Abstract 1122‐000013: Spinal Dural Arterio‐Venous Fistula: A Masquerade as a Longitudinal Myelitis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Amardeep Saund ◽  
Saleem Al Mawed ◽  
Adnan Subei ◽  
Brijesh Mehta
Keyword(s):  
Delayed Diagnosis ◽  
Transverse Myelitis ◽  
Diagnostic Feature ◽  
Segmental Artery ◽  
Csf Analysis ◽  
Digital Subtraction Angiogram ◽  
Venous Fistula ◽  
The Right ◽  
High Index Of Suspicion ◽  
Extensive Transverse Myelitis

Introduction : SDAVF are rare and frequently misdiagnosed due to their nonspecific symptomatology and delay of presentation on imaging. Spinal digital subtraction angiogram is the gold standard diagnostic test. Delayed diagnosis and treatment of SDAVF can lead to irreversible neurologic damage. Methods : None Results : Two female patients, 69 and 74 years old, each developed recurrent episodes of subacute worsening myelopathy and urinary retention. The subacute onset of symptoms and longitudinal appearance on cord imaging raised concern for inflammatory myelitis. Despite a negative CSF analysis, and the absence of serum inflammatory, metabolic and infectious markers, the working diagnosis was seronegative neuromyelitis optica spectrum disorder. In accordance, both patients were treated with plasma exchange and IV rituximab, initially displaying stabilization on imaging. However, further worsening and extension of the myelopathy alongside the presence of flow voids in one patient’s repeat MRI nine months post‐presentation raised the question of an alternate etiology. A spinal angiogram was ordered for the patient, revealing SDAVF. Subsequently, the patient underwent complete Onyx embolization of the right L2 feeder and surgical clipping of the right L1 feeder. This resulted in stabilization and improvement of symptoms. Although the second patient did not display flow voids in their MRI, they were ordered a spinal angiogram due to their similar clinical course, indeed confirming SDAVF. The patient underwent successful complete embolization of the L3 segmental artery on the right resulting in improvement of symptoms. Conclusions : Clinicians should have a high index of suspicion for SDAVF when a patient presents with a longitudinally extensive transverse myelitis negative for inflammatory markers and is unresponsive to treatment. While the appearance of flow voids on imaging is a helpful diagnostic feature, these may not be present in patients.

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.

Intracranial dural arteriovenous fistula mistaken as cervical transverse myelitis

2018 ◽  
Vol 19 (3) ◽  
pp. 264-267
Author(s):  
Gowri A Peethambar ◽  
Daniel H Whittam ◽  
Saif Huda ◽  
Sundus Alusi ◽  
Mani Puthuran ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transverse Myelitis ◽  
Corticosteroid Treatment ◽  
Older Men ◽  
Longitudinally Extensive Transverse Myelitis ◽  
High Index Of Suspicion ◽  
Extensive Transverse Myelitis ◽  
Uncommon Location

We describe a man with an intracranial dural arteriovenous fistula that presented as a subacute longitudinally extensive cervical myelopathy. The uncommon location of the fistula and the absence of specific radiological signs resulted in initial misdiagnosis as longitudinally extensive transverse myelitis. Neurologists should have a high index of suspicion for dural arteriovenous fistula in older men, especially those with subacute or chronic symptoms, acellular cerebrospinal fluid and, particularly, if there is neurological deterioration soon after corticosteroid treatment. Patients need early angiography to identify this treatable cause of myelopathy.

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 Meningitis as a recurrent manifestation of anti-AQP4/anti-MOG negative neuromyelitis optica spectrum disorder: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chenyang Zhang ◽  
Kang Zhang ◽  
Bing Chen ◽  
Jiao Yin ◽  
Miaomiao Dong ◽  
...  
Keyword(s):  
Neuromyelitis Optica ◽  
Area Postrema ◽  
Neurological Diseases ◽  
Brain Magnetic Resonance Imaging ◽  
Transverse Myelitis ◽  
Corticosteroid Treatment ◽  
Neck Stiffness ◽  
Mixed Cell ◽  
Glucose Levels ◽  
The Right

Abstract Background Neuromyelitis optica spectrum disorders (NMOSD), a group of autoimmune neurological diseases, involve the optic nerve, spinal cord, and brain. Meningitis is rarely reported as the primary clinical manifestation of both anti-aquaporin-4 (AQP4)/ anti-myelin oligodendrocyte glycoprotein (MOG) antibody-negative NMOSD (NMOSDneg). Case presentation A 30-year-old man initially presented with fever, headache, and neck stiffness. Lumbar puncture revealed mixed cell reaction and decreased glucose levels. As a result, tuberculous meningitis was suspected. After 1 month, the patient developed longitudinally extensive transverse myelitis and area postrema syndrome. This was followed by the presentation of meningitis-like symptoms once again in the third attack, but his condition eventually improved after corticosteroid treatment without relapse for 2 years. However, he was readmitted to our hospital owing to symptoms of diplopia, hiccup, and numbness in the right hand. Brain magnetic resonance imaging (MRI) revealed that the area postrema still contained lesions. Spinal MRI revealed several segmental enhancements at the C4–C5, T1, and T5 levels. Anti-AQP4 and anti-MOG antibodies were persistently absent in the serum and cerebrospinal fluid (CSF). The patient was finally diagnosed with NMOSDneg. Conclusions Meningitis could be a recurrent manifestation of NMOSDneg and requires more careful evaluation.

The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

2021 ◽  
pp. 112972982199853
Author(s):  
Jens M Poth ◽  
Stefan F Ehrentraut ◽  
Se-Chan Kim
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Needle Insertion ◽  
Major Surgery ◽  
Axillary Vein ◽  
Central Venous ◽  
Supraclavicular Fossa ◽  
The Right ◽  
High Index Of Suspicion ◽  
Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

scholarly journals A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child

2021 ◽  
Vol 9 (5) ◽  
pp. 950
Author(s):  
Chiara Sodini ◽  
Elena Mariotti Zani ◽  
Francesco Pecora ◽  
Cristiano Conte ◽  
Viviana Dora Patianna ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Bartonella Henselae ◽  
Delayed Diagnosis ◽  
Mitral Valve Regurgitation ◽  
Low Grade ◽  
Systemic Involvement ◽  
Mild Disease ◽  
Precise Diagnosis ◽  
Major Illness ◽  
The Right

In most cases, infection due to Bartonella henselae causes a mild disease presenting with a regional lymphadenopathy frequently associated with a low-grade fever, headache, poor appetite and exhaustion that spontaneously resolves itself in a few weeks. As the infection is generally transmitted by cats through scratching or biting, the disease is named cat scratch disease (CSD). However, in 5–20% of cases, mainly in immunocompromised patients, systemic involvement can occur and CSD may result in major illness. This report describes a case of systemic CSD diagnosed in an immunocompetent 4-year-old child that can be used as an example of the problems that pediatricians must solve to reach a diagnosis of atypical CSD. Despite the child’s lack of history suggesting any contact with cats and the absence of regional lymphadenopathy, the presence of a high fever, deterioration of their general condition, increased inflammatory biomarkers, hepatosplenic lesions (i.e., multiple abscesses), pericardial effusion with mild mitral valve regurgitation and a mild dilatation of the proximal and medial portion of the right coronary artery, seroconversion for B. henselae (IgG 1:256) supported the diagnosis of atypical CSD. Administration of oral azithromycin was initiated (10 mg/kg/die for 3 days) with a progressive normalization of clinical, laboratory and US hepatosplenic and cardiac findings. This case shows that the diagnosis of atypical CSD is challenging. The nonspecific, composite and variable clinical features of this disease require a careful evaluation in order to achieve a precise diagnosis and to avoid both a delayed diagnosis and therapy with a risk of negative evolution.

scholarly journals AB0283 CHOREOATHETHOSIS AND LONGITUDINALLY EXTENSIVE TRANSVERSE MYELITIS AS RARE AND SEVERE MANIFESTATIONS OF NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS AND PRIMARY SJÖGREN’S SYNDROME – A TWO-CENTER EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1167.2-1168
Author(s):  
P. Korsten ◽  
M. Plüß ◽  
S. Glaubitz ◽  
A. Jambus ◽  
R. Vasko ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Complete Remission ◽  
Lupus Erythematosus ◽  
Transverse Myelitis ◽  
Primary Sjögren’S Syndrome ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Systemic Lupus ◽  
Primary Sjogren’S Syndrome ◽  
Life Threatening ◽  
Extensive Transverse Myelitis

Background:Systemic lupus erythematosus (SLE) can affect almost any organ system. Nevertheless, Lupus nephritis and neuropsychiatric manifestations (NPSLE) are associated with increased mortality (1). Therapeutic options include glucocorticoids, often pulse methylprednisolone (MP), and other immunosuppressive therapies. In refractory cases, therapeutic plasma exchange, rituximab, or intravenous immunoglobulins are often used (2). However, an optimal therapeutic strategy has not been established because NPSLE is an exclusion criterion in most clinical trials. In addition, NPSLE can present with a broad spectrum of manifestations ranging from cognitive dysfunction to severe and life-threatening disease with choreoathetosis or transverse myelitis (TM). In primary Sjögren’s syndrome (pSS), neurological manifestations most often include peripheral neuropathies, but TM has also been reported.Objectives:To analyze the clinical presentation and outcomes after treatment in severe, life-threatening NPSLE.Methods:We retrospectively analyzed clinical, laboratory, and imaging features in severe NPSLE manifestations in SLE and pSS patients at two tertiary academic centers (University Medical Center Göttingen, Germany, and ASST Spedali Civili Brescia, Italy) with a high volume of SLE patients. Severe NPSLE was defined as either severe movement disorder or extensive tetra- or paraplegia secondary to (longitudinally extensive) transverse myelitis.Results:Our retrospective chart review resulted in seven patients fulfilling the inclusion criteria (six with SLE and 1 with pSS). Of these, five were females (71.4%). Median age was 26 (16-55) years. Three were of Asian origin, four were of European descent. Median disease duration was 15 (2-228) months. Three patients presented with severe choreoathetosis, all had positive ANA, anti-dsDNA antibodies (abs), and complement consumption. Of note, all three had at least one positive antiphospholipid antibody (APLA). All patients received IV MP 1g x 3 and mycophenolate mofetil and achieved complete remission. Of the four patients with longitudinally extensive TM, all were ANA positive, only two had anti-dsDNA abs. None of them had APLA, and only one tested positive for anti-aquaporine-4 abs. Of all patients, only one had positive ribosomal P-abs. Patients with TM received IV MP 1g x 5 and either RTX (4 cycles with 375 mg/m2 or IVIg 0.4 g/kg/d x 5). All four TM patients improved; two improved markedly, two only moderately with residual deficits as assessed by EDMUS-grading scale and functional independence measure.Conclusion:Severe NPSLE, defined as choreoathetosis or TM require intensive treatment. While the former patients achieved complete remission, two of four patients with TM only achieved partial remission. Our data support the use of early and aggressive immunosuppressive therapy. Nevertheless, therapy for TM in the context remains insufficient and should be assessed in a controlled clinical trial setting.References:[1]Monahan RC, et al. Mortality in patients with systemic lupus erythematosus and neuropsychiatric involvement: A retrospective analysis from a tertiary referral center in the Netherlands. Lupus. 2020 Dec;29(14):1892–901.[2]Papachristos DA, et al. Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review. Semin Arthritis Rheum. 2020 Dec 17;51(1):49–71.Disclosure of Interests:PETER KORSTEN Consultant of: PK has received honoraria by Abbvie, Bristol-Myers-Squibb, Chugai, Gilead, Glaxo Smith Kline, Janssen-Cilag, Pfizer, and Sanofi-Aventis, all unrelated to this study., Grant/research support from: PK has received research grants from GSK, unrelated to this study., Marlene Plüß: None declared, Stefanie Glaubitz: None declared, Ala Jambus: None declared, Radovan Vasko: None declared, Bettina Meike Göricke: None declared, Silvia Piantoni: None declared

scholarly journals Intraorbital wooden foreign body detected by computed tomography and magnetic resonance imaging

2016 ◽  
Vol 30 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Alfredo Di Gaeta ◽  
Francesco Giurazza ◽  
Eugenio Capobianco ◽  
Alvaro Diano ◽  
Mario Muto
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Magnetic Resonance ◽  
Delayed Diagnosis ◽  
Clinical History ◽  
Definitive Diagnosis ◽  
Double Vision ◽  
Resonance Imaging ◽  
Wooden Foreign Body ◽  
The Right

To identify and localize an intraorbital wooden foreign body is often a challenging radiological issue; delayed diagnosis can lead to serious adverse complications. Preliminary radiographic interpretations are often integrated with computed tomography and magnetic resonance, which play a crucial role in reaching the correct definitive diagnosis. We report on a 40 years old male complaining of pain in the right orbit referred to our hospital for evaluation of eyeball pain and double vision with an unclear clinical history. Computed tomography and magnetic resonance scans supposed the presence of an abscess caused by a foreign intraorbital body, confirmed by surgical findings.

Granulomatosis with polyangiitis presenting as pancreatic disease

2021 ◽  
Vol 14 (3) ◽  
pp. e241033
Author(s):  
Jessie Jia Tao ◽  
Arnav Agarwal ◽  
Ari Benjamin Cuperfain ◽  
Christian Pagnoux
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Epigastric Pain ◽  
Delayed Diagnosis ◽  
Pancreatic Disease ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Rapid Progression ◽  
Radiographic Evidence ◽  
High Index Of Suspicion ◽  
Parenchymal Lung

Granulomatosis with polyangiitis (GPA) is a rare necrotising small vessel vasculitis typically associated with oronasal, pulmonary and renal manifestations. Pancreatic disease is an exceedingly rare initial presentation and is associated with delayed diagnosis and rapid progression. We discuss a 66-year-old woman presenting with epigastric pain, elevated lipase and radiographic evidence of focal pancreatitis. She had no relevant medical history and no lithiasis seen on imaging. Pertinent findings include strawberry gingivitis, positive proteinase-antineutrophil cytoplasm antibody (98% specificity) and focal nodular parenchymal lung lesions on CT chest—all of which are consistent with a diagnosis of GPA. She was promptly started on high-dose steroids which resulted in significant clinical and biochemical improvement. Cyclophosphamide was added once biopsy confirmed the absence of malignancy. In order to optimise the clinical outcomes of GPA, physicians must keep a wide differential and high index of suspicion in the setting of unexplained pancreatitis with systemic features.

Acute transverse myelitis after inactivated COVID-19 vaccine

2021 ◽  
Vol 74 (7-8) ◽  
pp. 273-276
Author(s):  
Nazan Şimşek Erdem ◽  
Seden Demirci ◽  
Tuğba Özel ◽  
Khalida Mamadova ◽  
Kamil Karaali ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Life Sciences ◽  
Transverse Myelitis ◽  
Upper Extremities ◽  
Resonance Imaging ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Acute Transverse Myelitis ◽  
Spinal Cord Segment ◽  
Extensive Transverse Myelitis ◽  
Spine Magnetic Resonance Imaging

Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been rapidly developed to prevent coronavirus disease 2019 (COVID-19) pandemic. There is increasing safety concerns regarding COVID-19 vaccines. We report a 78-year old woman who was presented with tetraparesis, paresthesias of bilateral upper extremities, and urinary retention of one-day duration. Three weeks before these symptoms, she was vaccinated with CoronaVAC vaccine (Sinovac Life Sciences, China). Spine magnetic resonance imaging showed longitudinally extensive transverse myelitis (TM) from the C1 to the T3 spinal cord segment. An extensive diagnostic workup was performed to exclude other possible causes of TM. We suggest that longitudinally extensive TM may be associated with COVID-19 vaccination in this case. To the best of our knowledge, this is the first report of longitudinally extensive TM developing after CoronaVac vaccination. Clinicians should be aware of neurological symptoms after vaccination of COVID-19.

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