scholarly journals Neurorehatilitation and complex therapeutical approaches in a patient with spinal multiple sclerosis

2020 ◽  
pp. 60-63
Author(s):  
Roman Corina FILIP ◽  
Maria-Gabriela CATANĂ
Keyword(s):  
Multiple Sclerosis ◽  
Medical Research Council ◽  
Spastic Paraparesis ◽  
Acute Onset ◽  
Lower Limbs ◽  
Oligoclonal Bands ◽  
Motor Deficit ◽  
Cerebral Mri ◽  
Spinal Form ◽  
Spine Mri

The purely spinal form of multiple sclerosis, presenting as a progressive spastic paraparesis, hemiparesis, or, spastic monoparesis of a leg with varying degrees of posterior column involvement, is a special source of diagnostic difficulty. We present the case of a 47 years old patient, with no personal pathological antecedents, admitted in our department through the emergency ward for motor deficit of the lower limbs, sympthomatology that had an acute onset the day before admittance. The neurologic examination revealed: orthostatism and gait not possible, spastic paraparesis – 3/5 MRC (medical research council), deep tendon reflexes were found to be hyperactive on both lower extremities, bilateral plantar extension, a dermatomic level of sensory disturbance at T10 – T11 vertebral segment and urinary retention. The cerebral MRI revealed no pathological findings. The lumbar punction revealed oligoclonal bands and the spine MRI outlined multiple focal images with demyelination aspect reaching the cervical and dorsal level of the medullary cord. The patient had two more relapses each at approximately 6 months, and this allowed us to establish the final diagnostic: Pure spinal multiple sclerosis. Key words: spinal multiple sclerosis, paraparesis, neurorehabilitation,

Acute Unilateral Papillitis versus Retrobulbar Neuritis: Relation to Multiple Sclerosis

1996 ◽  
Vol 1 (4) ◽  
pp. 223-227 ◽  
Author(s):  
JL Frederiksen ◽  
J Olesen ◽  
HBW Larsson ◽  
J Petrera ◽  
FT Sellebjerg
Keyword(s):  
Multiple Sclerosis ◽  
Tissue Type ◽  
Oligoclonal Bands ◽  
Retrobulbar Neuritis ◽  
Acute Optic Neuritis ◽  
Cerebral Mri ◽  
Definite Multiple Sclerosis ◽  
Igg Index ◽  
Clinically Definite Multiple Sclerosis ◽  
Csf Oligoclonal Bands

Prospectively referred patients with unilateral acute optic neuritis (ON) (n=223; aged 12–57; 158 women), either idiopathic or part of clinically definite multiple sclerosis (CDMS), were systematically examined by the same physician. We analysed whether the 161 patients with retrobulbar neuritis and the 62 patients with papillitis differed from each other clinically or according to paraclinical tests. The following characteristics were observed in retrobulbar ON respectively papillitis: median age 33 and 33 years, women 70% and 73%, clinically definite MS 30% and 27%. Abnormal results in retrobulbar ON and in papillitis (indicated in brackets) did not differ significantly and were found as follows: cerebral MRI in 56% (63%), VEP from the eye with acute ON in 82% (88%), VEP from the eye without acute ON in 38% (33%), SEP from median nerves in 9% (10%), SEP from tibial nerves in 22% (22%) and biotesiometry in 32% (27%). In the CSF, oligoclonal bands were present in 42% (53%), increased IgG-index in 40% (44%) and increased leucocyte count in 39% (29%). The HLA-DR15 tissue type was present in 47% (43%). There were no significant differences between retrobulbar ON and papillitis when the idiopathic cases and cases with clinically definite MS were analysed separately. Our data document that unilateral retrobulbar ON and papillitis are both part of the MS spectrum and not different from each other with regard to clinical and paraclinical parameters, indicating that the two groups can be pooled in future treatment trials.

scholarly journals Oral Cladribine is Effective in the Treatment of Tumefactive Demyelination in Relapsing Remitting Multiple Sclerosis – A Case Report

2020 ◽  
Vol 14 (1) ◽  
pp. 109-114
Author(s):  
Jihad Said Inshasi ◽  
Pournamy Sarathchandran ◽  
Mona Chetan Thakre ◽  
Nouf Saeed Al Talai ◽  
Reem Al Suwaidi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Magnetic Resonance ◽  
Immune Reconstitution ◽  
Acute Onset ◽  
Oligoclonal Bands ◽  
Resonance Spectroscopy ◽  
Sensory Level ◽  
Limb Weakness ◽  
The Brain

This case report describes a 32-year old Emirati patient with tumefactive multiple sclerosis (TMS) treated with a short course of cladribine tablets. The patient presented initially with acute onset of progressive gait unsteadiness, lower limb weakness, associated with numbness of four days duration. Neurological examination of right arms and both legs weakness with sensory level at T10. Contrast-enhanced magnetic resonance imaging (MRI) of the brain showed a large tumefactive demyelination with multiple demyelinating lesions in the brain, consistent with a diagnosis of multiple sclerosis. MRI of the spine cervical and dorsal revealed multiple enhancing lesions as well. Cerebrospinal fluid oligoclonal bands were positive, and IgG index was high. Magnetic resonance spectroscopy showed elevation of lactate on short echo time (TE) and elevation of choline on long TE. The patient was treated with pulse steroid followed by oral cladribine as immune reconstitution therapy in the acute phase. The patient showed significant improvement clinically and radiologically to the treatment. The patient was followed up for 2 years and showed excellent resolution of the tumefactive lesion with no new lesions. Immune reconstitution therapy can be an option for treatment of tumefactive demyelination in multiple sclerosis in the acute setting. To our knowledge, there are no reports of the use of immune reconstitution therapies for the treatment of tumefactive lesions in multiple sclerosis.

scholarly journals Acute Aortic Occlusion with Acute Onset of Paraplegia and Severe Hyposthenia

2020 ◽  
pp. 1-3
Author(s):  
Stefania Tamburrini ◽  
Daniela Viola ◽  
Fabio Spinetti ◽  
Giuseppe Mercogliano ◽  
Giuseppe Sarti ◽  
...  
Keyword(s):  
Lower Limb ◽  
Mesenteric Artery ◽  
Limb Ischemia ◽  
Acute Onset ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Acute Limb Ischemia ◽  
Neurological Assessment ◽  
Bilateral Lower Limb ◽  
Acute Aortic Occlusion

A 75-years-old man presented at our ED with acute onset of paraplegia and severe bilateral lower limb hyposthenia. The patient ‘s neurological assessment was negative except for lower limbs positive Mingazzini test. CT angiography detected a complete lack of opacification of the abdominal aorta immediately below the emergency of the inferior mesenteric artery, caused by a coarse thrombus in the left ventricle. We present a case of acute aortic and lumbar arteries thrombosis with paraplegia and no clear symptoms of acute limb ischemia, in which the motor deficit in the lower extremities was explained by anterior spinal cord syndrome secondary to acute occlusion of lumbar arteries.

Cortical relapses in multiple sclerosis

2016 ◽  
Vol 22 (9) ◽  
pp. 1184-1191 ◽  
Author(s):  
Marco Puthenparampil ◽  
Davide Poggiali ◽  
Francesco Causin ◽  
Giuseppe Rolma ◽  
Francesca Rinaldi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Acute Onset ◽  
Inversion Recovery ◽  
Motor Deficit ◽  
Psychotic Symptoms ◽  
Cognitive Disability ◽  
Cortical Lesions ◽  
Focal Lesions ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri

Background: Multiple sclerosis (MS) is a white and grey matter disease of the central nervous system (CNS). It is recognized that cortical damage (i.e. focal lesions and atrophy) plays a role in determining the accumulation of physical and cognitive disability that is observed in patients with progressive MS. To date, an association of cortical lesions with clinical relapses has not been described. Results: We report clinical and magnetic resonance imaging (MRI) findings of five relapsing–remitting MS (RRMS) patients who had clinical relapses characterized by the acute appearance of cortical symptoms, due to the development of large, snake-like, cortical inflammatory lesions. Symptoms were: acute Wernicke’s aphasia mimicking stroke; agraphia with acalculia, not associated to a motor deficit nor linguistic disturbance; hyposthenia of the left arm, followed by muscle twitching of the hand, spreading to arm and face; acute onset of left lower limb paroxysmal hypertonia; and temporal lobe status epilepticus, with psychotic symptoms. Conclusions: Cortical relapses may occur in MS. MRI examination in MS should include sequences, such as double inversion recovery (DIR) or phase sensitive inversion recovery (PSIR), that are aimed at visualizing cortical lesions, especially in the presence of symptoms of cortical dysfunction. Our observation further stresses and extends the clinical relevance of cortical pathology in MS.

scholarly journals Characteristics of pediatric multiple sclerosis: A tertiary referral center study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243031
Author(s):  
Blažo Nikolić ◽  
Nikola Ivančević ◽  
Ivan Zaletel ◽  
Branislav Rovčanin ◽  
Janko Samardžić ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Hearing Loss ◽  
Autoimmune Diseases ◽  
Optic Neuritis ◽  
Frequent Occurrence ◽  
Oligoclonal Bands ◽  
Motor Deficit ◽  
Pediatric Multiple Sclerosis ◽  
Initial Symptoms ◽  
Tertiary Center

Objective The present study represents one of the largest series of pediatric multiple sclerosis (PedMS) in Western Balkan region. This is the first study aimed to evaluate the characteristics of PedMS in the Serbian population. Methods This retrospective study on 54 PedMS, aged 7–17 years, was performed at the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade, Serbia, a tertiary center for the diagnosis and treatment of children with neurological and psychiatric diseases. Results Female to male ratio was 37 (68.5%): 17 (31.5%). Family history of MS was noted in 9.3% and autoimmune diseases in 24.1% patients. Co-occurring migraine was in 7,4%. Monofocal onset of disease was present in 77.8% patients. The most common initial symptoms were optic neuritis (37%), sensory disturbances (31.5%), motor deficit (24.1%), cerebellar (18.5%) and brainstem lesions (16.7%), pain (9.3%), acute disseminated encephalomyelitis like symptoms (1.9%), and hearing loss (3.7%). Visual evoked potentials were pathological in 75.9% of patients. Oligoclonal bands were positive in 68.5% of patients. Magnetic resonance imaging showed periventricular (94.4%), infratentorial (77.8%), juxtacortical and cortical changes (55.6%) and changes in the cervical spinal cord (33.3%). The median EDSS score was 2.0. Conclusion Our cohort significantly differs from the literature data regarding more frequent occurrence of optic neuritis, hearing loss as a first symptom, the relapsing-remitting course of the disease, higher proportion of early onset of disease, presence of co-occurring migraine and the frequent occurrence of epilepsy and other autoimmune diseases in the family.

scholarly journals The coexistence of multiple sclerosis and hereditary spastic paraparesis in a patient

2013 ◽  
Vol 5 (2) ◽  
pp. 6 ◽  
Author(s):  
Işıl Yazıcı ◽  
Nılufer Yıldırım ◽  
Yaşar Zorlu
Keyword(s):  
Multiple Sclerosis ◽  
Axonal Degeneration ◽  
Spastic Paraparesis ◽  
Clinical History ◽  
Lower Limbs ◽  
Axonal Loss ◽  
Cognitive Tests ◽  
Central Nervous System Inflammation ◽  
Hereditary Spastic Paraparesis ◽  
Corticospinal Tracts

Multiple sclerosis (MS) is a chronic disease characterized by multiple areas of central nervous system inflammation, demyelination and axonal loss. Hereditary spastic paraparesis (HSP) is characterized clinically by progressive spasticity and weakness of the lower limbs and pathologically by retrograd axonal degeneration of the corticospinal tracts and posterior columns. We identified a patient with clinical history and investigation findings consistent with the concurrence of both MS and HSP. Laboratory and radiological investigations, cognitive tests were performed. Genetic confirmation for spastin gene mutation has been completed. If this coexistence is not coincidence the mutation in the spastin gene may be a strong susceptibility <em>locus</em> for MS.

scholarly journals Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

2012 ◽  
Vol 10 (4) ◽  
pp. 508-511 ◽  
Author(s):  
Leonardo Giacomini ◽  
Roger Neves Mathias ◽  
Andrei Fernandes Joaquim ◽  
Mateus Dal Fabbro ◽  
Enrico Ghizoni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factor ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Indication For Surgery ◽  
Sensory Deficits ◽  
Sensory Involvement ◽  
Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

scholarly journals A case of Gayet-Wernicke encephalopathy with misleading symptoms

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Hadbi ◽  
Dalila Benalakma ◽  
Nadia Fellah
Keyword(s):  
Visual Acuity ◽  
Hyperemesis Gravidarum ◽  
Neurological Complication ◽  
Vitamin Supplementation ◽  
Motor Deficit ◽  
Ophthalmological Examination ◽  
Cerebral Mri ◽  
Sensory Motor ◽  
Brain Stroke ◽  
Decrease In Visual Acuity

Abstract Background The dramatic evolution of incoercible vomiting in pregnancy is at the origin of a rare and serious neurological complication known as EGW; its symptomatology is polymorphic posing a diagnostic problem. MRI is the test of choice for screening. Early vitamin supplementation is essential to improve the maternal-fetal prognosis. Case presentation A 35-year-old parturient, G5P1, without particular pathological history presented incoercible vomiting at 8 weeks, which led to dehydration, undernutrition, and impairment of general condition. Neurological signs: headaches, confused scored at 14 on the Glasgow scale, amnesia, a cerebellar syndrome, sensory-motor deficit. Ophthalmological examination revealed: edema in the eye fundus, a decrease in visual acuity, nystagmus, and ophthalmoplegia. The biological analysis showed moderate hepatic cytolysis. Given the polymorphic neurological symptomatology presented by our parturient, several differential diagnoses were evoked: intracranial hypertension (headache - vomiting - decrease in visual acuity - papillary edema), brain stroke (sensory-motor deficit, ground “pregnancy”), deficit in vitamin B12 (sensory-motor deficit, confusion, memory impairment), and GWE (nystagmus-confusion-ataxia). Cerebral MRI has allowed us to establish the diagnosis of GWE. Conclusion All pregnant with severe hyperemesis gravidarum should be supplemented with thiamine prior to glucose administration to prevent and improve the prognosis of GWE.

scholarly journals Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Morio ◽  
Hirotsugu Miyoshi ◽  
Noboru Saeki ◽  
Yukari Toyota ◽  
Yasuo M. Tsutsumi
Keyword(s):  
Spinal Cord ◽  
General Anesthesia ◽  
Supine Position ◽  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Acute Onset ◽  
Lower Limbs ◽  
Canal Stenosis ◽  
Cord Injury ◽  
Aneurysm Repair

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

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