Japanese encephalitis presenting as transverse myelitis: An uncommon presentation

Japanese Encephalitis Virus (JEV) is the main cause of viral encephalitis in South East Asia. Commonly, it presents as an acute encephalitic syndrome with fever, headache, seizures, and altered sensorium as clinical manifestations. However, there can be atypical presentations such as acute transverse myelitis (ATM) as the initial manifestation. Clinicians should be aware of such possibilities and myelitis due to the JE virus should be considered as a differential in children presenting with encephalomyelitis

Longitudinal Extensive Transverse Myelitis as a Neurological Sequelae post-Sea Urchin Stings: A Case Report

@#Puncture injury from sea-urchin stings may lead to a local and systemic inflammatory reaction. We are reporting a case of longitudinal extensive transverse myelitis (LETM), which occurred ten days post-sea-urchin stings, where the patient presented with bilateral lower limb weakness. MRI showed multilevel segment spinal cord T2-weighted hyperintensity. Prompt intravenous methylprednisolone was administered, and the patient had a full recovery. To date, there is no case report of LETM associated with sea-urchin stings. Possible mechanism due to delayed immunological hypersensitivity to sea-urchin venom. This case demonstrates the potential serious neurological sequelae that may be associated with post-sea-urchin sting and the importance of prompt recognition and management in aiding recovery.

Role of microRNA-92b in the pathophysiology of acute transverse myelitis in children / 中华实用儿科临床杂志

Objective To explore microRNAs that play key regulatory roles in the pathophysiology of acute transverse myelitis in children,and to find therapeutic targets.Methods Twelve patients with acute transverse myelitis were enrolled as ATM group and three children with normal cerebrospinal fluid as the control group.MicroRNA in cerebrospinal fluid of children with acute transverse myelitis was detected by using microarray4.0 chip.Bioinformatics was used to demonstrate microRNA,which plays a key regulatory role,and to predict target genes.Real-time quantitative polymerase chain reaction (qPCR) technique was adopted for in biology and technology duplication.Enzyme-linked immunosorbent assay (ELISA) and Western blot technique were used to detect the expression of key miRNA target protein.The key candidate microRNA was inhibited/overexpressed in dorsal root ganglion neurons,and the function was verified in vitro.Flavopiridol was used to inhibit the activity of CDKs to verify that miR-92b worked through p57-CDKs-GAP-43 pathway.Results The characteristic elevation of miR-92b in cerebrospinal fluid samples of acute transverse myelitis was significant.Bioinformatics analysis showed that p57 was the target gene of miR-92b.The expression of miR-92b was contrary to the p57 protein.In vitro experiments showed that the length of axons in miR-92bmimics group was significantly shorter than that in the blank group.The axons of neurons in antimiR-92b group were obviously prolonged.In the miR-92b mimics + Flavopiridol groups,the axons of neurons were still significantly prolonged compared with that in the blank group.Western blot showed that p57 and GAP-43 protein expression in miR-92b mimics group was lower than that in blank group.The expression of p57 and GAP-43 protein in antimiR-92b group was significantly higher than that in blank group.But in miR-92b mimics + Flavopiridol group,the expression of p57 was lower compared with that in blank group,and the expression of GAP-43 protein was higher compared with that in blank group.Conclusions Up-regulation of miR-92b in children with acute transverse myelitis leads to a down-regulation of p57.The activity of CDKs is enhanced,which inhibits the expression of GAP-43 protein and the regeneration of axons in spinal cord injury region.MiR-92b is one of the key targets in the treatment of children with acute transverse myelitis.

Epstein-Barr Virus Infection associated Transverse Myelitis with Brain Involvement in an Immunosuppressed Patient: A Case Report / 대한소아신경학회지

A 19-year-old girl with immunosuppressive agents of tacrolimus and mychophenolate mofetil following liver transplantation due to glycogen storage disease visited hospital due to lower extremity motor weakness and blurred vision. Motor power was checked as grade II in the upper extremities and grade 0 in the lower extremities with absence of deep tendon reflexes and anal sphincter dysfunction. The magnetic resonance imaging (MRI) showed increased T2 high signal intensity lesions from C4 to L2 level of spinal cord, cerebral cortex, and the left optic nerve. The cerebrospinal fluid (CSF) analysis showed pleocytosis. Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) was detected as 5,954 copies/mL in CSF whereas all other microbiologic tests were negative. Anti-aquaporin 4 antibody and oligoclonal band were not detected. Intravenous immunoglobulin, methylprednisolone pulse therapy and 3-week course of acyclovir were administered. Although motor power in the upper extremities recovered to grade V, motor power in the lower extremities did not show any improvement. The EBV viral load was not detected in the follow-up CSF examination. EBV infection in an immune-compromised patient could cause extensive demyelinating diseases in central nervous system and result in severe disability.

Concurrency of Guillain-Barre syndrome and acute transverse myelitis: a case report and review of literature / 소아과

Guillain-Barré syndrome and acute transverse myelitis manifest as demyelinating diseases of the peripheral and central nervous system. Concurrency of these two disorders is rarely documented in literature. A 4-year-old girl presenting with cough, fever, and an impaired walking ability was admitted to hospital. She had no previous complaints in her medical history. A physical examination revealed lack of muscle strength of the lower extremities and deep tendon reflexes. MRI could not be carried out due to technical problems; therefore, both Guillain-Barré syndrome and acute transverse myelitis were considered for the diagnosis. Intravenous immunoglobulin treatment was started as first line therapy. Because this treatment did not relieve the patient's symptoms, spinal MRI was carried out on the fourth day of admission and demyelinating areas were identified. Based on the new findings, the patient was diagnosed with acute transverse myelitis, and high dose intravenous methylprednisolone therapy was started. Electromyography findings were consistent with acute polyneuropathy affecting both motor and sensory fibers. Therefore, the patient was diagnosed with concurrency of Guillain-Barré syndrome and acute transverse myelitis. Interestingly, while concurrency of these 2 disorders is rare, this association has been demonstrated in various recent publications. Progress in diagnostic tests (magnetic resonance imaging and electrophysiological examination studies) has enabled clinicians to establish the right diagnosis. The possibility of concurrent Guillain-Barré syndrome and acute transverse myelitis should be considered if recovery takes longer than anticipated.

Factors associated with length of hospitalization in patients admitted with transient acute transverse myelitis / 中国综合临床

Objective To evaluate the days of hospitalization of acute transverse myelitis and its influencing factors.Methods File's of 158 patients with acute transverse myelitis as the first diagnosis in Feicheng Mining Centre Hospital were analyzed retrospectively.Access to the original medical records through the medical record number, and supplemented information, mainly including demographic data, neurological function defect degree, complications and complications.Results Hospitalization time was 4-41 d, an average of (17±6) d,including 23 patients hospitalized time ≤ 10 d(14.56％), 83 cases were ＞ 10-＜20 d(52.53％), 52 cases was≥20 d(32.91％).Age and Neurological score comparative differences are statistically significant (F=60.90,8.68, P＜0.05).Payment method, deep vein thrombosis, comparative differences were statistically significant(x2 =20.04, 14.27, 12.17,9.37,7.05;P＜0.05).There were ralationship between acute transverse myelitis with age, neurological score, payment (OR =1.140, 0.500,83.930,0.041;P＜ 0.005).Conclusion The degree of neurologic impairment is the most important influencing factors of acute transverse myelitis.Controlling hospital infection, preventing deep vein thrombosis, strengthening medical insurance management, are the effective ways to shorten the days of hospitalization of acute transverse myelitis.

Concomitant Acute Transverse Myelitis and Sensory Motor Axonal Polyneuropathy in Two Children: Two Case Reports

Acute transverse myelitis (ATM) is an upper motor neuron disease of the spinal cord, and concomitant association of peripheral polyneuropathy, particularly the axonal type, is rarely reported in children. Our cases presented with ATM complicated with axonal type polyneuropathy. Axonal type polyneuropathy may be caused by acute motor-sensory axonal neuropathy (AMSAN) or critical illness polyneuropathy and myopathy (CIPNM). These cases emphasize the need for nerve and muscle biopsies to make the differential diagnosis between AMSAN and CIPNM in patients with ATM complicated with axonal polyneuropathy.

Acute Non-Traumatic Paraparesis: A Comprehensive Analysis of Aetiology and Clinical Profile in an Indian Subpopulation.

Background and Objectives: This study was performed in a tertiary care hospital in western India. Our aim was to understand and analyze the clinical profile and causes of acute non-traumatic paraparesis and correlate them with relevant biochemical and radiological investigations. Methods: 100 cases of acute nontraumatic paraparesis admitted over a period of three years were studied. Data on age, sex, presenting symptoms, clinical signs and medical investigations was analyzed critically. This study used the mean and the median as measures of central tendency and standard deviation as a measure of dispersion. Results: Incidence of acute non-traumatic paraparesis was found to be the highest in the third and fourth decade of life (36% of cases). Incidence among males (54%) and females (46%) was fairly equal. An inability to walk (72%) or a difficulty in walking (28%) were the chief presenting symptoms. 76% of cases presented in a stage of spinal shock. Tuberculosis was the commonest cause (40%), followed by acute transverse myelitis (26%). 50% of cases had compressive myelopathy while 30% had non-compressive myelopathy. Investigations such as cerebrospinal fluid (CSF) analysis, nerve conduction studies and Magnetic Resonance Imaging (MRI) were useful in diagnosing the causes. Conclusion: The commonest cause of acute non-traumatic paraparesis was tuberculosis. Early use of the MRI scan helps to confirm etiology and site of lesion.

Ankylosing Spondylitis Associated with Acute Transverse Myelitis / 대한내과학회지

Neurological manifestations as extra-articular features of ankylosing spondylitis (AS) have not been reported often, and present as root lesions, cauda equina syndrome, and compression of the spinal cord. We report a 31-year-old man who complained of back pain and claudication of both lower extremities. The patient showed typical inflammatory back pain and significant sacroiliitis, consistent with AS. He also had mechanical back pain and unexplained neurological symptoms. A neurological evaluation, including spinal magnetic resonance imaging and a cerebrospinal fluid study, revealed that the patient had acute transverse myelitis (ATM). ATM can be associated with connective tissue diseases. The pathophysiology of ATM consists primarily of inflammatory disorders, similar to the neurological complications of AS. We suggest that ATM is a possible extra-articular manifestation of AS.

Mielitis transversa asociada a enfermedades autoinmunes: revisión / Autoimmune diseases associated to transverse myelitis: review

La mielitis transversa (MT), es un proceso inflamatorio que afecta un área restringida del cordón espinal. La presentación, usualmente dramática, con una rápida progresión de los síntomas que involucran las funciones motoras, sensitivas y autonómicas, hace de la MT aguda una emergencia médica. Aunque su asociación con el lupus eritematoso sistémico (LES) y el síndrome de Sjõgren (SS), ha sido reportada como rara, y no existe acuerdo con respecto al tratamiento de estos pacientes, los diferentes autores si enfatizan el hecho que un diagnóstico precoz y tratamiento agresivo, mejoran el pronóstico. En la revisión de la literatura (MEDLINE) se encontró que las principales enfermedades autoinmunes asociadas a la MT aguda son el LES y el SS. Además, se establece que los anticuerpos antifosfolipídicos (aAP) podrían tener un papel etiológico en la MT. Aunque no existen protocolos terapéuticos uniformes para el tratamiento de estos pacientes y el pronóstico, en muchos casos es pobre, ha sido postulado que el tratamiento temprano y agresivo (usualmente con bolos de esteroides y ciclofosfamida) puede ser crucial para una respuesta adecuada.

Transverse myelitis (TM) is an inflammatory process involving restricted areas of the spinal cord. The usually dramatic presentation with rapidly progressive symptoms involving motor, sensory and autonomic functions makes acute TM a medical emergency. Acute TM has been cited as a rare and unusual complication of systemic lupus erythematosus (SLE) and Sjõgren’s syndrome (SS), but early diagnosis and aggressive treatment might improve the prognosis. This review of the literature (MEDLINE), showed that, within autoimmune diseases, acute transverse myelitis is mainly associated with SLE and SS. Previous studies seem to indicate that the presence of antiphospholipid antibodies might play a role in the etiology of TM. Although no uniform therapeutic protocol exists, and the prognosis is usually poor, early aggressive treatment (usually with EV pulses of methylprednisolone and cyclophosphamide) might improve the prognosis.

Magnetic resonance imaging of spinal cord in acute transverse myelitis,neuromyelitis optica and multiple sclerosis / 重庆医科大学学报

Objective:To investigate the magnetic resonance imaging(MRI) findings of spinal cord between neuromyelitis optica(NMO),and multiple sclerosis(MS).Methods:Subjects who were diagnosed or suspected as NMO or MS in the hospital since 2004 underwent free MRI(1.5T)scanning and imaging analysis of the brain,spinal cord and eye free.with reference to magnetic records,the results of cerebrospinal fluid(CSF)and visual evoked potential(VEP),patients who fulfilled the diagnostic criteria for the latest diagnostic criteria for NMO or McDonald Criteria for MS were enrolled and the follow-up study were carried out.Results:41 patients with NMO and 121patients with MS were included in this study.As to spinal cord injury,In NMO,most patients’number of affected segments was more than 5(78.1%),and most of the patients suffered either cervical spinal cord injury or cervical-thoracic spinal cord joint injury(80.5%).The lesions changed continually,and the spinal cord swelled obviously in acute phase,with white and gray matter of spinal cord injured simultaneously.For most MS patients,the thoracic spinal injury was frequent(46.6%).There were 41 patients(59.4%)whose affected segments were more than 3,but the affection was discontinuous and progressive,and the majority was white matter injury.There was statistical difference in the affected segments between the two groups(P

Differentiation between Idiopathic Acute Transverse Myelitis and Myelopathic Multiple Sclerosis by MRI

BACKGROUND: Idiopathic acute transverse myelitis (ATM) is an inflammatory or demyelinating illness of unknown etiology. It is usually monophasic, though recurrences at the same spinal level of the initial attack have been reported. In Korea, the spinal cord is the most commonly affected site of multiple sclerosis (MS) and its clinical features often resemble those of ATM. As the prognoses of these two conditions are different, it is important to distinguish them from each other. The purpose of this study was to evaluate spinal MRI findings that could help differentiate ATM from myelopathic MS. METHODS: A total of 50 MRIs obtained less than four weeks after the onset of symptoms in 13 patients with ATM and 24 patients with clinically definite MS were reviewed retrospectively. The diagnostic criterion for ATM was a rapid onset of spinal motor and sensory dysfunction referable to a distinct spinal cord level with sphincter dysfunction, reaching its peak within 4 weeks, in the absence of pre-existing neurological diseases and spinal cord compression. For MS, Poser's criteria were used. We analyzed the lesion length, location, cross-sectional area, cord morphology, and contrast enhancement patterns in each of the groups. RESULTS: Characteristic MRI findings of ATM included; 1) centrally located hyperintensity (86%) occupying more than half of the cross-sectional area of the cord (100%), 2) thoracic preponderance in lesion location (thoracic: 7, cervicothoracic:3, cervical: 1), 3) lesion length of more than 3 vertebral segments (100%), 4) cord swelling (73%), and 5) focal or diffuse enhancement (90%). Most MRI findings of myelopathic MS (MMS) were not different from those of ATM, especially in Asian-type MS. Different MRI features of MMS from those of ATM included: 1) peripherally located hyperintensity occupying less than half of the cross-sectional area of the cord (20.8%), 2) lesion length less than two vertebral segments (33.3%), 3) normal cord morphology (25%), 4) no enhancement (36.1%), and 5) multifocality (22.2%), which were more commonly found in Western-type MS. CONCLUSIONS: Although there were some differences of spinal MRI features between ATM and MMS, it was not easy to differentiate them by MRI findings alone. The findings suggest that Asian-type MS has unique MRI characteristics similar to those of ATM and different from those of Western-type MS.