An acute onset of paraparesis in 65 years old Croatian woman – a case report

High Doses

Neuromyelitis optica (NMO, Devic`sdisease) is a rare inflammatory, demyelinating disease of the central nervous system that predominantly affects the spinal cord and optic nerves. Seropositivity for NMO-IgG (aquaporin 4antybodies) and longitudinally extensive spinal cord lesions (3 or more segments) are characteristics of NMO. We described a 65-year old woman with an acute onset of paraparesis that was not recognized as NMO at the beginning. The diagnosis was made three months later when she was readmitted because of the relapse.Despite the treatment with high doses of methylprednisolone, plasmapheresis and immunoglobulins her condition stayed unchanged – she was paraplegic and incontinent.

Neuromyelitis optica with brain stem involvement in a middle-aged Ethiopian woman: a case report and review of literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-03019-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Rodas Asrat Kassu ◽

Hailu Abera Mulatu ◽

Sisay Gizaw ◽

Henok Fisseha ◽

Amir Musema ◽

...

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Case Report ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Optic Nerves ◽

Abstract Introduction Neuromyelitis optica is a demyelinating disease of the central nervous system that predominantly affects the optic nerves and spinal cord. In neuromyelitis optica, white blood cells and antibodies primarily attack the optic nerves and the spinal cord, but may also attack the brain. Brainstem manifestation has been described recently. So far, neuromyelitis optica is very rare in Ethiopia and there were only two case reports, but this is the first case report of neuromyelitis optica with brainstem involvement. Case presentation A 47-year-old Addis Ababa woman presented to Saint Paul’s Hospital Millennium Medical College with a history of visual loss of 7 years and bilateral lower limb weakness of 4 days duration. She had bilateral oculomotor nerve palsy. Her past medical history showed systemic hypertension for 18 years and dyslipidemia for 1 year. The objective evaluation of the patient revealed right optic nerve atrophy suggesting optic neuritis and flaccid paraplegia with sensory level at the fourth thoracic vertebra. Diagnostic work-up using electromyography and spinal magnetic resonance imaging revealed demyelinating anterior visual pathway dysfunction and signs of extensive cervicothoracic transverse myelitis from the third cervical to lower thoracic vertebrae, respectively. Then a diagnosis of neuromyelitis optica was established. After treatment with high-dose systemic steroid followed by azathioprine, the patient was stable for several months with significant improvement of vision and lower-extremity weakness with no relapse of symptoms. Conclusion The case described here is a rare inflammatory demyelinating disorder of the central nervous system occurring in East Africa. It reminds clinicians to suspect neuromyelitis optica in a patient who presented with unexplained recurrent optic neuritis to make a timely diagnosis and prevention of permanent neuronal damage. Neuromyelitis optica can also be associated with oculomotor nerve involvement.

Acute Disseminated Encephalomyelitis Following Typhoid Fever: A Case Report

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v9i4.10237 ◽

2014 ◽

Vol 9 (4) ◽

pp. 55-58

Author(s):

R Adhikari ◽

A Tayal ◽

PK Chhetri ◽

B Pokhrel

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Case Report ◽

Typhoid Fever ◽

Demyelinating Disease ◽

Acute Disseminated Encephalomyelitis ◽

Medical Sciences ◽

Cerebellar Syndrome ◽

Immune Mediated ◽

The involvement of central nervous system in children with typhoid fever is common. Acute disseminated encephalomyelitis is a rare immune mediated and demyelinating disease of the central nervous system that usually affects children. We report a 7-year-old child with typhoid fever who developed acute cerebellar syndrome due to acute disseminated encephalomyelitis.Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 55-58 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10237

Myelography and the 20th Century Localization of Spinal Cord Lesions

European Neurology ◽

10.1159/000509863 ◽

2020 ◽

Vol 83 (4) ◽

pp. 447-452

Author(s):

Bart Lutters ◽

Rob J.M. Groen ◽

Peter J. Koehler

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Foreign Body ◽

20Th Century ◽

Prolonged Exposure ◽

Contrast Material ◽

Spinal Cord Lesions ◽

Technical Performance ◽

In this article, we commemorate the centenary of myelography, a neuroradiological procedure that, despite certain disadvantages, significantly contributed to the diagnosis and localization of spinal cord lesions during the 20th century. From the start, the use of myelography was characterized by different views regarding the potential dangers associated with the prolonged exposure of a “foreign body” to the central nervous system. Such differences in attitude resulted in divergent myelography practices; its precise indications, technical performance, and adopted contrast material remaining subject to variability until the procedure were eventually replaced by MRI at the close of the 20th century.

Neuromyelitis Optica

10.1093/med/9780199937837.003.0088 ◽

2017 ◽

Cited By ~ 1

Author(s):

Teri L. Schreiner ◽

Jeffrey L. Bennett

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Water Channel ◽

Transverse Myelitis ◽

Inflammatory Disorder ◽

Neuromyelitis optica (NMO), or Devic’s disease is an inflammatory disorder of the central nervous system that preferentially affects the optic nerves and spinal cord. Initially considered a variant of multiple sclerosis (MS), NMO is now clearly recognized to have distinct clinical, radiographic, and pathologic characteristics. Historically, the diagnosis of NMO required bilateral optic neuritis and transverse myelitis; however, the identification of a specific biomarker, NMO-IgG, an autoantibody against the aquaporin-4 (AQP4) water channel, has broadened NMO spectrum disease to include patients with diverse clinical and radiographic presentations. This chapter addresses the diagnosis, pathophysiology, and management of the disease.

Neuromyelitis optica: a distinct demyelinating disease of the central nervous system

Acta Neurologica Scandinavica ◽

10.1111/j.1600-0404.2008.01002.x ◽

2008 ◽

Vol 118 (4) ◽

pp. 209-217 ◽

Cited By ~ 49

Author(s):

A. A. Argyriou ◽

N. Makris

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Neuromyelitis Optica ◽

Demyelinating Disease ◽

Cerebral Schistosomiasis

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v22i3.1019 ◽

2018 ◽

Vol 22 (3) ◽

pp. 120-123

Author(s):

Antônio Santos de Araújo Júnior ◽

Pedro Alberto Arlani ◽

Arnaldo Salvestrini Júnior ◽

Mirella Martins Fazzito ◽

Evandro Sobroza De Mello ◽

...

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

High Index ◽

Neurological Deterioration ◽

Spinal Cord Lesions ◽

Brain Infection ◽

Endemic Areas ◽

Contaminated Waters

Schistosomiasis is a cutaneously acquired infection caused by trematodes (fla¬tworms from the phylum Platyhelminthes), due to swimming in contaminated waters. The central nervous system (CNS) schistosomiasis is a rare presen¬tation of the disease. Brain infection due to S. Mansoni has been rarely reported, in anedoctal fashion. It should be early recognized , since an available treatment may prevent neurological deterioration. A high index of sus¬picion is necessary, mainly in patients coming from endemic areas, with brain or spinal cord lesions associated with eosino¬philia and inflammatory CSF. The finding schistosoma eggs in stools or in a CNS biopsy confirms the diagnosis. We re¬port on a 35-year old brazilian man harboring an isolated brain infection due to S. mansoni.

Brainstem manifestations in neuromyelitis optica: a multicenter study of 258 patients

Multiple Sclerosis Journal ◽

10.1177/1352458513507822 ◽

2013 ◽

Vol 20 (7) ◽

pp. 843-847 ◽

Cited By ~ 90

Author(s):

L Kremer ◽

M Mealy ◽

A Jacob ◽

I Nakashima ◽

P Cabre ◽

...

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Hearing Loss ◽

Neuromyelitis Optica ◽

Multicenter Study ◽

High Frequency ◽

Caucasian Population ◽

Optic Nerve Involvement

Background: Neuromyelitis optica (NMO) is a severe autoimmune disease of the central nervous system characterized by spinal cord and optic nerve involvement. Brainstem manifestations have recently been described. Objective: To evaluate the time of occurrence, the frequency and the characteristics of brainstem symptoms in a cohort of patients with NMO according to the ethnic background and the serologic status for anti-aquaporin-4 antibodies (AQP4-abs). Methods: We performed a multicenter study of 258 patients with NMO according to the 2006 Wingerchuk criteria and we evaluated prospectively the frequency, the date of onset and the duration of various brainstem signs in this population. Results: Brainstem signs were observed in 81 patients (31.4%). The most frequently observed signs were vomiting (33.1%), hiccups (22.3%), oculomotor dysfunction (19.8%), pruritus (12.4%), followed by hearing loss (2.5%), facial palsy (2.5%), vertigo or vestibular ataxia (1.7%), trigeminal neuralgia (2.5%) and other cranial nerve signs (3.3%). They were inaugural in 44 patients (54.3%). The prevalence was higher in the non-Caucasian population (36.6%) than in the Caucasian population (26%) ( p<0.05) and was higher in AQP4-ab-seropositive patients (32.7%) than in seronegative patients (26%) (not significant). Conclusions: This study confirms the high frequency of brainstem symptoms in NMO with a majority of vomiting and hiccups. The prevalence of these manifestations was higher in the non Caucasian population.

Intracerebral Hemorrhage in Patients with Neuromyelitis Optica: Case Report with Literature Review for Possible Pathological Association

Case Reports in Neurology ◽

10.1159/000513644 ◽

2021 ◽

pp. 157-165

Author(s):

Hosna Saad Elshony ◽

Abdelrahman Idris ◽

Abdulaziz Al-Ghamdi ◽

Rabia Muddassir

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Case Report ◽

Subarachnoid Hemorrhage ◽

Literature Review ◽

Intracerebral Hemorrhage ◽

Neuromyelitis Optica ◽

Transverse Myelitis ◽

Demyelinating Disorder ◽

Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder of the central nervous system which is characterized by attacks of optic neuritis and transverse myelitis. An association between NMO and intracerebral hemorrhage (ICH) has been rarely recognized, having been reported only 3 times before. Here we report on a patient with NMO who eventually developed subarachnoid hemorrhage, in order to emphasize that the association between NMO and ICH is mostly not incidental and that the pathological basis for this association should be investigated thoroughly.

Syringomyelia in demyelinating disease of the central nervous system: Report of two cases

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1110657s ◽

2011 ◽

Vol 139 (9-10) ◽

pp. 657-660 ◽

Cited By ~ 1

Author(s):

Dejan Savic ◽

Slobodan Vojinovic ◽

Mirjana Spasic ◽

Zoran Peric ◽

Stevo Lukic

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Magnetic Resonance ◽

Demyelinating Disease ◽

Clinical Signs ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Introduction. Syringomyelia is a cavitary extension inside the spinal cord which can be either symptomatic or congenitally-idiopathic. Syringomyelia during the course of the disease in patients presenting with clinically definite multiple sclerosis was described earlier. Syringomyelia in patients presenting with a clinically isolated syndrome suggestive of multiple sclerosis is unusual. Case Outline. We present two patients presenting with demy-elinating disease of the central nervous system with syringomyelia in the cervical and thoracic spinal cord. We did not find classical clinical signs of syringomyelia in our patients, but we disclosed syringomyelia incidentally during magnetic resonance exploration. Magnetic resonance exploration using the gadolinium contrast revealed the signs of active demyelinating lesions in the spinal cord in one patient but not in the other. Conclusion. Syringomyelia in demyelinating disease of the central nervous system opens the question whether it is a coincidental finding or a part of clinical features of the disease. Differentiation of the significance of syringomyelia finding in these patients plays a role in the choice of treatment concept in such patients.

An uncommon cause of vertigo: Neuromyelitis optica spectrum disorder

Ear Nose & Throat Journal ◽

10.1177/01455613211053393 ◽

2021 ◽

pp. 014556132110533

Author(s):

Kuan-Ling Lin ◽

Ching-Yu Yang ◽

Wen-Ko Su

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Neuromyelitis Optica ◽

Spectrum Disorder ◽

Atypical Presentation ◽

Neuromyelitis Optica Spectrum Disorder ◽

Positive Serum ◽

Aquaporin 4 Antibody

Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon antibody-mediated disease of the central nervous system. Its classic presentation includes long segments of spinal cord inflammation, optic neuritis with or without intractable vomiting, and hiccups. Here, we described a case of a 39-year-old woman with an atypical presentation of vertigo, which was finally diagnosed as NMOSD by a positive serum aquaporin-4 antibody.