Acute spinal cord infarction syndrome unusually mimicking Transverse myelitis: A case report

Anterior Spinal Cord Infarction (ASCI) syndrome typically results from ischemia that affects the anterior spinal artery territory characterized by history of sudden onset flaccid paraplegia or quadriplegia depending on the level of the lesion. We describe a 57-years-old woman with sudden onset flaccid weakness of the lower limbs and numbness of the feet of two days duration, preceded by a day history of fever and several episodes of vomiting. Examination initially revealed bilateral hypotonia, hyporeflexia and dense paraplegia, with preservation of dorsal column sensations (fine touch/2-point discrimination, position and vibration sensation). Twenty-four hours thereafter a repeat examination showed hyper-reflexia and extensor plantar response with spastic paraplegia. Thoracic spine Magnetic Resonance Imaging (MRI) revealed thinning of the spinal cord extending from T1 to T9 levels with associated widening of the thecal sac suggestive of anterior spinal cord infarction with no other signal changes seen within the substance.

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CASE REPORT ON A RARE NEUROLOGICAL COMPLICATION OF MYCOBACTERIUM TUBERCULOSIS INFECTION IN HIV PATIENT

10.36106/ijsr/4105568 ◽

2021 ◽

pp. 1-2

Author(s):

K. Shivaraju ◽

Mandhala Saikrishna

Keyword(s):

Spinal Cord ◽

Mycobacterium Tuberculosis ◽

Case Report ◽

Neurological Complication ◽

Transverse Myelitis ◽

Sudden Onset ◽

Lower Limbs ◽

Tuberculosis Infection ◽

Mycobacterium Tuberculosis Infection ◽

History Of

LETM is rarely caused by tuberculosis infection. LETM is a contiguous immune-mediated inammatory lesion of the spinal cord that extends to three or more segments of spinal cord. Here we presenting a case of 55 years old female patient with known HIV infection and no history of tuberculosis infection admitted in the hospital with complains of sudden onset of asymmetrical weakness of lower limbs and urinary incontinence from four days. on evaluation she was underwent some series of investigations, in that nally diagnosed with longitudinally extensive transverse myelitis due to tuberculosis infection. Then patient was treated with ART and ATT with steroids and supportive treatment along with physiotherapy. after some days patient condition was gradually improving with treatment and discharged, advised physiotherapy daily and followup on OPD basis. So based on this case report, we recommend that clinicians should suspect mycobacterium tuberculosis infection when patient diagnosed with transverse myelitis

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Neurobrucellosis with ischemic stroke and spinal cord involvement: a case report

BMC Neurology ◽

10.1186/s12883-021-02155-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongfeng Wen ◽

Di Jin ◽

Lina Cai ◽

Tao Wu ◽

Haichao Liu

Keyword(s):

Spinal Cord ◽

Ischemic Stroke ◽

Clinical Manifestations ◽

Transverse Myelitis ◽

Lower Limbs ◽

Spinal Cord Atrophy ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Next Generation Sequencing Ngs

Abstract Background Brucellosis is a common zoonotic disease that may have a variety of clinical manifestations when it affects the nervous system. Ischemic stroke is a rare clinical symptom, but if it is not diagnosed and treated early, it may cause more severe consequences. Case presentation We report a 38-year-old man presenting with hearing impairment for four years and sudden weakness of the right limb for two years, recurrent aphasia, and gradual weakness of bilateral lower limbs for nine months. He had bilateral positive Babinski’s sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed ischemic infarcts in the pons and extensive enhancement of spinal meninges combined with spinal cord atrophy and ischemia. The tests revealed Brucella Rose Bengal positive in serum and CSF. Brucella culture in CSF was also positive. Next-generation sequencing (NGS) of CSF revealed positive for Brucella with 105 species were detected. He showed significant improvement with antibiotics at five months follow-up. Conclusions Neurobrucellosis may mimic stroke and transverse myelitis like syndromes. NB is a treatable infectious condition and should always be considered in the differentials, especially if there are risk factors, as in our case.

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Case report: “an unexpected origin of coma in a young adult”

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00390-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Ranjana Chandrikasing ◽

Sudeshkoemar Ramnarain ◽

Rakesh Bansie ◽

Harvey Yang ◽

Huibert Ponssen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Transverse Myelitis ◽

Respiratory Acidosis ◽

Sudden Onset ◽

Lower Limbs ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Hypoventilation Syndrome ◽

Diaphragmatic Weakness

AbstractWe report a peculiar case of acute non-traumatic coma due to neuromuscular hypoventilation syndrome caused by a non-traumatic spinal cord injury (NTSCI). A 21-year-old patient presented to the emergency room complaining of sudden onset weakness in his lower limbs and shortness of breath. While in the ER, he briefly became comatose and labs revealed an acute respiratory acidosis. Detailed neurologic examination ultimately revealed upper motor neuron signs and quadriplegia. He was ultimately diagnosed with a non-traumatic spinal cord injury, in particular, a cervical transverse myelitis which had caused acute diaphragmatic weakness. Although a very rare cause of coma, emergency medicine physicians need to be aware of transverse myelitis, a disorder that may result in rapidly progressive neurologic decline and is treated with immunomodulation.

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P.095 Holey Spinal Cord - A case of spinal cord stroke secondary to fibrocartilaginous embolism

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

10.1017/cjn.2018.197 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S41-S41

Author(s):

S Wasyliw ◽

P Masiowski

Keyword(s):

Spinal Cord ◽

Transverse Myelitis ◽

Professional Sports ◽

Spinal Cord Infarction ◽

Fibrocartilaginous Embolism ◽

Unsteady Gait ◽

Spinal Cord Infarct ◽

History Of ◽

Bone Infarct ◽

The Right

Background: Fibrocartilaginous embolism (FCE) is a rare reported cause of spinal cord infarction and likely underdiagnosed due to clinical unfamiliarity. FCE can present after a mild trauma and is characterized by back or neck pain along and a rapidly progressive myelopathy. We present a case of FCE and discuss how this clinical entity can break the typical rules of stroke. Methods: Case presentation Results: An otherwise healthy, 56-year-old professional sports coach presented a couple day history of progressive leg paresthesias and mild back pain, followed by unsteady gait and then inability to void. The left leg demonstrated mild weakness, hyperreflexivity, ataxia and an upgoing plantar response. The right leg became spastic and he then developed bilateral impairment of vibration and proprioception at the toes. An initial limited MRI lumbar spine was negative. A repeat MRI spine showed mild diffusion restriction of T10-11 and T11-12 and evidence of a bone infarct L2. He was diagnosed with a spinal cord infarct secondary to FCE. Conclusions: FCE should be considered in the differential for acute myelopathy. It can present with a progressive nature like transverse myelitis and MRI may be non-diagnostic. As more cases are being reported, FCE is becoming better defined and recognized.

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Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials

Brain Sciences ◽

10.3390/brainsci10050282 ◽

2020 ◽

Vol 10 (5) ◽

pp. 282

Author(s):

Marilisa Boscarino ◽

Jacopo Lanzone ◽

Lorenzo Ricci ◽

Mario Tombini ◽

Vincenzo Di Lazzaro ◽

...

Keyword(s):

Spinal Cord ◽

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Dorsal Column ◽

Lower Limbs ◽

Neurological Involvement ◽

Conduction Time ◽

Lesion Analysis ◽

Magnetic Resonance Imaging Mri ◽

Work Up

Anti-Myelin Associated Glycoprotein (anti-MAG) neurological involvement classically manifests as a peripheral neuropathy with prominent sensitive symptoms. We describe a case report of a patient with positive anti-MAG antibodies presenting with clinical and neurophysiological evidence of spinal cord impairment. A 69-year-old woman came to our attention with subacute onset of dysesthesias at lower limbs and ataxia. Blood routine tests and hematological work-up led to a diagnosis of monoclonal gammopathy of undetermined significance. High titers of anti-MAG antibodies was revealed (34,594.70 BTU/mL, normal range 0–1000). Nerve conduction studies (NCS) ruled out a polyneuropathy at lower limbs. Somatosensory evoked potentials (SSEPs) showed prolonged central conduction time (CTT) at lower limbs, suggesting a dorsal column damage. Brain and spinal cord Magnetic Resonance Imaging (MRI) did not reveal any significant lesion. Analysis of cerebrospinal fluid (CSF) evidenced an albumin-cytologic dissociation. She was treated with corticosteroids with temporary remission of sensory symptoms and normalization of CTT. Subsequently, she developed a multineuropathy which was successfully treated with Rituximab. We discuss the potential role of anti-MAG antibodies in the pathophysiology of dorsal column impairment and the clinical usefulness of SSEPs in monitoring the evolution of anti-MAG neuropathy.

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Disseminated Cryptococcosis revealed by transverse myelitis in Immunocompetent patient: a case report and review of the literature

BMC Neurology ◽

10.1186/s12883-020-1598-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Fangfang Qu ◽

Zhenzhen Qu ◽

Yingqian Lv ◽

Bo Song ◽

Bailin Wu

Keyword(s):

Spinal Cord ◽

Amphotericin B ◽

Transverse Myelitis ◽

Immunocompetent Patient ◽

Lower Limbs ◽

Coxsackie Virus ◽

Gadolinium Contrast ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Cord Injury

Abstract Background Transverse myelitis (TM) is due to inflammatory spinal cord injury with bilateral neurologic involvement, which is sensory, motor, or autonomic in nature. It may be associated with autoimmune disease, vaccination, intoxication and infections. The most common infection cause of TM is Coxsackie virus and Mycoplasma pneumoniae. The cryptococcosis is rare. We present the case of disseminated cryptococcosis revealed by transverse myelitis in an immunocompetent 55-year-old male patient. The literature review is also stated. Case presentation The 55-year-old man suffered from gradual numbness, weakness in both lower limbs and finally paralyzed in the bed. The thoracic spine Computed tomography (CT) was normal, but multiple nodules in the lung were accidentally discovered. Thoracic Magnetic Resonance Imaging (MRI) showed diffused thoracic spinal cord thickening and extensively intramedullary T2 hyper intensity areas. Gadolinium contrast enhanced T1WI showed an intramedullary circle-enhanced nodule at 9th thoracic level. Diagnosis was made by histological examination of the bilateral lung biopsy. The patient was treated successfully with systemic amphotericin B liposome and fluconazole and intrathecal dexamethasone and amphotericin B liposome. Conclusions This is a patient with disseminated cryptococcosis involving the lung, spinal cord and adrenal glands, which is rare in the absence of immunodeficiency.

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Acute Transverse Myelitis Associated with COVID-19 vaccine: A Case Report

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i3.4818 ◽

2021 ◽

Vol 12 (3) ◽

pp. 2083-2087

Author(s):

Ali Alshararni

Keyword(s):

Spinal Cord ◽

Case Report ◽

Acute Inflammation ◽

Transverse Myelitis ◽

Preventive Measure ◽

Mri Findings ◽

Dorsal Spinal Cord ◽

Lumbosacral Spinal Cord ◽

Acute Transverse Myelitis ◽

Magnetic Resonance Imaging Mri

The case report demonstrates the issue of Khalid Ali, who is a citizen of Yamen, explicitly living in Saudi Arabia. He is 38 years, weighs 82kgs, and of 162 cm in height. He is a sales professional and married with two kids. Khalid Ali has been living healthy until two years ago when he started experiencing pains in his lower extremities accompanied by numbness. He was treated, and everything went back to normal until soon when the case came back after the administration of the Pfizer vaccine as a preventive measure for COVID-19 disease. The consequence of the administration of the Pfizer vaccine resulted in severe pain and weaknesses in his legs and severe headache on the second day, which resulted in him being put on an ICU after 48 hours since he was almost paralyzed. A series of tests were conducted on him, including magnetic resonance imaging (MRI), hematology, and biochemistry which involved Cerebrospinal Fluid (CSF) protein test. MRI findings were significant since they indicated acute inflammation on the spine observed on the dorsal spinal cord with contrast and lumbosacral spinal cord. All the hematology tests turned out to be expected. Biochemistry conducted tests were similarly standard except for CSF protein which was highly abnormal. The combination of the high abnormal CSF protein test and acute inflammation of the spine observed from the MRI findings were confirmed evidence of acute transverse myelitis as a result of the administration of the Pfizer vaccine.

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Emergency Magnetic Resonance Examination of Patients with Spinal Cord Symptoms

Acta Radiologica ◽

10.1177/028418518802900115 ◽

1988 ◽

Vol 29 (1) ◽

pp. 69-75 ◽

Cited By ~ 17

Author(s):

E.-M. Larsson ◽

S. Holtås ◽

S. Cronqvist

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Epidural Abscess ◽

Imaging System ◽

Epidural Haematoma ◽

Sudden Onset ◽

Surface Coils ◽

Signal Characteristics ◽

Traumatic Lesions ◽

Magnetic Resonance Imaging Mri

Eighteen consecutive patients with spinal cord symptoms of sudden or relatively sudden onset were examined with magnetic resonance imaging (MRI). The examinations were performed on a 0.3 tesla permanent/resistive imaging system using solenoidal surface coils. MRI revealed epidural tumour in five patients, intramedullary tumour in one, epidural abscess in one, myelitis in two, spontaneous intraspinal epidural haematoma in two, disc herniation in two, traumatic lesions in four and no abnormality in one patient. MRI was found to be capable of non-invasively and painlessly detecting and exactly defining the extent of intraspinal and paraspinal lesions. In some cases the nature of the lesion could be inferred from specific signal characteristics, which is a unique property of MRI. The results strongly suggest that MRI is superior to myelography and other imaging methods and should be regarded as the examination of choice in the emergency examination of patients with spinal cord symptoms.

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Non traumatic spinal epidural haematoma

Acute Medicine Journal ◽

10.52964/amja.0787 ◽

2019 ◽

Vol 18 (4) ◽

pp. 255-258

Author(s):

Naureen Abdul Khalid ◽

◽

Nainal Shah ◽

Keyword(s):

Magnetic Resonance Imaging ◽

Trauma Surgery ◽

Epidural Haematoma ◽

Rare Condition ◽

Sudden Onset ◽

Resonance Imaging ◽

Spinal Epidural Haematoma ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Spinal Epidural

Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.

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Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20164579 ◽

2016 ◽

Vol 5 (1) ◽

pp. 357 ◽

Cited By ~ 1

Author(s):

Alagoma Iyagba ◽

Arthur Onwuchekwa

Keyword(s):

Sudden Onset ◽

Lower Limbs ◽

Neck Stiffness ◽

Cerebellar Haemorrhage ◽

Initial Manifestation ◽

Truncal Ataxia ◽

Accident And Emergency ◽

Undiagnosed Hypertension ◽

History Of ◽

Clonic Seizures

Vermal cerebellar haemorrhage is bleeding affecting the midline region of the cerebellum. It is uncommon, accounting for 5-13% of all intracerebral haemorrhages. It is a grave condition with a high mortality. The diagnosis must be made early, if not, most patients would die within 48 hours. A 70-year-old lady presented to the accident and emergency department with a six hours history of sudden onset generalized tonic-clonic seizures following activity and loss of consciousness. She was unconscious with a Glasgow coma score of 3/15 with neck stiffness, generalized hypotonia and globally diminished reflexes. Her blood pressure was 240/120 mmHg with a mean arterial pressure of 160 mmHg. The brain computerized tomographic scan showed a hyperdense area in the cerebellar vermis with extension to both hemispheres and fourth ventricle. Consciousness was regained after three weeks of conservative management following which she became extremely restless and noticed to have developed titubations with nystagmus of both eyes. She also developed intention tremors, scanning dysarthria, generalized hypotonia, dysmetria, dysdiadochokinesia and intentional bilateral tremors. Her recovery was slow and gradual. Once she was able to stand with support, she was noticed to have florid truncal ataxia, lower limbs ataxia, and titubations.

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