Sốc thần kinh do viêm tủy leo cấp: một trường hợp rất hiếm gặp

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2021.73.3 ◽

2021 ◽

Author(s):

Kiem Hao Tran

Keyword(s):

Acute Flaccid Paralysis ◽

Muscle Power ◽

White Blood Cells ◽

Transverse Myelitis ◽

Flaccid Paralysis ◽

Spine Injury ◽

Severe Respiratory Distress ◽

First Case ◽

Neurogenic Shock ◽

High Level

Giới thiệu: Sốc thần kinh là một tình trạng đe dọa tính mạng, phần lớn liên quan đến chấn thương cột sống cổ hoặc cột sống ngực cao; trong khi đó, viêm tủy cắt ngang gây ra sốc thần kinh rất hiếm gặp. Chúng tôi trình bày một trường hợp sốc thần kinh do viêm tủy leo cấp ở trẻ em. Báo cáo trường hợp: Trẻ nam 11 tuổi nhập viện với biểu hiện liệt mềm cấp tính và bí tiểu, sau đó liệt tiến triển leo cấp gây liệt chi trên và suy hô hấp nặng. Kết quả dịch não tủy cho thấy tăng protetin và tăng số lượng bạch cầu (chủ yếu tế bào lympho). Trẻ được chẩn đoán viêm tủy cắt ngang và điều trị với methylprednisolone. Sau đó, bệnh nhân có biểu hiện của sốc thần kinh với các triệu chứng hạ huyết áp (63/45 mmHg), nhịp chậm (60 lần/phút), thời gian đổ đầy mao mạch nhanh (Refill < 2s), giảm tri giác. Sau khi được điều trị với hồi sức dịch, vận mạch (Noradrenalin) và Atropin, tình trạng sốc được cải thiện. Trẻ tiếp tục được điều trị viêm tủy cắt ngang cấp và tình trạng liệt chi trên và cơ hô hấp bắt đầu cải thiện dần. Kết luận: Sốc thần kinh cần chú ý chẩn đoán trên những bệnh nhân viêm tủy thể leo cấp. Sử dụng các thuốc vận mạch thích hợp là điều trị nền tảng trong sốc thần kinh. Từ khoá: Sốc, thần kinh, viêm tủy cắt ngang, liệt Landry. ABSTRACT NEUROGENIC SHOCK DUE TO TRANSVERSE MYELITIS WITH LANDRY’S ACUTE FLACCID PARALYSIS: AN EXTREMLY RARE CASE Introduction: Neurogenic shock is a life-threatening condition that is mostly associated with cervical and high thoracic spine injury. In fact, transverse myelitis leading to neurogenic shock is extremely rare. This is the first case of neurogenic shock due to transverse myelitis with Landry’s acute flaccid paralysis in a child we have experienced so far. Case report: An 11 - year - old boy was admitted to our center with Landry’s acute flaccid paralysis and urinary retention, which led the patient to severe respiratory distress. Test indicated high level of protein and white blood cells in cerebrospinal fluid. He was diagnosed with transverse myelitis and then treated with methylprednisolone. The patient developed hypotension (63/45 mmHg), bradycardia (60 beats per minute), warm flushed skin, and decreased consciousness as a result of neurogenic shock. Fluid resuscitation, noradrenalin, and atropin were ndicated, and the shock was well controlled. The transverse myelitis was maintainly treated, and the muscle power of upper extremities, as well as respiratory muscle were gradually improved. Conclusion: Neurogenic shock occurring from transverse myelitis should be considered in the patient with Landry’s acute flaccid paralysis. Keywords: Shock, neurogenic, transverse myelitis, Landry’s paralysis.

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Acute Flaccid Myelitis: A Clinical Review

Seminars in Neurology ◽

10.1055/s-0040-1705123 ◽

2020 ◽

Vol 40 (02) ◽

pp. 211-218

Author(s):

Olwen C. Murphy ◽

Carlos A. Pardo

Keyword(s):

Spinal Cord ◽

Acute Flaccid Paralysis ◽

Clinical Manifestations ◽

Transverse Myelitis ◽

The United States ◽

Acute Onset ◽

Flaccid Paralysis ◽

Limb Weakness ◽

Acute Flaccid Myelitis ◽

Enterovirus D68

AbstractAcute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the spinal cord gray matter on magnetic resonance imaging. In most cases, prodromal fever or respiratory symptoms occur, followed by acute-onset flaccid limb weakness. Respiratory, axial, bulbar, facial, and extraocular muscles may also be affected. The clinical manifestations have been described as “polio-like,” due to striking similarities to cases of poliomyelitis. The primary site of injury in AFM is the anterior horn cells of the spinal cord, resulting in a motor neuronopathy. Seasonal peaks of cases have occurred in the United States every 2 years since 2012. However, AFM remains a rare disease, which can make it challenging for physicians to recognize and differentiate from other causes of acute flaccid paralysis such as Guillain–Barre syndrome, spinal cord stroke, and transverse myelitis. Epidemiological evidence suggests that AFM is linked to a viral etiology, with nonpolio enteroviruses (in particular enterovirus D68) demonstrating a plausible association. The epidemiology, possible etiological factors, clinical features, differential diagnosis, treatment, and outcomes of AFM are discussed in this review.

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Coincidence of Guillain-Barré syndrome presenting with Landry’s acute flaccid paralysis and transverse myelitis

Reumatologia/Rheumatology ◽

10.5114/reum.2019.84819 ◽

2019 ◽

Vol 57 (2) ◽

pp. 120-122 ◽

Cited By ~ 1

Author(s):

Desislava Kalinova ◽

Rasho Rashkov

Keyword(s):

Acute Flaccid Paralysis ◽

Transverse Myelitis ◽

Flaccid Paralysis ◽

Guillain Barre Syndrome ◽

Guillain Barré Syndrome ◽

Guillain Barré

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Acute Flaccid Paralysis: A Registry-based Study of Demographic, Clinical, and Diagnostic Characteristics of Children in a Referral Center in Iran

10.21203/rs.3.rs-57505/v1 ◽

2020 ◽

Author(s):

Ali Reza Tavasoli ◽

Roxana Pazouki ◽

Sareh Hosseinpour ◽

Mahmoud Reza Ashrafi ◽

Masood Ghahvechi Akbari ◽

...

Keyword(s):

Acute Flaccid Paralysis ◽

Medical Center ◽

Transverse Myelitis ◽

Referral Hospital ◽

Flaccid Paralysis ◽

Guillain Barre Syndrome ◽

Diagnostic Approach ◽

Guillain Barré Syndrome ◽

The Mean ◽

Guillain Barré

Abstract Background: Acute Flaccid Paralysis(AFP) is a clinical syndrome characterized by acute progressive weakness in limbs and respiratory and swallowing muscles. Etiologies of AFP mostly include infections in anterior horn cells of the spinal cord, Guillain-Barre syndrome(GBS), transverse myelitis, viral myositis, myasthenia gravis and botulism. An accurate and early diagnosis of AFP is crucial. The aims of this study were to determine the main etiologies and characteristics of AFP in children and also design a diagnostic approach for AFP based on a hospital-based registry system.Method: This retrospective, cross-sectional study is a five-years survey, from 2011 to 2016 in Children’s Medical Center as the main children referral hospital in Iran. Totally 118 patients who had met AFP ICD-10- CM and inclusion criteria were included. All clinical and Paracinical data were collected based on a prepared questionnaire for the study.Result: The mean age of the patients was 6.09 ± 3.60 years old. The most frequent underlying etiologies were GBS, viral myositis and Vaccine-Associated Paralytic Poliomyelitis(VAPP) accounting for 67.8%, 15.3% and 5% of the patients, respectively. In terms of preceding clinical symptoms coryza, fever and gastrointestinal symptoms were more common. The most common neurologic presenting symptom was motor dysfunction. Cerebrospinal fluid analysis mainly indicated increase level of protein in favor of GBS. Elevated Creatine kinase level with the mean of 2184 IU/L has been reported in patients with viral myositis. Brain imaging principally revealed normal results and spinal MRI findings were compatible with the diagnoses of GBS and transvers myelitis. All stool sample results for polio virus detection were negative.Conclusion: In this study, we determined the etiologies of AFP in Iranian children referred to Children’s Medical Center. Guillain-Barre syndrome, viral myositis, transverse myelitis and VAPP were the most common etiologies. We also recommended a diagnostic approach for AFP in pediatric population regards to main etiologies in emergency room of a children referral hospital.

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D.10 Acute flaccid paralysis in Canadian youth, 1996 to 2014

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.83 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S15-S16

Author(s):

J Rotondo ◽

S Desai ◽

M Beaulieu ◽

TF Booth

Keyword(s):

Surveillance System ◽

Acute Flaccid Paralysis ◽

Transverse Myelitis ◽

Flaccid Paralysis ◽

Hospital Length Of Stay ◽

Muscle Involvement ◽

Initial Report ◽

Average Hospital ◽

Canadian Youth ◽

Afp Surveillance

Background: Acute flaccid paralysis (AFP) is notifiable in Canada with a differential diagnosis that includes a number of conditions. This analysis describes the epidemiology of AFP in Canadian youth less than 15 years old. Methods: Monthly active surveillance for AFP was conducted as part of the Canadian AFP Surveillance System. Results: From 1996 to 2014, 850 cases of AFP were reported, representing an average annual crude incidence rate of 0.77 cases per 100,000 youth less than 15 years old. The mean age of cases was 6.8 years (median 5.9 years). Nine percent had an abnormal neurological history and 53% had an acute respiratory illness within 30 days of onset. Fever occurred in 23% of cases, 96% experienced bilateral weakness, 21% had respiratory muscle involvement, and 26% had cranial nerve involvement. The average hospital length of stay was 13.5 days. The most common diagnoses were Guillain-Barré Syndrome (GBS) or a variant (70%), and transverse myelitis (TM, 14%). At the time of the initial report, 14% had fully recovered. Conclusions: Our AFP surveillance system provides a baseline for AFP and its causes in the Canadian paediatric population. While rare, AFP is associated with severe morbidity in youth. GBS and TM were the most common diagnoses.

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