scholarly journals Acute longitudinal extensive transverse myelitis secondary to asymptomatic SARS-CoV-2 infection

2021 ◽  
Vol 14 (7) ◽  
pp. e244687
Author(s):  
Gabriel Lee
Keyword(s):  
Lower Limb ◽  
Post Partum ◽  
Rare Complication ◽  
Transverse Myelitis ◽  
Sensory Loss ◽  
Nasopharyngeal Swab ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Extensive Transverse Myelitis

A 35-year-old woman, 6 months post partum, presented with acute onset back pain at the T8 level progressing to bilateral lower limb weakness and sensory loss with urinary retention and constipation. This patient had a pre-existing inflammatory disease, having recently developed ulcerative colitis antenatally. Five days prior to admission, she had tested positive asymptomatically on a SARS-CoV-2 reverse-transcriptase PCR nasopharyngeal swab. The positive swab result was confirmed on admission. Clinical examination revealed bilaterally exaggerated knee reflexes, lower limb weakness and positive Babinski’s sign. Sensation was impaired at L4 and L5 dermatomes and absent at S1 and S2. MRI findings suggested longitudinal extensive transverse myelitis, with multiple regions of patchy hyperintensity seen in the thoracic region of the spinal cord both centrally and peripherally. She was started on a course of intravenous corticosteroids and improvement was seen both clinically and on repeat imaging. This case demonstrates a rare complication to an asymptomatic COVID-19 infection and explores the potential neurotropic properties of COVID-19.

scholarly journals Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wee Yong Tan ◽  
Abdul Hanif Khan Yusof Khan ◽  
Mohd Naim Mohd Yaakob ◽  
Anna Misyail Abdul Rashid ◽  
Wei Chao Loh ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Neurological Complications ◽  
High Dose ◽  
Sensory Level ◽  
Limb Weakness ◽  
Efficacy Trials ◽  
First Case ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Magnetic Resonance Imaging Mri ◽  
Extensive Transverse Myelitis

Abstract Background Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine. Case presentation We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment. Conclusion LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

Longitudinally Extensive Transverse Myelitis (LETM) and Myopericarditis in a 7-Month-Old Child with SARs-CoV-2 Infection

2021 ◽  
Author(s):  
Giacomo Brisca ◽  
Stefano Sotgiu ◽  
Daniela Pirlo ◽  
Barbara Tubino ◽  
Laura Siri ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Transverse Myelitis ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Complications ◽  
Nasopharyngeal Swab ◽  
High Dose ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Permanent Disability ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Extensive Transverse Myelitis

Abstract Introduction In the last few months, some pediatric cases with neurological and neuroradiological pictures related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported, often associated with multisystem inflammatory syndrome (MIS-C). The most frequently encountered pediatric neurological complications seem to be postinfectious immune-mediated acute disseminated encephalomyelitis (ADEM)-like changes of the brain, myelitis, neural enhancement, and splenial lesions. Concomitant neurological and cardiac involvement has been reported only in MIS-C, although specific clinical details are often not fully available. Methods In this case report, a very young child infected with SARs-CoV-2 and diagnosed as longitudinal extensive transverse myelitis with concomitant myo-pericarditis is presented. Results A previously healthy 7-month-old girl presented with abrupt onset of generalized weakness with inability to sit up. She had had mild respiratory symptoms 1 week earlier. Spinal magnetic resonance imaging (MRI) showed a T2-hyperintense intramedullary lesion extending from C4 to T2, compatible with acute longitudinally extensive transverse myelitis (LETM). Cerebrospinal fluid analysis was negative.Echocardiography and blood tests were suggestive for myo-pericarditis. Real time polymerase chain reaction for SARS-CoV-2 on nasopharyngeal swab sample tested positive. She was promptly treated with high dose of steroids and immunoglobulin with satisfactory clinical response. Conclusion To the evolving literature of neurological complications of SARs-CoV-2 infection, we add the youngest patient described to date with isolated LETM and concomitant cardiac involvement. Our case suggests that clinicians should be aware of this association, although difficult to recognize in infants. Practitioners are encouraged to consider aggressive first-line immunotherapies with the final aim to prevent permanent disability.

Spontaneous Spinal Subarachnoid Haemorrhage: A Rare Complication of Dengue Fever

2017 ◽  
Vol 2 (2) ◽  
pp. 54
Author(s):  
Nur Hidayati Mohd Sharif ◽  
Nor Arisah Misnan ◽  
Norashikin Saidon ◽  
Phaik Yee Ooi ◽  
Hilwati Hashim
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Lower Limb ◽  
Rare Complication ◽  
Dengue Infection ◽  
Febrile Illness ◽  
Neurological Complications ◽  
Sensory Function ◽  
Limb Weakness ◽  
Surgical Interventions ◽  
Lower Limb Weakness

A 37-year-old woman presented with a short history of fever and bilateral lower limb weakness. She also had impaired sensory function up to T4 spine level and lax anal tone. Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite medical and surgical interventions, her lower limb weakness persists. A high index of suspicion is needed to recognise dengue-related neurological complications. This diagnosis should be considered in any patients from dengue endemic areas presenting with acute febrile illness with atypical neurological manifestations.

scholarly journals Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual—A Rare Complication of Varicella-Zoster Virus Reactivation

Medicina ◽  
2019 ◽  
Vol 55 (5) ◽  
pp. 201 ◽  
Author(s):  
Samar A. Abbas ◽  
Jeanine El Helou ◽  
Moussa A. Chalah ◽  
Hanine Hilal ◽  
Gaby Saliba ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Rare Complication ◽  
Neurological Complication ◽  
Immunosuppressive Agents ◽  
Transverse Myelitis ◽  
Therapeutic Interventions ◽  
Immunocompromised Patients ◽  
Varicella Zoster ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Extensive Transverse Myelitis

Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult—a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.

scholarly journals A Rare Complication of Herpes Zoster: Segmental Zoster Paresis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Hooi Khee Teo ◽  
Mayank Chawla ◽  
Manish Kaushik
Keyword(s):  
Herpes Zoster ◽  
Lower Limb ◽  
Rare Complication ◽  
Good Prognosis ◽  
Interesting Case ◽  
Motor Neuropathy ◽  
Rare Presentation ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
The Right

Herpes zoster is a common presentation in both the community and emergency department; however segmental zoster paresis is a rare complication that can lead to misdiagnosis. We present a case of a 74-year-old Indian gentleman with a background of well controlled diabetes mellitus, hypertension, and ischaemic heart disease who presented with sudden right lower limb weakness. This was preceded by a 5-day history of paraesthesia starting in the right foot and ascending up the right lower limb. On examination, there was a characteristic vesicular rash in the L2/3 region with MRC grading 3/5 in the right hip flexors. The rest of the neurological examination was unremarkable. MRI of the spine did not show any evidence of spinal disease. The patient was initiated on IV acyclovir with improvement of the lower limb weakness to MRC grading 5/5 as the vesicles improved. This is an interesting case as it highlights a rare presentation of zoster: segmental motor paresis that recovered fully with resolution of the rash. It shows the importance of recognizing motor neuropathy as a complication of shingles as it has a very good prognosis with most patients regaining full motor function of the affected limb with treatment.

scholarly journals Longitudinal extensive transverse myelitis with sixth nerve palsy post ChAdOx1 nCov-19 vaccine: A case report and literature review

2021 ◽  
Vol 12 (2) ◽  
pp. 526-538
Author(s):  
Abed AlRaouf Kawtharani ◽  
Battoul Fakhry ◽  
Abbass Serhan
Keyword(s):  
Nerve Palsy ◽  
Transverse Myelitis ◽  
Demyelinating Diseases ◽  
Limb Weakness ◽  
Term Care ◽  
Sixth Nerve Palsy ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Post Marketing Surveillance ◽  
Extensive Transverse Myelitis ◽  
Sixth Nerve

Concurrently with the quick development of COVID-19 vaccines globally, concerns about vaccination efficacy and safety are rising. Neurological complications such as transverse myelitis (TM) are major worries because they can cause lifelong disabilities, which may require long term care. Here, we report a case of longitudinal extensive transverse myelitis (LETM), with sixth nerve palsy in a young female occurring shortly after ChAdOx1 nCov-19 vaccine. The patient recalled developing strabismus, progressive ascending bilateral lower limb weakness, along with upper extremity paresthesia, abnormal sensation below T6 dermatomes, and difficulty in urination. She presented to the hospital with complete paralysis below the neck associated with urinary retention. Extensive diagnostic studies were performed to rule out alternative etiologies, including but not limited to demyelinating diseases, para-post infectious agents, paraneoplastic syndromes, tumors, and autoimmune diseases. She was treated with corticosteroids and discharged upon clinical improvement. However, the patient clinically deteriorated and intravenous immunoglobulin was administered. Unfortunately, the patient is still suffering from physical impairment. We suggested that LETM could be induced by an autoimmune process triggered molecule mimicry. In conclusion, safety monitoring of the COVID-19 vaccines is of great importance in the post marketing surveillance, particularly for rare adverse events.

scholarly journals Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
D. Tsiptsios ◽  
D. Daud ◽  
K. Tsamakis ◽  
E. Rizos ◽  
A. Anastadiadis ◽  
...  
Keyword(s):  
Drug Overdose ◽  
Lower Limb ◽  
Rare Complication ◽  
Femoral Nerve ◽  
Lithotomy Position ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Lower Limb Pain ◽  
Uncommon Complication

Background. Bilateral femoral neuropathy is an uncommon complication of various surgical and nonsurgical procedures, such as pelvic/abdominal surgery or vaginal delivery. Case Report. We report a case of a 41-year-old male who was found unresponsive against the wall in a “lithotomy-type” position with both knees flexed at approximately 90 degrees and both hips flexed and externally rotated at approximately 90 and 60 degrees, respectively, 24–48 hours after a drug overdose (combination of dihydrocodeine, paracetamol, diazepam, and amitriptyline). During his recovery, he complained of severe bilateral proximal lower limb weakness and bilateral distal lower limb pain and allodynia. His symptoms were initially attributed to critical illness myopathy/neuropathy (CIMN). However, thorough clinical and neurophysiological evaluation revealed that his symptoms were due to severe bilateral femoral neuropathies. Conclusions. To our knowledge, this is the first reported case of bilateral femoral nerve palsy due to prolonged posturing in a “lithotomy-type” position in the context of a drug overdose.

Longitudinal Extensive Transverse Myelitis following T-ALL

2016 ◽  
Vol 47 (S 01) ◽  
Author(s):  
V. Kraus ◽  
C. Makowski ◽  
H. Jünger ◽  
A. Wawer ◽  
P. Strotmann ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Extensive Transverse Myelitis

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

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