scholarly journals Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Varshney Ankur Nandan ◽  
Kumar Nilesh ◽  
Behera Dibyaranjan ◽  
Tiwari Ashutosh ◽  
Anand Ravi ◽  
...  
Keyword(s):  
Japanese Encephalitis ◽  
Vasogenic Edema ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Internal Capsule ◽  
Endemic Region ◽  
Rare Presentation ◽  
Initial Manifestation ◽  
Altered Sensorium ◽  
Acute Transverse Myelitis

Japanese encephalitis, an inflammatory brain disease prevalent in Southeast Asia, usually presented with fever, headache, convulsions, brain stem signs with pyramidal and extrapyramidal features, and altered sensorium. Acute transverse myelitis, as the initial manifestation of Japanese encephalitis, is an unusual manifestation and is seldom reported. We hereby report a case of 13-year-old adolescent boy who presented to us with fever and acute onset paraparesis with urinary retention initially, progressing to quadriparesis and then followed by headache and altered sensorium. Brain MRI revealed bilateral basal ganglia that were grossly swollen with vasogenic edema tracking along internal capsule and midbrain. Adjacent ventrolateral thalamus and internal capsule also showed mild abnormal intensities. Spinal screening showed abnormal cord intensities in entire cord with gross edema in cervical and conus regions. He had elevated IgM titres against JE virus in cerebrospinal fluid. The patient was treated conservatively along with intravenous methyl prednisolone for 5 days. He regained near normal power at 3 months in followup, but hesitancy, dysarthria, and slowness of movement still persisted. To conclude, a young boy presenting with ATM in an endemic region of JE, then a possibility of Japanese encephalitis, should be sought by clinicians as early use of immunomodulator shows survival benefit.

Extensive basal ganglia edema caused by a traumatic carotid-cavernous fistula: a rare presentation related to a basal vein of Rosenthal anatomical variation

2014 ◽  
Vol 121 (1) ◽  
pp. 63-66 ◽  
Author(s):  
Isabelle Ract ◽  
Aurélie Drier ◽  
Delphine Leclercq ◽  
Nader Sourour ◽  
Joseph Gabrieli ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Vasogenic Edema ◽  
Anatomical Variation ◽  
Brain Mri ◽  
Venous Congestion ◽  
Carotid Cavernous Fistula ◽  
Orbital Trauma ◽  
Rare Presentation ◽  
Cavernous Fistula ◽  
Basal Vein Of Rosenthal

The authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis, dysarthria, and a comatose state caused by right orbital trauma from a thin metal rod. Brain MRI showed a right CCF and vasogenic edema of the right side of the brainstem, right temporal lobe, and basal ganglia. Digital subtraction angiography confirmed a high-flow direct CCF and revealed a hypoplastic second segment of the BVR responsible for the hypertension in inferior striate veins and venous congestion. Endovascular treatment was performed on an emergency basis. One month after treatment, the patient's symptoms and MRI signal abnormalities almost totally disappeared. Basal ganglia and brainstem venous congestion may occur in traumatic CCF in cases of a hypoplastic or agenetic second segment of the BVR and may provoke emergency treatment.

Brain abnormalities in Sjogren syndrome with recurrent CNS manifestations: association with neuromyelitis optica

2009 ◽  
Vol 15 (9) ◽  
pp. 1069-1076 ◽  
Author(s):  
JH Min ◽  
HJ Kim ◽  
BJ Kim ◽  
KW Lee ◽  
IN Sunwoo ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Vasogenic Edema ◽  
Brain Mri ◽  
Internal Capsule ◽  
Sjögren Syndrome ◽  
Sjogren Syndrome ◽  
Brain Abnormalities ◽  
Posterior Limb ◽  
Brain Involvement

Background and objectives Optic neuritis or longitudinally extensive myelitis in Sjogren syndrome (SS) suggests a neuromyelitis optica spectrum disorder (NMOSD). However, brain abnormalities of SS remain to be elucidated for the association with neuromyelitis optica (NMO). Methods Twelve primary SS patients (all women, 42 ± 13.2 years) who had recurrent central nervous system (CNS) manifestations with brain involvement were retrospectively identified. Brain MRI, and neurologic and serologic findings were analyzed with the measurement of anti-aquaporin-4 antibody (AQP4-Ab). Results All patients showed brain lesions characteristic of NMO as follows: 1) the involved sites adjacent to the third and fourth ventricles and in the posterior limb of the internal capsule, 2) unique configurations, such as the longitudinal course from the internal capsule to the midbrain, large cerebral or cerebellar lesions over 3 cm, and cavity-like formations. AQP4-Ab was positive in six of eight patients tested, and all the seropositive patients showed lesions with increased diffusion, suggestive of vasogenic edema. Four patients met the revised criteria of NMO, and nine had features of NMOSDs. Of the remaining three patients showing only brain involvement, one had AQP4-Ab. Conclusions This study demonstrates that SS patients with recurrent CNS involvement have brain abnormalities characteristic of NMO and AQP4-Ab in Korea. The presence of AQP4-Ab in one SS patient with only brain involvement may suggest that the coexistence of NMO should be explored in SS patients with recurrent CNS manifestations, even without optic neuritis or myelitis.

scholarly journals Partial acute transverse myelitis is a predictor of multiple sclerosis in children

2014 ◽  
Vol 20 (11) ◽  
pp. 1485-1493 ◽  
Author(s):  
P Meyer ◽  
N Leboucq ◽  
N Molinari ◽  
A Roubertie ◽  
M Carneiro ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Prognostic Factors ◽  
Severe Disease ◽  
Brain Mri ◽  
Age At Onset ◽  
Transverse Myelitis ◽  
First Episode ◽  
Acute Transverse Myelitis ◽  
Subsequent Risk

Background: Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis. Objectives: To determine the clinical course and prognostic factors after a first episode of ATM in children. Methods: Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected. Results: Median age at onset was 11 years (range 3–15 years). Follow-up data were available for a median of 4 years (range 0.5–16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3–11), with a 60% probability of having a relapse at five years ( p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%). Conclusion: Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.

Acute transverse myelitis with normal brain MRI

2007 ◽  
Vol 255 (1) ◽  
pp. 89-93 ◽  
Author(s):  
J. Perumal ◽  
R. Zabad ◽  
C. Caon ◽  
M. MacKenzie ◽  
A. Tselis ◽  
...  
Keyword(s):  
Brain Mri ◽  
Transverse Myelitis ◽  
Normal Brain ◽  
Acute Transverse Myelitis

Neurological manifestations of scrub typhus in adults

2016 ◽  
Vol 47 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Abhinav Rana ◽  
Sanjay K Mahajan ◽  
Arindam Sharma ◽  
Sudhir Sharma ◽  
Balbir S Verma ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Transverse Myelitis ◽  
Neurological Dysfunction ◽  
Neurological Manifestations ◽  
Focal Neurological Deficit ◽  
Altered Sensorium ◽  
Csf Analysis ◽  
Acute Transverse Myelitis ◽  
The Right ◽  
Bilateral Papilloedema

In order to study the neurological manifestations in adult patients suffering from scrub typhus, 323 patients aged over 18 years, admitted with a positive diagnosis, were screened for neurological dysfunction; 37 patients with symptoms and/or signs suggestive of neurological dysfunction were included in the study. Of these, 31 (84%) patients had altered sensorium, four (11%) had cerebellitis, one (2%) patient had acute transverse myelitis and one (2%) had bilateral papilloedema without focal neurological deficit. Of the 31 patients with altered sensorium, 15 (40%) had meningoencephalitis, three (8%) had seizures, two (5%) had cerebral haemorrhages, one (2%) had a presentation likened to neuroleptic malignant syndrome (NMS) and one (2%) had a 6th nerve palsy with inflammation of the right cavernous sinus. Cerebrospinal fluid (CSF) analysis was abnormal in 23 patients (raised lymphocytes in 68%, raised protein in 80%). All patients improved with anti-rickettsial therapy.

Clinically isolated acute transverse myelitis: prognostic features and incidence

2009 ◽  
Vol 15 (11) ◽  
pp. 1295-1302 ◽  
Author(s):  
John Young ◽  
Stephen Quinn ◽  
Mike Hurrell ◽  
Bruce Taylor
Keyword(s):  
Multiple Sclerosis ◽  
New Zealand ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Hazard Ratio ◽  
Prognostic Features ◽  
Acute Transverse Myelitis ◽  
Definite Multiple Sclerosis ◽  
Clinically Definite Multiple Sclerosis ◽  
Abnormal Brain

Demyelinating acute transverse myelitis may be the first presentation of multiple sclerosis or remain a clinically isolated syndrome. North Canterbury, New Zealand provides a well circumscribed population to study acute transverse myelitis. Objective: to identify prognostic features, clinical outcomes and incidence of ATM in North Canterbury, New Zealand. All patients with acute transverse myelitis as a first neurological presentation diagnosed from January 2001 to December 2005 at a single institution providing all neurological care for North Canterbury were assessed for clinical data, MRI findings, cerebrospinal fluid results and clinical outcomes. CHAMPS, Barkhof/Tintore and Swanton criteria were applied to brain MRI. Sixty-one patients were identified with a mean duration of follow-up of 30 ± 17 months. Fifty percent of patients with ATM with brain lesions by CHAMPS criteria converted to clinically definite multiple sclerosis. No patients with idiopathic acute transverse myelitis converted to clinically definite multiple sclerosis. There was a strong association with conversion to clinically definite multiple sclerosis and abnormal brain MRI by CHAMPS criteria (hazard ratio, 5.63; 1.83—17.3), Barkhof/Tintore criteria (hazard ratio, 6.43; 2.31—17.9) and Swanton criteria (hazard ratio, 4.53; 1.67—12.3). The age standardized annual incidence of acute transverse myelitis was 24.6 (18.2—31.1) per million, of definite and possible idiopathic acute transverse myelitis was 6.2 (2.9—9.6) per million, and of acute transverse myelitis with brain lesions was 4.7 (1.9—7.6) per million. Patients with idiopathic acute transverse myelitis are at low risk for conversion to clinically definite multiple sclerosis. Abnormal brain MRI by CHAMPS criteria is a sensitive predictor of conversion to clinically definite multiple sclerosis. The annual incidence of acute transverse multiple sclerosis in North Canterbury, New Zealand is significantly higher than previously reported.

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