Evaluation of idiopathic transverse myelitis revealing specific myelopathy diagnoses

Neurology ◽  
2017 ◽  
Vol 90 (2) ◽  
pp. e96-e102 ◽  
Author(s):  
Nicholas L. Zalewski ◽  
Eoin P. Flanagan ◽  
B. Mark Keegan
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Diagnosis ◽  
Medical Records ◽  
Transverse Myelitis ◽  
Final Diagnosis ◽  
Patient Treatment ◽  
Presumptive Diagnosis ◽  
Treatment Changes ◽  
Vascular Myelopathy ◽  
Made In

ObjectiveTo evaluate specific myelopathy diagnoses made in patients with suspected idiopathic transverse myelitis (ITM).MethodsA total of 226 patients 18 years and older were referred to Mayo Clinic Neurology for suspected ITM from December 1, 2010, to December 31, 2015. Electronic medical records were reviewed for detailed clinical presentation and course, laboratory and electrophysiologic investigations, and neuroimaging to determine the etiology. Current diagnostic criteria for ITM and alternative myelopathy diagnoses were applied. All cases where any discrepancy was suspected from the final reported clinical diagnosis were reviewed by each author and a consensus final diagnosis was made.ResultsThe diagnostic criteria for ITM were met in 41 of 226 patients (18.1%). In 158 patients (69.9%), an alternative specific myelopathy diagnosis was made: multiple sclerosis or clinically isolated syndrome, 75; vascular myelopathy, 41; neurosarcoidosis, 12; neuromyelitis optica spectrum disorder, 12; myelin oligodendrocyte glycoprotein myelopathy, 5; neoplastic, 4; compressive, 3; nutritional, 3; infectious, 2; and other, 2. A myelopathy was not confirmed in 27 patients. Time from symptom onset to final clinical diagnosis in patients without ITM was a median of 9 months (range 0–288). Fifty-five patients (24%) required treatment changes according to their final clinical diagnosis.ConclusionsThe majority of patients with suspected ITM have an alternative specific myelopathy diagnosis. A presumptive diagnosis of ITM can lead to premature diagnostic conclusions affecting patient treatment.

scholarly journals Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy

Neurology ◽  
2017 ◽  
Vol 90 (1) ◽  
pp. e12-e21 ◽  
Author(s):  
Paula Barreras ◽  
Kathryn C. Fitzgerald ◽  
Maureen A. Mealy ◽  
Jorge A. Jimenez ◽  
Daniel Becker ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Transverse Myelitis ◽  
Final Diagnosis ◽  
Symptom Presentation ◽  
Multivariable Logistic Regression Model ◽  
Classification Rate ◽  
Presumptive Diagnosis ◽  
Temporal Profile ◽  
Clinical Biomarkers ◽  
Clinical Biomarker

ObjectiveTo assess the predictive value of the initial clinical and paraclinical features in the differentiation of inflammatory myelopathies from other causes of myelopathy in patients with initial diagnosis of transverse myelitis (TM).MethodsWe analyzed the clinical presentation, spinal cord MRI, and CSF features in a cohort of 457 patients referred to a specialized myelopathy center with the presumptive diagnosis of TM. After evaluation, the myelopathies were classified as inflammatory, ischemic/stroke, arteriovenous malformations/fistulas, spondylotic, or other. A multivariable logistic regression model was used to determine characteristics associated with the final diagnosis and predictors that would improve classification accuracy.ResultsOut of 457 patients referred as TM, only 247 (54%) were confirmed as inflammatory; the remaining 46% were diagnosed as vascular (20%), spondylotic (8%), or other myelopathy (18%). Our predictive model identified the temporal profile of symptom presentation (hyperacute <6 hours, acute 6–48 hours, subacute 48 hours–21 days, chronic >21 days), initial motor examination, and MRI lesion distribution as characteristics that improve the correct classification rate of myelopathies from 67% to 87% (multinomial area under the curve increased from 0.32 to 0.67), compared to only considering CSF pleocytosis and MRI gadolinium enhancement. Of all predictors, the temporal profile of symptoms contributed the most to the increased discriminatory power.ConclusionsThe temporal profile of symptoms serves as a clinical biomarker in the differential diagnosis of TM. The establishment of a definite diagnosis in TM requires a critical analysis of the MRI and CSF characteristics to rule out non-inflammatory causes of myelopathy.Classification of evidenceThis study provides Class IV evidence that for patients presenting with myelopathy, temporal profile of symptoms, initial motor examination, and MRI lesion distribution distinguish those with inflammatory myelopathies from those with other causes of myelopathy.

scholarly journals P.028 Each revision of the McDonald diagnostic criteria for multiple sclerosis allow earlier diagnosis in more patients

2018 ◽  
Vol 45 (s2) ◽  
pp. S23-S23
Author(s):  
Y Mahjoub ◽  
LM Metz ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trial ◽  
Diagnostic Criteria ◽  
Clinical Diagnosis ◽  
Transverse Myelitis ◽  
Imaging Data ◽  
Mcdonald Criteria ◽  
Clinical Onset ◽  
Spinal Lesion ◽  
The Impact

Background: The 2005, 2010, and 2017 McDonald diagnostic criteria for multiple sclerosis (MS) were compared at baseline in participants of a Canadian multicentre clinical trial of minocycline in clinically isolated syndrome (CIS). Methods: The cohort included 142 participants. Baseline clinical and imaging data were used to determine if participants met criteria for dissemination in space (DIS) and time (DIT) as required for each version of the criteria. We also explored the impact of permitting a clinical diagnosis of transverse myelitis to represent a spinal cord lesion, and for multifocal clinical onset to represent DIS. Results: The clinical trial excluded patients meeting the 2005 McDonald criteria at baseline. The 2010 criteria were met by 28.9% (41/142) of participants. If a multifocal clinical presentation was considered evidence of DIS 29.6% (42/142) met the 2010 criteria. The 2017 criteria were met by 36.7% (52/142). Allowing a clinical diagnosis of transverse myelitis to confirm a spinal lesion, or multifocal onset to confirm evidence of DIS, led to a diagnosis in 38% (54/142) and 38.7% (55/142), respectively. Conclusions: This study confirms that each revision of the McDonald diagnostic criteria allowed an MS diagnosis in more CIS patients at onset. Exploration of other modifications suggests further improvement may be possible.

scholarly journals Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. e414-e420 ◽  
Author(s):  
Elia Sechi ◽  
Eslam Shosha ◽  
Jonathan P. Williams ◽  
Sean J. Pittock ◽  
Brian G. Weinshenker ◽  
...  
Keyword(s):  
Predominantly White ◽  
Diagnostic Criteria ◽  
Medical Records ◽  
Transverse Myelitis ◽  
Population Based ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Olmsted County ◽  
White Population ◽  
Rochester Epidemiology Project

ObjectiveDiagnostic criteria from 2002 classify transverse myelitis (TM) as idiopathic or disease associated but predate the discovery of aquaporin-4 (AQP4)–immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which associate with TM. Prior incidence estimates of idiopathic TM (ITM) range from 1 to 6.2 per 1 million. We sought to determine whether the population-based incidence and prevalence of ITM were reduced by testing patients with ITM for AQP4/MOG-IgG and reclassifying seropositive cases as having disease-associated TM.MethodsFor this observational study, we retrospectively identified all cases of incident (January 1, 2003–December 31, 2016) and prevalent (December 31, 2016) ITM in Olmsted County (85% white) by using the Rochester Epidemiology Project medical records linkage system. ITM was defined by the 2002 Transverse MyelitisConsortium Working Group diagnostic criteria. Available sera were tested for AQP4-IgG and MOG-IgG.ResultsTwenty-four patients (incident 22, prevalent 17) initially met 2002 ITM criteria (longitudinally extensive TM [LETM] 6). Sera were tested for AQP4-IgG in 22 of 24 (92%) and MOG-IgG in 21 of 24 (88%). Three seropositive cases (AQP4-IgG 2, MOG-IgG 1) were identified and reclassified as having disease-associated TM, accounting for 14% of total incident and 12% of total prevalent cases. AQP4-IgG and MOG-IgG seropositive cases represented 50% (3 of 6) of idiopathic LETM. After reclassification of seropositive patients, the final ITM incidence was 8.6 per 1,000,000 and prevalence was 7.9 per 100,000. Three cases of ITM (14%) subsequently fulfilled multiple sclerosis criteria within the study period.ConclusionsThe availability of AQP4-IgG and MOG-IgG modestly reduced ITM incidence and prevalence, which remained higher than previously reported in this predominantly white population. Incorporation of these biomarkers into future revisions of TM diagnostic criteria should be considered.

scholarly journals Transmissible spongy encephalopathy (with a case report)

2014 ◽  
Vol 21 (2) ◽  
pp. 40-43
Author(s):  
N. V. Shuleshova ◽  
S. V. Lovitskiy ◽  
I. S. Platonova ◽  
I. V. Dvorakovskaya ◽  
V. V. Baykov
Keyword(s):  
Case Report ◽  
Clinical Diagnosis ◽  
Final Diagnosis ◽  
Patient Treatment

The article presents the description of a case of spongy encephalopathy diagnosed morphologically in a 54 year old female. The disease lasted for 1-2 years, and had a lethal issue. The patient had undergone both out-patient and in-patient treatment in 4 city hospitals. The final diagnosis was maid after autopsy only. Difficulties of clinical diagnosis of Kreitsfeld Jacob disease which is one of the forms of transmissible spongy encephalopathy are discussed.

Cholescintigraphy versus Infusion Cholecystography in Acute Cholecystitis

1990 ◽  
Vol 29 (02) ◽  
pp. 51-53
Author(s):  
G. Edlund ◽  
V. Kempi
Keyword(s):  
Acute Cholecystitis ◽  
Clinical Diagnosis ◽  
Random Order ◽  
Final Diagnosis

Patients with the clinical diagnosis of acute cholecystitis were studied with intravenous cholecystography and cholescintigraphy. The two examinations alternated in a random order. The final diagnosis was ascertained by surgery in most patients. Either cholecystography or cholescintigraphy could be used in the diagnostics of patients with suspected acute cholecystitis. The methods have about the same accuracy. However, cholescintigraphy is performed more easily and more rapidly than intravenous cholecystography.

Concordancia entre el motivo de consulta y el diagnóstico final en pacientes pediátricos

2021 ◽  
Author(s):  
◽  
N. Castañeda-Villa
Keyword(s):  
Medical Records ◽  
Pediatric Patients ◽  
Interdisciplinary Team ◽  
Final Diagnosis ◽  
Definitive Diagnosis ◽  
Clinical Aspect ◽  
Observer Agreement ◽  
Medical Group ◽  
Research Assistant ◽  
Kappa Index

Concordance analysis using Cohen's Kappa index (􏰀􏰀) has been widely used in clinical research to determine the degree of agreement between two measurements made by the same observer (intra-observer agreement) or between the measurements of two observers on the same variable (inter- observer agreement). In this work, we used 􏰀􏰀 to determine the degree of inter-observer agreement between the reason for consultation and the final diagnosis issued by an interdisciplinary team of The Mexican Institute of Hearing and Language (IMAL). The institute receives around ten pediatric patients per month; the reasons for consulting these patients are diverse. In this research, 53 pediatric patients completed their studies in the IMAL and received a final diagnostic. A research assistant manually collected the data from the medical records of the IMAL Medical Direction. For example, 1) reason for consultation, 2) studies carried out, 3) recommendations, and 4) the final diagnosis. The global concordance between consultation and the definitive diagnosis was 􏰀􏰀 = 0.44 (moderate concordance). Although a Health Professional suggested the reason for consultation, it only covers a clinical aspect. Therefore, we think that the moderate concordance obtained is since an interdisciplinary medical group issues the final diagnostic, achieving a complete diagnosis; this allows the adequate medical care and rehabilitation of the pediatric patient.

scholarly journals Causes of diagnostic pitfalls upon analysis results of «physicians’ causes»

2003 ◽  
Vol 2 (2) ◽  
pp. 56-61
Author(s):  
A. I. Osipov ◽  
Yu. N. Bunin ◽  
S. Yu. Kladov ◽  
A. S. Sokolov ◽  
A. D. Shnayder
Keyword(s):  
Medical Errors ◽  
Final Diagnosis ◽  
Perforated Ulcer ◽  
Medical Aid ◽  
Methodological Errors ◽  
Laboratory Results ◽  
Tomsk Region ◽  
Civil Cases ◽  
Diagnostic Pitfalls ◽  
Made In

130 criminal and civil cases had been maintained against physicians in Tomsk region within 1996—2002. There were pitfalls in diagnoses and wrong medical aid in 59 (45,4%) cases. Across diagnostic pitfalls, such as incomplete examination of patients, incomplete registration of laboratory results etc., there were methodological errors. It is known that diagnosis process proceeds in hypothesis form at all stages. While obtaining the history a physician is guided by suppositions arising during inquiring a patient. These suppositions are later verified in the process of an objective examination of the patient. Therefore the most frequent reasons of medical errors are the final diagnosis on the basis of the history and physicians’ inability to use the diagnostic suppositions while diagnosing at all stages. The majority of pitfalls has been made in diagnoses of appendicitis, stomach and duodenum perforated ulcer.

scholarly journals Solitary Schwannoma on the Hypothenar Region of the Hand: A Literature Review

2020 ◽  
Vol 5 (10) ◽  
pp. 449-452
Author(s):  
Kastanis G ◽  
Kapsetakis P ◽  
Magarakis G ◽  
Bachlitzanaki M ◽  
Christoforidis C ◽  
...  
Keyword(s):  
Literature Review ◽  
Clinical Diagnosis ◽  
Peripheral Nerves ◽  
Histopathological Examination ◽  
Final Diagnosis ◽  
Benign Tumors ◽  
Rare Manifestation ◽  
Histopathological Evidence ◽  
Volar Surface

Schwannomas or neurilemmomas are the most common benign tumors of the neural sheaths of the peripheral nerves. Incidence of these tumors in the hand accounts to 0.8-2%. The majority of them appear as an isolated grown mass along the route of the nerves. Peripheral nerves benign tumors present many difficulties concerning the clinical diagnosis and only histopathological evidence provides the final diagnosis. In this case study, we present a 45 year old man with a grown asymptomatic mass on the volar surface of right hand (hypothenar) remained for two years and impinging the skin of the hand only the last months. Initial MRI results diagnosed the mass as gaglion cyst. Histopathological examination revealed a schwannoma. We present this case as a rare manifestation of a schwannoma in hypothenar area of the hand. A literature review of diagnoses and therapeutic management is also presented.

scholarly journals The Frequency and Causes of Subepidermal Gaps or Blisters and the Compliance Rate Between Clinical Diagnosis and Pathology Reports from 2015 to 2019

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Abbas Darjani ◽  
Hojat Eftekhari ◽  
Seyedeh Rojin Amini Rad ◽  
Narges Alizadeh ◽  
Rana Rafiee ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Compliance Rate ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Direct Immunofluorescence ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Pathology Reports

Background: Skin diseases are the fourth most common cause of human illness, and blisters with different clinical manifestations make a diagnostic challenge. Objectives: This study aimed to evaluate the frequency and causes of subepidermal gaps or blisters, as well as the compliance rate between the initial and final clinical diagnoses based on pathology reports. Methods: In this cross-sectional study, pathology reports of subepidermal blisters or gaps were evaluated in the patients referred to the Razi Laboratory of Rasht from 2015 to 2019. The samples were examined by a pathologist after hematoxylin and eosin staining. The reports included demographic information, clinical differential diagnoses, final diagnosis, direct immunofluorescence findings, and salt split results. Finally, the compliance rate of clinical diagnosis with pathology reports was determined. Results: A total of 183 pathology reports were evaluated, 170 of which contained the final diagnosis. Females were more frequently affected by the disease, and pemphigoid bolus and lichen planus were the most prevalent final diagnoses. The compliance rate between the initial and final diagnoses was 94%. About 37.2% of the reports lacked direct immunofluorescence (DIF) and salt split, and only 42.6% of the samples had undergone DIF examination, while 20.2% had both DIF and salt split. There was no significant association between the compliance rate of the final diagnosis with age, sex, and undergoing diagnostic tests. Conclusions: A high incidence of subepidermal gaps or blisters was seen in middle-aged individuals and females. The compliance rate of the initial clinical diagnosis with the final diagnosis based on pathological reports was high. Our findings emphasize the importance of histopathological examination and the complementary role of direct immunofluorescence and salt split in diagnosis.

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