Neurologic Emergencies

2020 ◽  
pp. 213-234
Author(s):  
Molly Hartrich ◽  
Emily Rose
Keyword(s):  
Neuromuscular Disorders ◽  
Transverse Myelitis ◽  
Altered Mental Status ◽  
Periodic Paralysis ◽  
Motor Dysfunction ◽  
Nmda Receptor Encephalitis ◽  
Acute Flaccid Myelitis ◽  
Neurologic Emergencies ◽  
Toxic Ingestion ◽  
Atypical Presentations

Neurologic emergencies may occur in children and generate a significant differential diagnosis of potentially life-threatening etiologies. This chapter reviews the most common and/or important neurological emergencies, including febrile seizures, first presentation of afebrile seizures, seizure variants, breakthrough seizures in epilepsy, seizures due to toxic ingestion, status epilepticus, altered mental status, headache, migraine syndromes, encephalitis, acute demyelinating encephalomyelitis, acute cerebellar ataxia, anti-NMDA receptor encephalitis, motor dysfunction/weakness syndromes such as Guillain-Barre syndrome, polyneuropathies, transverse myelitis, acute periodic paralysis, acute flaccid myelitis, and neuromuscular disorders such as botulism, myasthenia gravis. The common presentations, atypical presentations, evaluation, disposition, clinical pearls, and pitfalls of these important pediatric neurologic emergencies are discussed.

scholarly journals Anti-NMDA Receptor Encephalitis in a Patient with a History of Autism Spectrum Disorder

2020 ◽  
Vol 10 (3) ◽  
pp. 231-235
Author(s):  
Xavier Diao ◽  
Milana Mor
Keyword(s):  
Autism Spectrum Disorder ◽  
Nmda Receptor ◽  
Neuropsychiatric Symptoms ◽  
Antipsychotic Agents ◽  
Altered Mental Status ◽  
Autism Spectrum ◽  
Acute Onset ◽  
Spectrum Disorder ◽  
Nmda Receptor Encephalitis ◽  
History Of

Background: Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune syndrome characterized by a well-described constellation of neuropsychiatric symptoms. Its exact pathophysiology is poorly understood, but it is thought to be mediated by autoantibodies against NMDA (N-methyl-D-aspartate)-type glutamate receptors in the central nervous system. There is ongoing literature to suggest that patients with autism spectrum disorder (ASD) have evidence of neuroinflammation—or by definition, encephalitis. Objective: To investigate the link between autism spectrum disorder and autoimmune encephalitides. Methods: We present a case of anti-NMDA receptor encephalitis in a patient with autism spectrum disorder. “OP” is a 16-year-old male with a history of attention-deficit/ hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) who presented with a 3-day history of acute-onset altered mental status, electroencephalogram (EEG)-corroborated seizures, and slurred speech. Laboratory studies were significant for serum- and cerebrospinal fluid (CSF)-positive NMDA antibodies. The child psychiatry consult-liaison service was consulted for significant agitation and behavioral dyscontrol. We recommended 1:1 observation for safety, as well as antipsychotic agents titrated to clinical effect. The patient had a protracted hospital course, but was eventually discharged to an acute rehabilitation facility for continued stabilization and therapy. Conclusion: It remains to be seen if the relation between encephalitis and ASD is uni- or bidirectional, that is: whether children with ASD have a genetic diathesis to developing encephalitides (such as those mediated by the NMDAR), or conversely, if deranged or inflamed neuroreceptor processes are implicated in the development of ASD.

scholarly journals Severe tooth loss secondary to orofacial dyskinesias in anti-NMDA receptor encephalitis

2019 ◽  
Vol 12 (3) ◽  
pp. e228380
Author(s):  
Daniel Garbin Di Luca ◽  
Jason H Margolesky
Keyword(s):  
Emergency Department ◽  
Nmda Receptor ◽  
Tooth Loss ◽  
Altered Mental Status ◽  
Psychiatric History ◽  
Aggressive Treatment ◽  
Orofacial Dyskinesia ◽  
Speech Output ◽  
Nmda Receptor Encephalitis ◽  
Receptor Antibodies

A 24-year-old woman with no significant medical or psychiatric history was brought to the emergency department due to altered mental status and bizarre behaviour. Physical examination was remarkable for decreased speech output and orofacial dyskinesia. Upon further evaluation, electroencephalogram showed extreme delta brush waves and cerebrospinal fluid was positive for anti-NMDA receptor antibodies. Despite aggressive treatment with steroids and immunosuppressive therapy, her dyskinesia was severe enough to cause tooth loss, tongue and lip laceration.

scholarly journals Mycoplasma pneumoniae-associated transverse myelitis presenting as asymmetric flaccid paralysis

2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Shafee Salloum ◽  
Ajay Goenka ◽  
Elizabeth Ey
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Transverse Myelitis ◽  
Sudden Onset ◽  
Motor Dysfunction ◽  
Flaccid Paralysis ◽  
Inflammatory Disorder ◽  
Acute Transverse Myelitis ◽  
Autonomic Changes ◽  
Autonomic Dysfunctions ◽  
Mycoplasma Pneumoniae Infection

Acute transverse myelitis is a rare spinal cord inflammatory disorder that manifests as sudden onset of motor, sensory, and autonomic dysfunctions. Here, we report a case of acute transverse myelitis in a 13-year-old boy secondary to Mycoplasma pneumoniae infection. He presented with left facial palsy and contralateral upper extremity weakness without sensory or autonomic changes. The patient was diagnosed with transverse myelitis based on his magnetic resonance imaging findings, although his presentation was mainly motor dysfunction, which is more consistent with acute flaccid paralysis.

scholarly journals Acute Flaccid Myelitis in COVID-19

2020 ◽  
Vol 6 (3) ◽  
pp. 20200098
Author(s):  
Mohamed Abdelhady ◽  
Ahmed Elsotouhy ◽  
Surjith Vattoth
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Case Reports ◽  
Transverse Myelitis ◽  
Acute Disseminated Encephalomyelitis ◽  
Imaging Findings ◽  
Metabolic Complications ◽  
Acute Flaccid Myelitis ◽  
Post Infectious ◽  
Spinal Cord Imaging

Spinal cord imaging findings in COVID-19 are evolving with the increasing frequency of neurological symptoms among COVID-19 patients. Several mechanisms are postulated to be the cause of central nervous system affection including direct virus neuroinvasive potential, post infectious secondary immunogenic hyperreaction, hypercoagulability, sepsis and possible vasculitis as well as systemic and metabolic complications associated with critical illness. Only a few case reports of spinal cord imaging findings are described in COVID-19, which include transverse myelitis, acute disseminated encephalomyelitis and post-infectious Guillain Barre’ syndrome. We are describing a case of myelitis which, to the best of our knowledge, is the first reported case of myelitis in COVID-19.

Acute Flaccid Myelitis: A Clinical Review

2020 ◽  
Vol 40 (02) ◽  
pp. 211-218
Author(s):  
Olwen C. Murphy ◽  
Carlos A. Pardo
Keyword(s):  
Spinal Cord ◽  
Acute Flaccid Paralysis ◽  
Clinical Manifestations ◽  
Transverse Myelitis ◽  
The United States ◽  
Acute Onset ◽  
Flaccid Paralysis ◽  
Limb Weakness ◽  
Acute Flaccid Myelitis ◽  
Enterovirus D68

AbstractAcute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the spinal cord gray matter on magnetic resonance imaging. In most cases, prodromal fever or respiratory symptoms occur, followed by acute-onset flaccid limb weakness. Respiratory, axial, bulbar, facial, and extraocular muscles may also be affected. The clinical manifestations have been described as “polio-like,” due to striking similarities to cases of poliomyelitis. The primary site of injury in AFM is the anterior horn cells of the spinal cord, resulting in a motor neuronopathy. Seasonal peaks of cases have occurred in the United States every 2 years since 2012. However, AFM remains a rare disease, which can make it challenging for physicians to recognize and differentiate from other causes of acute flaccid paralysis such as Guillain–Barre syndrome, spinal cord stroke, and transverse myelitis. Epidemiological evidence suggests that AFM is linked to a viral etiology, with nonpolio enteroviruses (in particular enterovirus D68) demonstrating a plausible association. The epidemiology, possible etiological factors, clinical features, differential diagnosis, treatment, and outcomes of AFM are discussed in this review.

scholarly journals A Case Report: Co-presenting COVID-19 Infection and Acute Drug Intoxication

2020 ◽  
Vol 4 (3) ◽  
pp. 340-343
Author(s):  
Jeremy Riekena ◽  
Irene Lee ◽  
Anita Lui ◽  
Marion-Vincent Mempin
Keyword(s):  
Case Report ◽  
Respiratory Acidosis ◽  
Altered Mental Status ◽  
Arterial Blood Gas ◽  
Atypical Symptoms ◽  
Arterial Blood ◽  
Opiate Abuse ◽  
Chief Complaints ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Background: Coronavirus disease 2019 (COVID-19) has spread throughout the world since late 2019. Symptoms appear after a two-week incubation period and commonly include fever, cough, myalgia or fatigue, and shortness of breath. Case Report: A 32-year-old male with a history of opiate abuse presented to the emergency department with altered mental status. The patient was lethargic and hypoxic with improvement from naloxone. Official chest radiograph was read as normal; however, the treating clinicians noted bilateral interstitial opacities, raising concern for underlying infectious etiology. Opiates and cocaine were positive on drug screen, and an arterial blood gas on room air showed hypoxemia with respiratory acidosis. The patient was intubated during the treatment course due to persistent hypoxemia and for airway protection after resuscitation. The COVID-19 test was positive on admission, and later computed tomography showed ground-glass opacities. The patient was extubated and discharged after one week on the ventilator. Conclusion: When screening patients at and during evaluation, physicans should consider a broad differential as patients with atypical presentations may be overlooked as candidates for COVID-19 testing. As screening and evaluation protocols evolve, we emphasize maintaining a high index of suspicion for COVID-19 in patients with atypical symptoms or presenting with other chief complaints in order to avoid spreading the disease.

Neuromuscular Disorders

2017 ◽  
Author(s):  
E. Lee Murray ◽  
Veda V. Vedanarayanan
Keyword(s):  
Peripheral Nerves ◽  
Chronic Conditions ◽  
Neuromuscular Disorders ◽  
Periodic Paralysis ◽  
Muscular Weakness ◽  
Myasthenic Syndrome ◽  
Critical Illness Neuromyopathy ◽  
Tick Paralysis ◽  
Reason For Admission ◽  
Lateral Sclerosis

The hospital neurologist may encounter neuromuscular disorders as known chronic conditions that are exacerbated by a hospital stay, be the principal reason for admission, or develop during a prolonged hospitalization. This chapter details the presentation, diagnosis, and management of conditions affecting the peripheral nerves and neuromuscular junction, such as myasthenia gravis, Lambert-Eaton (myasthenic) syndrome, botulism, and tick paralysis; as well as muscular weakness from various causes such as rhabdomyolysis, critical illness neuromyopathy, inflammatory myopathies, muscular dystrophies, periodic paralysis, and metabolic and endocrine myopathies. Also discussed are motoneuron degeneration, including amyotrophic lateral sclerosis and progressive muscle atrophy, and neuromuscular respiratory failure.

scholarly journals Clinical Approach to Pediatric Transverse Myelitis, Neuromyelitis Optica Spectrum Disorder and Acute Flaccid Myelitis

Children ◽  
2019 ◽  
Vol 6 (5) ◽  
pp. 70 ◽  
Author(s):  
Cynthia Wang ◽  
Benjamin Greenberg
Keyword(s):  
Clinical Presentation ◽  
Bladder Dysfunction ◽  
Transverse Myelitis ◽  
Bowel Dysfunction ◽  
Spectrum Disorder ◽  
Clinical Approach ◽  
Acute Flaccid Myelitis ◽  
Acute Transverse Myelitis ◽  
Immune Mediated

Pediatric transverse myelitis (TM) is an acquired, immune-mediated disorder that leads to injury of the spinal cord and often manifests as weakness, numbness, bowel dysfunction, and/or bladder dysfunction. Multiple etiologies for myelitis can result in a similar clinical presentation, including idiopathic transverse myelitis (TM), multiple sclerosis (MS), neuromyeltis optica spectrum disorder (NMOSD) associated with anti-aquaporin 4 antibodies, MOG antibody-associated disease, and acute flaccid myelitis (AFM). Diagnosis relies on clinical recognition of the syndrome and confirming inflammation through imaging and/or laboratory studies. Acute treatment is targeted at decreasing immune-mediated injury, and chronic preventative therapy may be indicated if TM is determined to be a manifestation of a relapsing disorder (i.e., NMOSD). Timely recognition and treatment of acute transverse myelitis is essential, as it can be associated with significant morbidity and long-term disability.

scholarly journals Association of Autonomic Storming with Urinary Catheter Removal in NMDA Receptor Encephalitis: A Case Report

2020 ◽  
Vol 11 (1) ◽  
pp. 45-48
Author(s):  
Natalie Neale ◽  
Cody Nathan ◽  
Sok Lee ◽  
Atul Kalanuria
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Nmda Receptor ◽  
Urinary Retention ◽  
Urinary Catheter ◽  
Altered Mental Status ◽  
Catheter Removal ◽  
Nmda Receptor Encephalitis ◽  
First Case

We present a case of a 47-year-old female who presented with altered mental status and was found to have severe anti-NMDA receptor encephalitis. Her intensive care unit course was complicated by paroxysmal sympathetic storming. She also had urinary retention for which a catheter was placed early in her admission, but attempts at removal were associated with worsening storming. Her average Clinical Features Scale score was 5.9 when the catheter was not in place compared to 3.6 with the catheter in place. This is the first case report to our knowledge demonstrating an association between urinary catheter removal and autonomic storming in anti-NMDA receptor encephalitis.

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