scholarly journals Case Report: Post-Chikungunya–Associated Myeloneuropathy

2021 ◽  
Author(s):  
Ameya Patwardhan ◽  
Atchayaram Nalini ◽  
Priyanka Priyadarshini Baishya ◽  
Karthik Kulanthaivelu ◽  
Haripriya Krishnareddy ◽  
...  
Keyword(s):  
Early Recognition ◽  
Wide Spectrum ◽  
Rare Complication ◽  
Neurological Complications ◽  
Immunoglobulin M ◽  
Sensory Level ◽  
Normal Brain ◽  
Mri Findings ◽  
Limb Weakness ◽  
Hyperintense Signal

Chikungunya virus (CHIKV) is an arbovirus endemic to South Asia with frequent outbreaks. A wide spectrum of neurological complications has been described in Chikungunya infections. Myeloneuropathy is a rare complication seen in Chikungunya and is proposed to have an underlying immune mediated pathogenesis. We report a case of a 45-year-old man presenting to the emergency services with acute onset of quadriparesis, breathlessness, urinary retention, profound pain, and sensory disturbances 6 weeks after the onset of high-grade fever and arthralgia. On examination, the patient had Medical Research Council grade 1 flaccid quadriparesis with prominent wasting and areflexia with distinct sensory level at T4. Immunoglobulin M CHIKV antibodies were positive, tested twice at a 1-week interval. He had notable magnetic resonance imaging (MRI) findings in the form of patchy T2 hyperintensities involving the entire length of the cervical and thoracic cord with normal brain imaging and extensive short tau inversion recovery hyperintense signal changes on muscle MRI. He was treated with five cycles of plasmapheresis and intravenous methylprednisolone followed by oral steroids for 8 weeks. At 20-week follow-up, the patient had improvement in upper limb weakness, but paraparesis persisted. The case highlights the presence of unusual MRI findings and also the importance of early recognition of after infective neurological complications, and prompt treatment with immunomodulation may be beneficial.

scholarly journals Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wee Yong Tan ◽  
Abdul Hanif Khan Yusof Khan ◽  
Mohd Naim Mohd Yaakob ◽  
Anna Misyail Abdul Rashid ◽  
Wei Chao Loh ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Neurological Complications ◽  
High Dose ◽  
Sensory Level ◽  
Limb Weakness ◽  
Efficacy Trials ◽  
First Case ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Magnetic Resonance Imaging Mri ◽  
Extensive Transverse Myelitis

Abstract Background Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine. Case presentation We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment. Conclusion LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

Spontaneous Spinal Subarachnoid Haemorrhage: A Rare Complication of Dengue Fever

2017 ◽  
Vol 2 (2) ◽  
pp. 54
Author(s):  
Nur Hidayati Mohd Sharif ◽  
Nor Arisah Misnan ◽  
Norashikin Saidon ◽  
Phaik Yee Ooi ◽  
Hilwati Hashim
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Lower Limb ◽  
Rare Complication ◽  
Dengue Infection ◽  
Febrile Illness ◽  
Neurological Complications ◽  
Sensory Function ◽  
Limb Weakness ◽  
Surgical Interventions ◽  
Lower Limb Weakness

A 37-year-old woman presented with a short history of fever and bilateral lower limb weakness. She also had impaired sensory function up to T4 spine level and lax anal tone. Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite medical and surgical interventions, her lower limb weakness persists. A high index of suspicion is needed to recognise dengue-related neurological complications. This diagnosis should be considered in any patients from dengue endemic areas presenting with acute febrile illness with atypical neurological manifestations.

scholarly journals Guillain-Barré syndrome as the first presentation of human immunodeficiency virus infection

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mariana Lopes ◽  
Patrícia Marques ◽  
Bruno Silva ◽  
Gonçalo Cruz ◽  
José Eduardo Serra ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Rare Complication ◽  
Neurological Complications ◽  
Late Presentation ◽  
Study Patient ◽  
Limb Weakness ◽  
Hiv Test ◽  
Immunodeficiency Virus

Abstract Aim Antiretroviral therapy (ART) development has reduced the severity of neurological complications of the human immunodeficiency virus (HIV), but they remain prevalent and need prompt recognition. Acute inflammatory demyelinating polyneuropathy (AIDP) is a rare complication of human immunodeficiency virus (HIV) infection that may appear at any stage of the disease. In this case, AIDP represents a late presentation of HIV infection. Methods Descriptive study. Patient data were collected from their medical records and by health assessment interviews. Results We report a case of a 52-year-old male with acute lower limb weakness. Given the suggestive clinical presentation of AIDP and a positive HIV test, intravenous immunoglobulin (IVIG) was administered along with antiretroviral therapy. Progressive weakness to the upper limbs, autonomic dysfunction, and pain was observed. The second regimen of IVIG plus corticosteroids was administered. Muscle strength improved after three weeks. Conclusions Screening for HIV in a patient with AIDP may provide a better outcome because of the early start of ART with good central nervous system penetration in HIV-infected patients.

scholarly journals P14.123 Neurological complications related to checkpoints inhibitors

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii97-iii98
Author(s):  
I Esparragosa ◽  
R Valenti-Azcarate ◽  
D Moreno-Ajona ◽  
J Gallego Perez de Larraya
Keyword(s):  
Cerebrospinal Fluid ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Oral Prednisone ◽  
Fatal Outcome ◽  
Case Series ◽  
Neurological Complications ◽  
Ovarian Adenocarcinoma ◽  
Inflammatory Myositis ◽  
Oncological Treatment

Abstract BACKGROUND Currently, immunotherapy is part of the therapeutic arsenal for oncological treatment. Indeed, the need for new medications has led to the development of immune checkpoint inhibitors. Despite favourable oncological outcomes, these treatments have been associated with immune-related adverse events. Although infrequent, neurological toxicities have been reported. Early recognition is crucial for improvement of functional outcome and requires a multidisciplinary approach. OBJECTIVE To describe a case series of patients with neurological complications related to checkpoint inhibitors. PATIENTS AND METHODS We identified six oncological patients who presented immunomediated neurological complications, derived from the use of checkpoints inhibitors. Five cases were men. Ages ranged from 58 to 73 years. Nivolumab, alone or combined, was the most commonly associated drug (4/6). Underlying diseases included lung carcinoma (2/6), melanoma (2/6), renal carcinoma (1/6) and ovarian adenocarcinoma (1/6). An acute demyelinating sensory-motor polyneuropathy and an acute axonal sensory polyneuropathy were documented in two and one case, respectively. In these, the cerebrospinal fluid analysis revealed albuminocytologic dissociation. All three cases improved after treatment with intravenous immunoglobulins (0.4 g/Kg a day for five days). The latter and another case were diagnosed of aseptic meningitis after cerebrospinal fluid lymphocytic pleocytosis was found. High fever was also associated with lower extremities areflexia, weakness and ataxia. Methylprednisolone (1g/day for five days) was administered. One case of necrotizing inflammatory myositis with high levels of creatine kinasa, confirmed by muscular biopsy, involving cervical weakness and ptosis, was effectively treated with Methylprednisolone (1g/day for five days) follow by oral prednisone tapering. An anti-Yo related pancerebellar syndrome was the only case with a fatal outcome despite treatment. CONCLUSION The increasingly frequent use of immunotherapy in the treatment of cancer may lead to an increase in neurological complications. These include a broad spectrum of syndromes with peripheral nervous system predominantly susceptible. Early identification of these and appropriate management of drug-related toxicity are required. Immune-modulating therapies are particularly beneficial.

scholarly journals Air embolism: A rare complication of esophagogastroduodenoscopy!

2014 ◽  
Vol 05 (03) ◽  
pp. 114-115
Author(s):  
Ajay B. Jhaveri ◽  
Sharad C. Shah ◽  
Prasanna S. Shah
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Rare Complication ◽  
Air Embolism ◽  
Neurological Complications ◽  
High Flow ◽  
Cerebral Air Embolism ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
High Index Of Suspicion ◽  
The Impact

AbstractNeurological complications of gastrointestinal endoscopy are extremely rare; cerebral air embolism has been described and can be severe and fatal. A high index of suspicion for an air embolism is a must in case of procedural or periprocedural cardiopulmonary instability and neurologic symptoms, particularly in patients with recognized risk factors. The diagnosis of an air embolism is often difficult and is complicated by the fact that air may be rapidly absorbed from the circulation. Simple maneuvers to decrease the impact of a potential air embolism include; stopping the procedure, administering high flow 100% oxygen, placing the patient in Trendelenburg and left lateral decubitus position, and discontinuing nitrous oxide. C T Scan and 2 D ECHO are important diagnostic tests.

scholarly journals Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome: A Case Report

2015 ◽  
Vol 3 (3) ◽  
pp. 159-162
Author(s):  
Iman D. Johan-Arief, ◽  
Shen H. Lee ◽  
Xin Y. Er ◽  
Ganesh Kasinathan ◽  
Naganathan Pillai
Keyword(s):  
Chest Radiograph ◽  
Early Recognition ◽  
Pulmonary Hemorrhage ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Resource Limited ◽  
High Fatality Rate ◽  
Intravenous Antibiotics ◽  
Wide Range ◽  
History Of

Background: Leptospirosis is an infectious disease caused by the spirochete of the genus leptospira. It is thought to be the most common zoonosis globally and has a wide range of clinical presentations with pulmonary hemorrhage being one of its most severe manifestations. This entity known as acute pulmonary syndrome carries a high fatality rate. However, it can be effectively managed with methylprednisolone therapy. Case: We report a case of leptospirosis in a 26-year-old Bangladeshi male who was otherwise healthy. He presented with a 7-day history of fever with chills and rigors, and hemoptysis for a duration of 2 days. Physical examination revealed a febrile and lethargic man. Respiratory examination exhibited bilateral generalized crepitations over the lung fields. A chest radiograph performed showed bilateral alveolar shadowing. The diagnosis of leptospirosis was made based on positive Immunoglobulin M enzyme-linked immunosorbent assay serology, which was then confirmed by the microscopic agglutination test for leptospirosis. The patient was commenced on intravenous antibiotics and methylprednisolone at this time. He responded well clinically with resolution of fever and hemoptysis and a marked decrease in crepitations upon auscultation. This correlated with radiological improvement evidence by an obvious reduction in alveolar shadowing on subsequent chest radiograph 2 days later. Conclusion: This case is highly pertinent to the medical field as leptospirosis is an ever-growing problem and acute pulmonary syndrome is an emerging manifestation of it. Therefore, early recognition and intervention is required as this can be effectively treated with methylprednisolone therapy even in resource-limited settings

scholarly journals The Downside of Radiosurgery, Possible Complications

2018 ◽  
Vol 25 (3) ◽  
pp. 286-299
Author(s):  
Luiz Claudio Modesto Pereira ◽  
Valeria Patricia De Araujo ◽  
Thiago Henrique de Moraes Modesto
Keyword(s):  
Tumor Imaging ◽  
Neurological Complications ◽  
Normal Brain ◽  
Radiation Delivery ◽  
Cranial Nerve Dysfunction ◽  
Technological Advances ◽  
Treatment Dose ◽  
Barrier Breakdown ◽  
Nerve Dysfunction ◽  
Blood Brain Barrier Breakdown

As a consequence of various last century scientific and technological advances radiotherapy and stereotactic radiosurgery (SRS) have emerged as safe and efficacious techniques for the treatment of various intracranial pathologies. Recent improvements such as in brain and tumor imaging, patient immobilization, 3D planning and radiation delivery allow it to target lesions more accurately and minimize radiation delivered to normal brain, leading to drastic improvements in terms of safety and post-therapy complication. Despite that SRS still implies in moderate to severe side effects in one fifth to one fourth of patients. Fortunately the most common SRS complications, such as edema, blood brain barrier breakdown and MRI abnormalities are self-limited and amenable to treatment. The precise pathophysiological processes of SRS complications are still under research, however multiple factors including treatment dose, modality and planning complexity, target size, shape and location are known to affect treatment results. The most reported potential SRS complications are ischemic stroke, brain or lesion hemorrhage, radiosurgeryinduced neoplasm, radiation necrosis, white matter changes, cranial nerve dysfunction and cognition problems. SRS induced neurological complications may persist only in as much as 5% of patients.

scholarly journals Guillain –Barrè Syndrome following Hepatitis E

2014 ◽  
Vol 2 (1) ◽  
pp. 48-49
Author(s):  
Poly Sengupta ◽  
Rama Biswas ◽  
Hasan Shahrear Ahmed ◽  
Kaniz Fatema
Keyword(s):  
Motor Nerve ◽  
Electrophysiological Study ◽  
Hepatitis E ◽  
Immunoglobulin M ◽  
Guillain Barre Syndrome ◽  
Limb Weakness ◽  
Laboratory Findings ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Upper Abdominal

Guillain- Barrè Syndrome is characterized by acute progressive symmetric limb weakness and areflexia. A 32 year old female presented with progressive ascending areflexic muscular weakness and bilateral lower motor neuron type of facial palsy. She had anorexia, nausea and upper abdominal pain for 2 weeks. The findings of motor nerve conduction study are consistent with acute inflammatory demyelinating polyradiculoneuropathy. She had elevated liver enzyme and positive immunoglobulin M antibody against hepatitis E in blood. Based on clinical features, laboratory findings and electrophysiological study, she was diagnosed as Guillain- Barrè Syndrome following hepatitis E. She was treated with intravenous immunoglobulin and recovered fully. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19973 Bangladesh Crit Care J March 2014; 2 (1): 48-49

Posterior Reversible Encephalopathy (PRES) in a Child with Severe Dengue

2019 ◽  
Vol 66 (3) ◽  
pp. 322-326
Author(s):  
Yogini Sawant ◽  
Suresh Birajdar ◽  
Hiren Doshi ◽  
Pooja Soni ◽  
Deepak Patkar ◽  
...  
Keyword(s):  
Pediatric Population ◽  
White Blood Cells ◽  
Neurological Complications ◽  
Severe Dengue ◽  
Mri Findings ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Reversible Encephalopathy ◽  
Csf Examination

Abstract Among neurological complications associated with dengue, posterior reversible encephalopathy syndrome (PRES) has not been reported in pediatric population. We report a 10-year-old girl with severe dengue who developed PRES. The patient presented with hemorrhagic shock that required fluid resuscitation and inotropic support. She developed seizures with encephalopathy 2 days after recovering from the shock. Cerebrospinal fluid (CSF) examination was negative for dengue (no white blood cells in CSF with negative polymerase chain reaction for dengue). Her clinical features and magnetic resonance imaging (MRI) findings showed typical changes associated with posterior encephalopathy that reverted after resolution of hypertension. Repeat MRI after a month was normal. PRES should be considered as a possible differential diagnoses of dengue associated encephalopathy, especially in cases with normal CSF examination and characteristic MRI changes.

scholarly journals A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

2019 ◽  
Vol 09 (01) ◽  
pp. e84-e87
Author(s):  
Jessica Morgan ◽  
Micaela Della Torre ◽  
Anna Whelan ◽  
Sophia Rodriguez ◽  
Laura DiGiovanni
Keyword(s):  
Liver Enzymes ◽  
Epigastric Pain ◽  
Early Recognition ◽  
Rare Complication ◽  
Liver Function Tests ◽  
True Incidence ◽  
Hepatic Infarction ◽  
Elevated Liver Enzymes ◽  
Blood Pressures ◽  
The Right

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.

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