Showing papers on "Myelitis published in 2011"
TL;DR: AQP4-Ab positive NMOSD is characterized by CSF features that are distinct from those in MS, and these findings are important for the differential diagnosis of MS andNMOSD and add to the understanding of the immunopathogenesis of this devastating condition.
302 citations
TL;DR: The signs and symptoms that suggest various etiologies and differential diagnoses of LETM are described, and illustrated by educational case studies.
Abstract: Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that extends over three or more vertebrae, as seen on MRI of the spine. The clinical presentation of a patient with LETM is often dramatic and can consist of paraparesis or tetraparesis, sensory disturbances, and gait, bladder, bowel and/or sexual dysfunction. LETM is a characteristic feature of neuromyelitis optica, but such spinal lesions can also occur in various other autoimmune and inflammatory diseases that involve the CNS--such as multiple sclerosis, sarcoidosis or Sjogren syndrome--or in infectious diseases with CNS involvement. Patients with a neoplastic disorder or traumatic spinal cord injury can also present with longitudinal spinal lesions. In this Review, the signs and symptoms that suggest various etiologies and differential diagnoses of LETM are described, and illustrated by educational case studies. The best therapeutic options for patients with each diagnosis are also discussed.
138 citations
TL;DR: Antiaquaporin-4 antibody (AQP4-ab) levels were tested in serum samples of patients diagnosed as having central nervous system inflammatory demyelinating disorders by their referring physicians to compare the differences between onset age, gender and clinical phenotypes and found optic neuritis was more common in paediatric patients, while myelitis wasMore common in older patients.
Abstract: Objective To analyse clinicoepidemiological features of neuromyelitis optica in a large cohort and to compare the differences between onset age, gender and clinical phenotypes. Methods Antiaquaporin-4 antibody (AQP4-ab) levels were tested in 2366 serum samples of patients diagnosed as having central nervous system inflammatory demyelinating disorders by their referring physicians. AQP4-ab was measured by indirect immunofluorescence staining using human AQP4-transfected HEK 293 cells. A blinded analysis was performed and was combined with clinical information. Results A total of 583 patients (91.4% women) were AQP4-ab-positive. The average onset age was 42.9±15.9 years. According to MRI studies, spinal-cord lesions were detected in 85.3% of the patients, longitudinally extensive transverse myelitis in 72.7% and cerebral lesions in 51.1%. Unilateral or bilateral blindness was observed in 16.2% of patients, 19.8% were associated with Sjogren syndrome, and 13.6% were associated with thyroid diseases. Myelin basic protein was detected in the cerebrospinal fluid of 57.5% patients. In addition, men presented with an older onset age, a greater number of brainstem MRI lesions and positive myelin basic protein in the cerebrospinal fluid. All child-onset patients ( Conclusions The clinical characteristics of AQP4-ab-positive patients were similar. However, optic neuritis was more common in paediatric patients, while myelitis was more common in older patients. A small number of patients exhibited only cerebral, brainstem, or cerebellar lesions during the initial several years and lower Extended Disability Status Scale scores.
112 citations
TL;DR: The results suggest that the rhesus monkey model may be used to study not only the basic pathogenesis of EV71 viral infections, but also to examine clinical features, such as neurological lesions, in the CNS and pathological changes in associated organs.
95 citations
TL;DR: The results enhance the understanding about mechanisms related to the anti-inflammatory property of the PEA suggesting that this N-acylethanolamine may represent a crucial therapeutic intervention both diminishing the immune/inflammatory response and promoting the initiation of neurotrophic substance after SCI.
Abstract: Spinal cord injury (SCI) has a significant impact on quality of life, expectancy, and economic burden, with considerable costs associated with primary care and loss of income. The complex pathophysiology of SCI may explain the difficulty in finding a suitable therapy for limiting neuronal injury and promoting regeneration. Although innovative medical care, advances in pharmacotherapy have been limited. The aim of the present study was to carefully investigate molecular pathways and subtypes of glial cells involved in the protective effect of PEA on inflammatory reaction associated with an experimental model of SCI. The compression model induced by applying an aneurysm clip to the spinal cord in mice is closer to the human situation, since it replicates the persistence of cord compression. Spinal cord trauma was induced in mice by the application of vascular clips to the dura via a four-level T5-T8 laminectomy. Repeated PEA administration (10 mg/kg i.p., 6 and 12 h after SCI) significantly reduced the degree of the severity of spinal cord trauma through the reduction of mast cell infiltration and activation. Moreover, PEA treatment significantly reduced the activation of microglia and astrocytes expressing cannabinoid CB(2) receptor after SCI. Importantly, the protective effect of PEA involved changes in the expression of neurotrophic factors, and in spinal cord dopaminergic function. Our results enhance our understanding about mechanisms related to the anti-inflammatory property of the PEA suggesting that this N-acylethanolamine may represent a crucial therapeutic intervention both diminishing the immune/inflammatory response and promoting the initiation of neurotrophic substance after SCI.
89 citations
TL;DR: The most common inflammatory and infectious conditions affecting the anatomic compartments of the spine are described, following an external to internal anatomic approach.
81 citations
TL;DR: Findings indicate that, not single, but various viral infections, can be associated with the development of NMO during the early stages of the illness, although the exact pathogenesis of N MO has yet to be clarified.
71 citations
TL;DR: The presentation of longitudinal myelitis in a patient with SS should be considered a possible NMOSD and checking for the presence of antiaquaporin-4 antibodies provides important prognostic information and may help to guide treatment decisions.
61 citations
TL;DR: It is concluded that human glial‐restricted progenitor cells have the capacity to myelinate dysmyelinated neonatal rodent brain and preserve conduction in the inflammatory demyelinated adult rodent spinal cord.
Abstract: Transplantation of glial progenitor cells results in transplant-derived myelination and improved function in rodents with genetic dysmyelination or chemical demyelination. However, glial cell transplantation in adult CNS inflammatory demyelinating models has not been well studied. Here we transplanted human glial-restricted progenitor (hGRP) cells into the spinal cord of adult rats with inflammatory demyelination, and monitored cell fate in chemically immunosuppressed animals. We found that hGRPs migrate extensively, expand within inflammatory spinal cord lesions, do not form tumors, and adopt a mature glial phenotype, albeit at a low rate. Human GRP-transplanted rats, but not controls, exhibited preserved electrophysiological conduction across the spinal cord, though no differences in behavioral improvement were noted between the two groups. Although these hGRPs myelinated extensively after implantation into neonatal shiverer mouse brain, only marginal remyelination was observed in the inflammatory spinal cord demyelination model. The low rate of transplant-derived myelination in adult rat spinal cord may reflect host age, species, transplant environment/location, and/or immune suppression regime differences. We conclude that hGRPs have the capacity to myelinate dysmyelinated neonatal rodent brain and preserve conduction in the inflammatory demyelinated adult rodent spinal cord. The latter benefit is likely dependent on trophic support and suggests further exploration of potential of glial progenitors in animal models of chronic inflammatory demyelination.
58 citations
TL;DR: Clinical and laboratory data extracted from published cases of SLE‐associated ATM, fulfilling the Transverse Myelitis Consortium Working Group diagnostic criteria, provided information on aPL, and detection of circulating aPL at ATM onset appears unreliable to suggest a thrombotic cause and perhaps not enough to dictate therapeutic anticoagulation.
Abstract: Current views suggest that prothrombotic properties of antiphospholipid antibodies (aPL) have a role in the development of acute transverse myelitis (ATM) in patients with systemic lupus erythematosus (SLE). Consequently, empiric anticoagulation may be included in these patients' treatment. We performed a systemic review of the literature to explore the clinical value of the presence of aPL in patients with lupus myelitis and the possible effectiveness of anticoagulation. We analyzed clinical and laboratory data extracted from published cases of SLE-associated ATM, fulfilling the Transverse Myelitis Consortium Working Group diagnostic criteria, that provided information on aPL. We report on a total of 70 patients. aPL, detected upon ATM onset in 54% of patients, neither predicted the involvement of the thoracic part of the spine, which has been postulated to reflect a predominantly thrombosis-induced injury, nor correlated with relapsing ATM, additional lupus CNS manifestations, or worse clinical outcome. An unfavorable outcome could be predicted by paralysis (P=0.02) and abnormal CSF findings at presentation (P=0.02). Whilst all patients received major immunosuppressive regimens, severe neurologic impairment (estimated Expanded Disability Status Scale score>7) was found primarily in aPL-negative patients (P=0.03). Anticoagulation was more frequently applied in aPL-positive patients (P=0.04), but any additional therapeutic effect was not evident. Detection of circulating aPL at ATM onset appears unreliable to suggest a thrombotic cause and perhaps not enough to dictate therapeutic anticoagulation. Registry creation of ATM in patients with SLE is needed to obtain more definite answers on the role of aPL in this condition.
53 citations
Journal Article•
TL;DR: This review will cover neurogenic DESD, with emphasis on definition, classifications, diagnosis and different therapeutic options available, and the mainstay of treatment is the use of antimuscarinics and catheterization.
Abstract: Spinal cord injury (SCI) affects 11.5 to 53.4 individuals per million of the population in developed countries each year. SCI is caused by trauma, although it can also result from myelopathy, myelitis, vascular disease or arteriovenous malformations and multiple sclerosis. Patients with complete lesions of the spinal cord between spinal cord level T6 and S2, after they recover from spinal shock, generally exhibit involuntary bladder contractions without sensation, smooth sphincter synergy, but with detrusor striated sphincter dyssynergia (DESD). Those with lesions above spinal cord level T6 may experience, in addition, smooth sphincter dyssynergia and autonomic hyperreflexia. DESD is a debilitating problem in patients with SCI. It carries a high risk of complications, and even life expectancy can be affected. Nearly half of the patients with untreated DESD will develop deleterious urologic complications, due to high intravesical pressures, resulting in urolithiasis, urinary tract infection (UTI), vesicoureteral reflux (VUR), hydronephrosis, obstructive uropathy, and renal failure. The mainstay of treatment is the use of antimuscarinics and catheterization, but in those for whom this is not possible external sphincterotomy has been a last resort option. External sphincterotomy is associated with significant risks, including haemorrhage; erectile dysfunction and the possibility of redo procedures. Over the last decade alternatives have been investigated, such as urethral stents and intrasphincteric botulinum toxin injection. In this review, we will cover neurogenic DESD, with emphasis on definition, classifications, diagnosis and different therapeutic options available.
TL;DR: In this article, the authors describe the neurologic complications of children hospitalized with influenza A H1N1 infection, including transverse myelitis, myositis, expressive aphasia, and syncope.
TL;DR: While cholinesterase inhibitors do not currently have a place in FTD treatment, memantine may be helpful, although the results of two placebo-controlled trials with this agent are not yet available.
Abstract: The spectrum of idiopathic inflammatory-demyelinating disorders of the CNS is classified based on clinical symptoms and signs, clinical severity, lesion distribution, neuroimaging features and cerebrospinal fluid characteristics. There is a wide variety of conditions in this broad spectrum. In some cases, the dissemination in the CNS is limited to the optic nerves and spinal cord. Neuromyelitis optica (NMO) and the NMO spectrum disorders have a predilection for the optic nerves and spinal cord. Clinical, MRI, cerebrospinal fluid and neuropathological features show that NMO could be considered as a distinct disease rather than as a variant of multiple sclerosis. Accurate and early diagnosis is critical to facilitate initiation of immunosuppressive and/or immunomodulatory therapy to prevent attacks and disability progression.
TL;DR: Two out of three baseline factors (age, periventricular lesions and inflammatory CSF) predicted conversion to MS with better accuracy than the revised McDonald criteria for dissemination in space.
Abstract: Objectives: To identify predictors of conversion to definite multiple sclerosis (MS) in patients with a cord clinically isolated syndrome.Methods: The predictive values for conversion to MS of clinical, magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) variables in 114 patients with acute partial myelitis confirmed by a spinal cord lesion on MRI were studied. Other causes of cord syndromes were excluded.Results: MS was diagnosed in 78 patients (86%) during 4.0 ± 1.9 years of follow-up. Some 67 of these patients had a second clinical episode. The diagnosis of isolated myelitis was maintained for 36 patients, 78% of whom (28 cases) were followed for at least 2 years, comparable to the MS patients. Age, bladder involvement, ≥2 cord lesions on MRI, ≥9 brain lesions, ≥3 periventricular lesions and intrathecal IgG synthesis predicted conversion to clinically definite MS. Multivariate logistic analysis identified three predictors of MS diagnosis: age ≤40 years, inflammatory CSF and ≥3 periventricula...
TL;DR: The identification of an autoantibody exclusively detected in NMO patients against aquaporin-4 (AQP-4) has allowed identification of cases beyond the classical phenotype and may benefit patients with institution of early treatment to reduce disability and prevent further attacks.
Abstract: Neuromyelitis optica (NMO) is an inflammatory disease of central nervous system classically characterized by acute, severe episodes of optic neuritis and longitudinally extensive transverse myelitis, usually with a relapsing course. The identification of an autoantibody exclusively detected in NMO patients against aquaporin-4 (AQP-4) has allowed identification of cases beyond the classical phenotype. Brain lesions, once thought as infrequent, can be observed in NMO patients, but lesions have different characteristics from the ones seen in multiple sclerosis. Additionally, some AQP-4 antibody positive patients may present with a variety of symptoms not being restricted to optic neuritis and acute myelitis during the first attack or in a relapse. Examples are not limited to, but may include patients only with brain and/or brainstem lesions, narcolepsy with hypothalamic lesions or patients with intractable hiccups, nausea and vomiting. The prompt identification of NMO patients with atypical presentations may benefit these patients with institution of early treatment to reduce disability and prevent further attacks.
TL;DR: A forgotten report by the famous British neuroanatomist, neuropathologist and neurologist Jacob Augustus Lockhart Clarke about a 17-year-old girl with bilateral optic neuritis and longitudinally extensive transverse myelitis is discussed.
Abstract: We discuss a forgotten report by the famous British neuroanatomist, neuropathologist and neurologist Jacob Augustus Lockhart Clarke (1817–1880) about a 17-year-old girl with bilateral optic neuritis and longitudinally extensive transverse myelitis. This report, which appeared in 1865, i.e. 15 years prior to Wilhelm Erb’s much-cited paper on the coincidence of optic neuritis and acute myelitis, represents the first known account of a case of Devic’s syndrome or neuromyelitis optica in the English-language medical literature.
TL;DR: Brainstem symptoms/signs and characteristic NMO imaging findings are common in Taiwanese patients with NMO, and should be considered a part of the illness in addition to optic neuritis and myelitis.
TL;DR: The finding of a single inflammatory MRI lesion in the spinal cord with positive Toxocara canis serology in the blood and CSF in cases of subacute or chronic myelitis suggests the diagnosis of ToxOCara myelopathy, irrespective of the presence of eosinophilia.
TL;DR: In light of the severe clinical presentation of TM and its morbidity and mortality, early diagnosis and aggressive treatment are vital for therapeutic success, and the excellent therapeutic response is verified, as it was seen in 64% of patients.
01 Jan 2011
TL;DR: Toxocara myelitis is a rare disease as mentioned in this paper, where patients present with myelopathy, occasionaleosinophilia in blood and cerebrospinal fluid (CSF), with abnormalsignals on magnetic resonance imaging (MRI).
Abstract: Toxocara myelitis is a rare disease. Few cases have beenreported in the literature. Patients present with myelopathy, occasionaleosinophilia in blood and cerebrospinal fluid (CSF), with abnormalsignals on magnetic resonance imaging (MRI). In the current study wereport 17 cases of isolated Toxocara myelitis from a single tertiary re-ferral center in Lebanon, with description of the clinical presentation,laboratory data, MRI findings, and response to antihelminthic treatment.Clinicalandlaboratorydatawerecollectedfor17patientswhopresentedwith evidence of spinal cord disease. The clinical presentation includedsensory, motor, and autonomic dysfunction, predominantly in the lowerextremities. Patients exhibited a subacute or chronic course; this waseither slowly progressive or remitting-relapsing with mild to moderatedisability. The patients underwent extensive blood and CSF workup aswell as MRI of the spinal cord and brain. Only 2 patients had a higheosinophil count in the CSF, although blood eosinophilia was seen in 6patients. All patients tested positive for Toxocara canis antibodies inthe blood and CSF. MRI of the spinal cord revealed a single charac-teristic lesion in the spinal cord with fusiform enlargement that wasisointense on T1-weighted images and hyperintense on T2-weightedimages. Nodular enhancement was seen after gadolinium injection.Treatmentwithalbendazole,withorwithoutsteroids,resultedin markedneurologic improvement and normalization of the MRI in all patients.The finding of a single inflammatory MRI lesion in the spinal cordwith positive Toxocara canis serology in the blood and CSF in cases ofsubacuteorchronicmyelitissuggeststhediagnosisofToxocaramyelitis,irrespective of the presence of eosinophilia. Antihelminthic treatmentis associated with a good outcome.(Medicine 2011;90: 337Y343)Abbreviations: AI = Hauser Ambulation Index, ANA = antinuclearantibodies,CSF=cerebrospinalfluid,CNS=centralnervoussystem,HIV = human immunodeficiency virus, MRI = magnetic resonanceimaging.
TL;DR: An approach to the classification and work-up standardizes diagnostic criteria and terminology to facilitate clinical research, and forms a useful tool in the clinical work- up for patients at presentation.
TL;DR: The objective was to identify the presence of NMOSD in patients with acute myelitis and suspected connective tissue disease (CTD), and to discuss the utility of this distinction in establishing a diagnostic and therapeutic plan.
Abstract: Introduction Neuromyelitis optica (NMO) is a demyelinating, organspecific, autoimmune disease that preferentially targets the optic nerve and spinal cord. The clinical syndrome was first described by Devic and Gault in 1894, and was considered a variant of multiple sclerosis (MS). A resurgence of interest has followed the recent identification of a disease-specific autoantibody, NMO-IgG, and its target antigen, the aquaporin 4 (AQP-4) receptor (1). NMO is classically defined by the presence of both optic neuritis (ON) and longitudinal myelitis (LM), with contiguous spinal cord involvement spanning 3 or more vertebrae. The clinical course is characterized by disease relapse and significant morbidity in more than 90% of cases (2). Research suggests that by 5 years, more than one-half of the patients will be unable to ambulate without assistance and/or be functionally blind (3). Formal diagnosis requires the presence of transverse myelitis (TM), ON, and 2 of 3 supporting criteria (Figure 1), one of which is the serum NMO-IgG antibody. The sensitivity of this assay ranges from 60– 70%, with a specificity of 90% (1,4). Given the potential for permanent disability following isolated attacks of myelitis or ON, efforts have been made to identify individuals at high risk for disease relapse or progression to full-spectrum NMO. Researchers have shown that patients with a single episode of LM in the setting of NMO-IgG positivity have a 50% risk of myelitis relapse or conversion to full-spectrum NMO over the subsequent 12 months (5). Similar data have shown an increased risk for myelitis in NMO-IgG–positive patients that experience recurrent ON (6). Recognition that incomplete forms of NMO are at an increased risk for progression based on the presence of antibody positivity has resulted in the designation of NMO spectrum disorders (NMOSD) (Figure 1). An association between the NMO-IgG antibody and LM in patients with systemic lupus erythematosus (SLE) and Sjögren’s syndrome (SS) has been reported in the literature (7,8), and has spurred interest in NMO/NMOSD from the field of rheumatology. Herein we describe a cohort of patients with autoimmune myelitis and discuss the implications of coexistent NMO/NMOSD for subsequent clinical management. Our objective was to identify the presence of NMOSD in patients with acute myelitis and suspected connective tissue disease (CTD), and to discuss the utility of this distinction in establishing a diagnostic and therapeutic plan.
TL;DR: A high index of clinical suspicion is required to diagnose NS and institute the treatment early, particularly in patients with promiscuous sexual behavior.
Abstract: Background : Symptomatic neurosyphilis (NS) can have varied syndromic presentations: Meningitis, meningovascular and parenchymatous involvement. Aims : To evaluate the different types of clinical syndrome of NS in a tertiary care hospital. Material and Methods : This was a study of clinical profile of 16 patients with NS, seen in between August 2008 and December 2010. Results : There were 13 male and 3 female patients in the age group of 23-48 years. The clinical syndromes included: Neuropsychiatric syndromes (10), myelopathy (5), and posterior circulation stroke (1). Neuropsychiatric symptoms were dementia, behavioral abnormalities, chronic psychosis, and myelopathy syndromes included acute transverse myelitis (ATM), chronic myelopathy, and syphilitic amyotrophy. Thirteen patients had positive venereal disease research laboratory test (VDRL) and/or high Treponema pallidum hemagglutination titer in blood. Cerebrospinal fluid was positive for VDRL in 14 patients, raised protein was seen in 13 patients and lymphocytic pleocytosis was seen in 10 patients. Human immunodeficiency virus serology was negative in all the patients. Fourteen patients fulfilled the criteria of definitive NS and two of presumptive NS. All the patients except one received injection Procaine penicillin for 14 days. The patient with myelitis received a course of steroid, and one patient with associated hypothyroidism received thyroid supplement in addition to penicillin. On follow-up, dementia of short duration and ischemic stroke improved significantly and clinical status remained the same for ATM; others with mild symptoms improved with residual deficit. Conclusion : Syphilis can affect any part of the neuraxis. A high index of clinical suspicion is required to diagnose NS and institute the treatment early, particularly in patients with promiscuous sexual behavior.
TL;DR: MRI findings in this patient with tabes dorsalis were similar to those seen in subacute combined degeneration, which is characterized predominantly by cord atrophy and intramedullary hyperintensities.
Abstract: BackgroundTabes dorsalis is a late manifestation of untreated syphilis that is characterized by ataxia, lancinating pains, and urinary incontinence. A form of tertiary syphilis or neurosyphilis, it is the result of slow, progressive degeneration of the nerve cells in the spinal cord.MethodCase report.FindingsA 39-year-old man presented with tingling paresthesia in the lower limbs, difficulty in walking, and loss of vision. Magnetic resonance imaging (MRI) of the dorsal spine showed intramedullary hyperintensity and cord atrophy, similar to changes seen in subacute combined degeneration. MRI features of tabes dorsalis have not been described previously to the best of our knowledge.ConclusionMRI findings in this patient with tabes dorsalis were similar to those seen in subacute combined degeneration, which is characterized predominantly by cord atrophy and intramedullary hyperintensities.
TL;DR: This is the first case of toxoplasmosis presenting initially with myelitis in the absence of encephalitis that subsequently progressed to myositis despite antiparasitic treatment, and the possibility of immune reconstitution inflammatory syndrome as a cause of his deterioration.
Abstract: IntroductionConcurrent toxoplasmosis infection of the brain, spinal cord, and muscle has never been reported together in a patient antemortem. Toxoplasma gondii is the most common focal central nervous system opportunistic infection in the acquired immune deficiency syndrome (AIDS) population. Despi
TL;DR: An elderly woman presenting with subacute onset paraparesis due to spinal cord involvement by an intravascular lymphoma is reported, and the presence of coexisting hematologic abnormalities should prompt consideration of a bone marrow biopsy.
TL;DR: Using very steep dose gradients from intensity-modulated radiotherapy (IMRT), a protocol based on the concept of partial volume dose to the spinal cord was evaluated and recommended a BED2 of 100 Gy or less at D1cc as a constraint for the spinal Cord in previously unirradiated cases.
Abstract: To perform aggressive radiotherapy for vertebral metastases. Using very steep dose gradients from intensity-modulated
radiotherapy (IMRT), a protocol based on the concept of partial volume dose to the spinal cord was evaluated. 50 patients with vertebral metastases were treated using IMRT. In previously unirradiated cases, where
a prescribed dose of 80 Gy (BED10) was delivered, the constraint to the spinal cord should be less than 100 Gy (BED2). For previously
irradiated cases, on the other hand, the dose is the same as in the previously unirradiated case; however, constraints for
the spinal cord are a cumulative BED2 of less than 150 Gy, BED2 of less than 100 Gy in each instance, and a treatment gap of
more than 6 months. There were 6 patients considered for a partial volume dose to the spinal cord. They all received higher BED2,
ranging from 51–157 Gy of D1cc. Among the 24 patients who survived longer than 1 year, there was 1 case of transient radiation myelitis. There were no
other cases of spinal cord sequelae. Based on the present results, we recommend a BED2 of 100 Gy or less at D1cc as a constraint for the spinal cord in
previously unirradiated cases, and a cumulative BED2 of 150 Gy or less at D1cc in previously irradiated cases, when the interval
was not shorter than 6 months and the BED2 for each session was 100 Gy or less. The prescribed BED10 of 80 Gy could be safely
delivered to the vertebral lesions.
TL;DR: A 72-year-old man developed herpes zoster rash involving the left C3-5 dermatomes while receiving treatment for myasthenia gravis, which was very well controlled with oral prednisolone (25 mg).
Abstract: A 72-year-old man developed herpes zoster rash involving the left C3-5 dermatomes. The patient was receiving treatment for myasthenia gravis, which was very well controlled with oral prednisolone (25 mg). There was no muscle weakness or other complications on examination in the outpatient clinic. Ten days before the onset of rash, he noticed weakness of the left arm. On admission, the left arm weakness was limited to muscles controlled by the C5 myelomere. He had no clinical symptoms of myelitis, but the T2-weighted magnetic …
TL;DR: The length of spinal cord lesion, rather than APTM/ACTM, may be a prognostic factor associated with clinical outcome and long-term disability in Chinese patients with ATM.
Abstract: The aim of the study was to characterize the demographic, clinical, and prognostic features of Chinese patients with acute transverse myelitis (ATM). The clinical data from ATM patients in a demyelinating disease database were analyzed retrospectively. Sixty-seven ATM patients with a follow-up duration longer than 2 years were identified. The frequency of neuromyelitis optica-related ATM (NMO-ATM) was high in our cohort (40.3%). Recurrent ATM (R-ATM), with a female predominance, was common in total idiopathic ATM (69.0%, 20/29). In R-ATM with longitudinally extensive spinal cord lesions (LESCLs), the high seropositivity of NMO-IgG, spinal cord lesions mostly involved the central gray matter and severer long-term disability were similar to NMO-ATM. In RTM without LESCLs, low seropositivity of NMO-IgG, preferentially involvement of the peripheral white matter and relative better neurological recovery were consistent with multiple sclerosis-related ATM (MS-ATM). The transition rates to MS in patients with acute partial transverse myelitis (APTM) and acute complete transverse myelitis (ACTM) were not significant (16.7 vs. 6.3%, P = 0.753), while LESCLs (OR = 11.4, P = 0.028) were significantly correlated with transition to NMO. The presence of LESCLs was the only variable showing a higher risk for reaching Rankin 3 (hazard ratio: 2.5, 95% CI: 1.0-6.1). Chinese patients with ATM had demographic, clinical, and prognostic features different from those in Western populations. Idiopathic R-ATM, common in Chinese, is a heterogeneous entity that shares partial clinical, spinal MRI and prognostic features with MS-ATM and NMO-ATM. The length of spinal cord lesion, rather than APTM/ACTM, may be a prognostic factor associated with clinical outcome and long-term disability in our population.
TL;DR: Virus-induced spinal cord damage results from a cytolytic effect on anterior horn cells or from predominantly cellular immune-mediated damage of long white matter tracts, and attacks of acute myelitis usually respond favorably to immunomodulatory therapy.