic subacute radiculomyelitis. A previously healthy 28-year-old man presented on 6 October 1994 with a 1-month history of progressive weakness, numbness and dysaesthesias of the lower limbs. He also complained of retrosternal pain and cough in the right lateral decubitus position. He developed urinary retention, left footdrop and paraesthesias in the cutaneous distribution of the C8 nerve roots. The clinical examination a week later revealed a mild distal paraparesis, predominantly in the left foot extensors and flexors (grade 2/5 weakness). The left ankle jerk and the right abdominal and left plantar cutaneous responses were absent. Diffuse hypaesthesia for touch and pinprick was observed below the T10 level. Vibratory hypaesthesia of the left lower limb was also found. No lymph nodes were palpable. Magnetic resonance imaging (MRI) of the spine (Fig. 1) showed increased signal on T2-weighted images within the cord, which was not widened, from T4 to T10. This lesion appeared as slightly decreased signal on T1 weighting, with discrete enhancement with gadolinium. These MRI findings were consistent with myelitis. The tibial nerve somatosensory evoked potentials showed a bilateral and symmetrical increase in central conduction time (spinal N24-parietal P40: 29.8ms), consistent with thoracic spinal cord dysfunction. EEG, brain-stem auditory, pattern visual and median-nerve somatosensory evoked potentials were unremarkable. Nerve conduction studies and EMG (needle examination) were normal in the upper limbs. Sural and superficial peroneal sensory nerve action potentials were normal, bilaterally. The left peroneal nerve was inexcitable. Diminished amplitude of the compound muscle action potentials and absent F waves were observed after stimulation of the right peroneal and left posterior tibial nerves. EMG of the lower limbs showed fibrillation potentials and positive sharp waves at rest in the bilateral L5 and left S 1 nerve-root innervated muscles. Large-amplitude, long-duration, polyphasic motor unit action potentials with diminished recruitment were observed in the bilateral L4-S 1 nerve-root innervated

Visceral and neurological complications in Varicella infections of adults

Abstract: Primary varicella-zoster virus (VZV) infections in adults generally follow a more severe course than in children and are more often associated with life-threatening complications. In the years 1992 to 1995 we observed 7 immunocompetent adults with a severe course of primary VZV infection. All 7 patients presented initially with a characteristic rash. In 6 patients the diagnosis of VZV was confirmed by ELISA on material taken from the lesions, and in all of them it was confirmed by serology. The following complications were observed: pneumonia (5x), elevated liver enzymes (4x), myocarditis (1x), encephalitis (1x) and myelitis (1x). Pulmonary lesions were characterized by bilateral interstitial infiltrates on chest-x-ray and required mechanical ventilation in 2 patients. The liver enzymes were only slightly elevated and clinically not significant. Myocarditis in one case was postulated in view of elevated creatine kinase levels, ECG-repolarization changes and AV-block III which required the insertion of a transitory pacemaker. Encephalitis presented as abnormal behaviour at work followed by seizures. Myelitis was suspected due to ascending sensory motor tetraparesis and confirmed by MRI. All patients were treated with high doses of parenteral acyclovir (3 x 10 mg/kg body weight i.v. per day) for 5-12 days. 6 patients recovered completely and only the patient with myelitis has residual neurological deficits 3 months after discharge. Although we cannot exclude the possibility that supportive therapy without acyclovir would have had the same outcome, we recommend high-dose parenteral acyclovir for treatment of visceral and neurological complications in primary VZV infections in adults.

Nervous system brucellosis in Lebanon. Report of six cases

Abstract: The authors report 6 cases of nervous system brucellosis (3 males, 3 females) and present the different clinical features of this localization. Meningoencephalitis is observed in 4 patients and is associated with subarachnoid hemorrhage in one. Pure meningitis occurred in one case and acute myelitis in another one. Cerebrospinal fluid composition is studied in all these patients. Rifampicine associated with Cotrimoxazole, for at least 3 months, is very helpful in nervous system brucellosis because of their good central nervous system penetration but neurological sequelae are noted in one case of meningoencephalitis with chronic infection and in the case of myelitis.

Toxoplasma gondii myelitis in AIDS

Abstract: Toxoplasmosis of the spinal cord is an uncommon manifestation of the acquired immunodeficiency syndrome (AIDS). Previously described patients generally have had poor outcomes. We report a case of successfully treated, biopsy-proven AIDS-related Toxoplasma gondii myelitis (TGM) in a 39-year old man who presented with a conus medullaris syndrome. A review of the literature and a suggested therapeutic approach to TGM are presented.