ABSTRACT
Objetivo: Relatar caso clinico de uma paciente com Mielite Transversa diagnosticada com Lúpus Eritematoso Sistêmico e Zika Vírus. Relato de Caso: Paciente diagnosticada em Lúpus Eritematoso Sistêmico (LES) com nefrite lúpica classe IV há 15 anos em remissão, iniciou quadro de mialgia difusa prejudicando deambulação. Após melhora espontânea do quadro, paciente permaneceu com queixa de astenia e cefaleia intensa unilateral esquerda recorrente, evoluindo com síncope, paraparesia em membro inferior em caráter progressivo ascendente seguido de crise convulsiva tipo tônico clônico generalizado de inicio disruptivo. Um primeiro exame do liquor cefalorraquidiano (LCR) foi solicitado, sem evidência de alteração na analise bioquímica simples. Outras alterações laboratoriais foram identificadas, além do método de reação em cadeia de polimerase (PCR) para Zika vírus na urina e liquor cefalorraquqidiano (após recoleta) detectáveis. Foram detectadas alterações à ressonância magnética compatíveis com mielite transversa. A investigação etiológica durou dois meses e meio, com duas internações no período. Apesar das manifestações neurológicas do Zika Vírus serem ordinariamente inespecíficas, raras e brandas, não se deve desconsiderar a hipótese diagnostica de mielite transversa em área endêmica para arboviroses com manifestações neurológicas mesmo após liquor cefalorraquidiano e outros exames inespecíficos com o achado clínico, considerando paciente remissiva do quadro de lupus eritematoso sistêmico há 15 anos
Objective: case report of a patient with transverse myelitis diagnosed with systemic lupus erythematosus and zika Virus. Case report: Patient diagnosed with Systemic Lupus Erythematosus (SLE) with class IV lupus nephritis for 15 years in remission, begins to have diffuse myalgia, impairing walking. After spontaneous improvement of the condition, the patient remained complaining of asthenia and recurrent left unilateral severe headache, evolving with syncope, progressive ascending paraparesis in the lower limb, followed by a generalized tonic clonic seizure type of disruptive onset. A first examination of the cerebrospinal fluid (CSF) was requested, without evidence of alteration in the simple biochemical analysis. Other laboratory alterations were identified, in addition to the polymerase chain reaction (PCR) for detectable Zika virus in urine and cerebrospinal liquor (after collection). Changes were detected on magnetic resonance imaging (MRI) compatible with transverse myelitis. The etiological investigation lasted two and a half months, with two hospitalizations in the period. Although the neurological manifestations of Zika Virus are ordinarily nonspecific, rare and mild, the diagnostic hypothesis of transverse myelitis in an endemic area for arboviruses with neurological manifestations should not be disregarded even after cerebrospinal fluid and unspecific with the other clinical, remissive of the clinical picture lupus erythemasous systemic 15 years ago.
Subject(s)
Lupus Erythematosus, Systemic , Myelitis, Transverse/diagnosis , Lupus Nephritis , Zika Virus , Neurologic ManifestationsABSTRACT
This study showed that laboratory markers of recent infection by dengue, Zika or chikungunya arboviruses were detected in the biological samples of approximately one-third of patients with encephalitis, myelitis, encephalomyelitis or Guillain-Barré syndrome, in a surveillance programme in Piauí state, Brazil, between 2015-2016. Fever and myalgia had been associated with these cases. Since in non-tropical countries most infections or parainfectious diseases associated with the nervous system are attributed to herpesviruses, enteroviruses, and Campylobacter jejuni, the present findings indicate that in tropical countries, arboviruses may now play a more important role and reinforce the need for their surveillance and systematic investigation in the tropics.
Subject(s)
Humans , Chikungunya virus/genetics , Chikungunya virus/immunology , Dengue Virus/genetics , Dengue Virus/immunology , Zika Virus/genetics , Zika Virus/immunology , Acute Disease , Reverse Transcriptase Polymerase Chain Reaction , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/virology , Encephalitis/diagnosis , Encephalitis/virology , Encephalomyelitis, Acute Disseminated/diagnosis , Encephalomyelitis, Acute Disseminated/virology , Enzyme-Linked Immunospot Assay , Myelitis, Transverse/diagnosis , Myelitis, Transverse/virology , Nervous System Diseases/diagnosis , Nervous System Diseases/virologyABSTRACT
La mielitis transversa longitudinal extensa (MTLE) se define como lesión de la médula espinal con una extensión de tres o más cuerpos vertebrales. La presentación clínica dependerá del área anatómica afectada incluyendo paraparesia, paraplejia, parestesias o pérdida sensorial en diferentes modalidades, síntomas urinarios entre otros. Sus etiologías son diversas como ser procesos metabólicos, tóxicos, inflamatorios, infecciosos. En el presente artículo describimos tres interesantes casos clínicos de MTLE. El primero una paciente joven con neuromielitis óptica; el segundo una paciente con neurosarcoidosis y el último caso un paciente con mielopatía tóxica producida por abuso de óxido de nitrógeno. Todos ellos con presentación clínica y radiológica similar resaltando la importancia de la obtención de una buena historia clínica.
Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that compromise 3 or more vertebral segments. Clinical presentation varies and will depend on the anatomical area that is compromised including paraparesis, paraplegia, paresthesia or sensory loss of any modalities and urinary or bowel symptoms. The etiologies are several such as toxic - metabolic abnormalities, inflammatory or infectious. Here in we present three interesting cases of LETM; the first case is a young patient with neuromyelitis optica; the second a case of neurosarcoidosis and the last case a toxic myelopathy secondary to nitrous oxide abuse. All of them with similarities in their clinical and radiologic presentation but with different etiologies highlighting the importance of obtaining a good medical history.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Myelitis, Transverse/drug therapy , Spinal Cord Diseases/pathology , Myelitis, Transverse/diagnosisSubject(s)
Aged , Female , Humans , Myelitis, Transverse/diagnosis , Neuromyelitis Optica/diagnosis , Age of Onset , Time FactorsABSTRACT
The conus medullaris is frequently affected by inflammatory and infectious lesions which many times are hardly differentiated because of the similarity of their clinical history and physical examination among the different etiologies. Magnetic resonance imaging presents high sensitivity in the detection of these lesions and plays a relevant role in the diagnosis as well as in the evolutive control of the condition. The present pictorial essay with selected cases from the archives of the authors' institution is aimed at demonstrating imaging findings which might help in the diagnosis of a specific etiology amongst inflammatory an infectious conditions and in the differentiation with diseases of neoplastic and vascular etiologies, for example. Findings such as enhancement pattern, presence of cysts, edema and involvement of other regions of the central nervous system are important for this differentiation, and may define a specific etiology as associated with clinical and laboratory tests findings.
O cone medular é frequentemente acometido por lesões de etiologia inflamatória e infecciosa, muitas vezes de difícil diferenciação devido a história clínica e exame físico semelhantes entre as diversas entidades. A ressonância magnética apresenta alta sensibilidade na detecção de lesões no cone medular e tem importante papel no diagnóstico e controle evolutivo. Este ensaio iconográfico com casos selecionados dos arquivos do nosso serviço tem como objetivo demonstrar achados de imagem que possam auxiliar no diagnóstico de uma etiologia específica entre as doenças inflamatórias e infecciosas e na diferenciação com doenças de outras etiologias como neoplasias e causas vasculares. Características como padrão de realce, presença de cistos, edema, além do acometimento de outras regiões do sistema nervoso central são importantes para esta diferenciação, podendo definir uma etiologia específica quando associadas ao quadro clínico e laboratorial.
Subject(s)
Humans , Diagnosis, Differential , Spinal Cord/physiopathology , Myelitis, Transverse/diagnosis , Neurocysticercosis/diagnosis , Neuroschistosomiasis/diagnosis , Sarcoidosis/diagnosis , Tuberculosis, Central Nervous System/diagnosis , Magnetic Resonance SpectroscopyABSTRACT
Cuando existe un proceso infeccioso inflamatorio a nivel del sistema nervioso central de cualquier causa, las lesiones no quedan limitadas al lugar primariamente afectado. Actualmente las meningoencefalitis se clasifican en primarias, secundarias y de etiología desconocida. En las secundarias el agente etiológico no afecta directamente el sistema nervioso central sino que lo hace a través de un mecanismo de hipersensibilidad. La varicela es una enfermedad infecciosa contagiosa aguda que se caracteriza por un exantema vesicular generalizado. Causada por el virus varicelazoster, esta afección puede causar complicaciones neurológicas entre las cuales las más temidas son la encefalitis de evolución fulminante y la mielitis transversa, esta última referida a un síndrome clínico en el cual hay señales de pérdida parcial o total de las funciones neurológicas por debajo de una lesión que, en cuanto a su patología, suele tener una dimensión longitudinal limitada en la médula espinal. Se conoce además que predispone a superinfecciones por estafilococos aureus y estreptococos del grupo A. Se presenta un caso clínico de meningoencefalomielitis en el curso de una varicela zoster que requirió ingreso en la Unidad de Cuidados Intensivos del Hospital General Docente de Morón Capitán Roberto Rodríguez Fernández.
When an inflammatory infectious process at level of the central nervous system of any cause exists, the injuries are not limited to the primarily affected place. Nowadays the meningoencephalitis is classified in primary, secondary and unknown aetiology. In secondary the etiologic agent does not affect the central nervous system directly but that does through a hypersensitivity mechanism. Chickenpox is an acute contagious infectious disease that is characterized by a generalized vesicular exanthema. Etiologically caused by varicella-zoster virus, this affection can cause neurological complications. The most feared complications are the encephalitis of sudden evolution and transverse myelitis, this last one referred to a clinical syndrome in which there are signals of partial or total loss of neurological functions below an injury that as far as its pathology usually has a limited longitudinal dimension in the spinal cord. It also knows that predispose to super infection by staphylococcus aureus and group A Streptococcus. A clinical case of meningoencephalomyelitis is presented in the course of a varicella zoster that it required admission in the intensive care unit from General Teaching Hospital, in Moron Capitán Roberto Rodríguez Fernández.
Subject(s)
Humans , Male , Female , Myelitis, Transverse/complications , Myelitis, Transverse/diagnosis , Case ReportsABSTRACT
Transverse myelitis is a very rare neurological condition associated with immunologic and infectious conditions causing interruption of the neuroanatomical pathways in a transverse plane in the spinal cord. Herein is described the fatal case of a patient that developed transverse myelitis after a Caesarean delivery, probably related to the epidural analgesia.
La mielitis transversa es un trastorno neurológico poco común, asociado con problemas inmunológicos e infecciosos que causan interrupciones de las vías neuroanatómicas en el plano transversal de la médula espinal. Aquí se describe el caso fatal de una paciente que desarrolló mielitis transversal luego de un parto con cesárea, probablemente en relación con la anestesia epidural.
Subject(s)
Adult , Female , Humans , Anesthesia, Epidural/adverse effects , Myelitis, Transverse/diagnosis , Myelitis, Transverse/etiology , Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Fatal Outcome , Magnetic Resonance Imaging , Postpartum PeriodABSTRACT
La mielitis transversa es una enfermedad inflamatoria que se caracteriza por disfunción de la médula espinal. Las causas reconocidas de mielitis transversa son autoinmunes, enfermedades desmielinizantes, post infecciosas y post vacunales, aunque hasta el 50% de los casos son idiopáticas. Las vacunas contra la rubéola, paperas, rabia y gripe estacional han sido asociadas a diversos trastornos neurológicos, como el Síndrome de Guillain Barré, la encefalomielitis diseminada aguda (ADEM) y la mielitis transversa. Como mecanismo preventivo luego de la pandemia de 2009, en febrero del año 2010 se inició en nuestro país la campaña de vacunación contra la Influenza A (H1N1). Se presenta el caso de una paciente con hipoestesias que aparecieron cuatro días después de haber recibido la vacuna monovalente anti-influenza A (H1N1) y progresaron con evidente nivel sensitivo. La paciente cumplía criterios diagnósticos de mielitis transversa, según el Transverse Myelitis Consortium Working Group. Tuvo remisión de las imágenes de la resonancia magnética y estabilidad clínica sin tratamiento con corticoides. Se discuten aspectos diagnósticos, pronósticos y terapéuticos de esta entidad clínica.
Transverse myelitis is an inflammatory disorder characterized by spinal cord dysfunction. Infectious, autoimmune, postinfectious and postvaccination diseases are the most common recognized causes of transverse myelitis, but near 50% of the cases are finally assumed as idiopathic. Rubeolla, mumps, rabies and influenza vaccines were associated with many neurologic complications, such as Guillain Barré Syndrome, acute disseminated encephalomyelitis (ADEM) and transverse myelitis. As a prevention measure after the 2009 pandemia, in February 2010 a National Campaigne of Vaccination against the Influenza A (H1N1) was started in our country. We report a case of a woman who received a monovalent Influenza A (H1N1) vaccine and four days after, began with sensory symptoms that progressed to a clear defined sensory level. She reached the clinical criteria of transverse myelitis, according to the Transverse Myelitis Consortium Working Group. One month later, the patient remained clinically stable and the MRI showed an improvement of the image without corticosteroids treatment. We discuss diagnostic, prognostic and therapeutic aspects of this clinical entity.
Subject(s)
Adult , Female , Humans , Influenza A Virus, H1N1 Subtype/immunology , Influenza Vaccines/adverse effects , Myelitis, Transverse/etiology , Myelitis, Transverse/diagnosisABSTRACT
Complications involving the central nervous system in patients suffering from hepatitis C virus (HCV) infectionhave been rare. Among them, it appears the transverse myelitis, which has already been reported in likely association with HCV. This paper presents the case study of a 65-year-old woman who developed cervical transverse myelitis linked to chronic HCV infection and anti-HCV antibodies in the spinal fluid, being excluded other etiologies for transverse myelitis. Current evidence has reinforced the likely association between chronic HCV infection and transverse myelitis, especially as recurrent manifestations of the disease. These findings reveal the need for more searching to establish the causal relationship between transverse myelitis and hepatitis C.
Subject(s)
Aged , Female , Humans , Hepatitis C, Chronic/complications , Myelitis, Transverse/etiology , Fatal Outcome , Hepatitis C, Chronic/diagnosis , Myelitis, Transverse/diagnosisSubject(s)
Adult , Humans , Leptospirosis/complications , Male , Myelitis, Transverse/diagnosis , Zoonoses/microbiologyABSTRACT
Transverse myelitis (TM) extending from midbrain to the entire spinal cord accompanied by internuclear ophthalmoplegia is extremely rare but cause serious central nervous system complications in patients with systemic lupus erythematosus. We report a case of a 28-yr-old woman with TM extending from the midbrain to the conus medullaris longitudinally and internuclear ophthalmoplegia associated with systemic lupus erythematosus. Her neurological symptoms had an abrupt catastrophic onset and rapidly progressed to respiratory failure within 24 hr. Bilateral internuclear ophthalmoplegia was also followed by TM. Brain MR images showed definite brainstem lesions, which were deeply associated with internuclear ophthalmoplegia, and diffuse signal changes in the whole spinal cord, medulla, pons and midbrain. Clinical improvement of her ophthalmoplegia and of neurological dysfunction of the upper extremities was noted after prompt and aggressive treatment with intravenous pulsed methylprednisolone and cyclophosphamide. However, the neurological dysfunction of the lower limbs and bladder and colon paralysis were almost unchanged until six months passed.
Subject(s)
Adult , Female , Humans , Cyclophosphamide/therapeutic use , Lupus Erythematosus, Systemic/complications , Magnetic Resonance Imaging , Myelitis, Transverse/diagnosis , Ocular Motility Disorders/diagnosis , Prednisolone/therapeutic useABSTRACT
A few cases of necrotizing myelitis have been reported in adults since its first description in 1973. No case has been described in the pediatric age group. A 12-year-old boy, who presented with acute flaccid paraplegia, loss of sphincter control and sensory loss showed features suggestive of necrotizing myelitis on magnetic resonance imaging. Investigations carried out could not reveal a specific etiological or pre-disposing factor. No clinical improvement occurred despite the therapy.
Subject(s)
Child , Humans , Immunocompetence , Male , Myelitis, Transverse/diagnosisABSTRACT
La mielitis transversa aguda se clasifica dentro de las leucomielopatías agudas, siendo una de las enfermedades desmielinizantes inflamatorias de más difícil diagnóstico y de pronóstico reservado debido a la gravedad del daño producido y sus secuelas funcionales. En esta patología, la conducción de los impulsos nerviosos ascendentes medulares resulta totalmente bloqueada en uno o más segmentos, pudiendo llevar a una parálisis sensitivo motora y autonómica con pérdida de control intestinal y vesical. Su etiología se desconoce, pero alrededor del 30 al 50 por ciento de los casos aparecen tras enfermedades virales inespecíficas y es más frecuente en pacientes menores de 40 años; también puede ser expresión de un brote de esclerosis múltiple o asociarse a ciertas infecciones bacterianas, como reacción ante vacunas o aparecer en adictos a drogas por vía intravenosa. Otras causas descritas son fármacos, como la sulfasalazina; las neoplasias, como el linfoma de células B y la leucemia mielomonocítica y paraneoplásica, fundamentalmente secundaria a carcinoma broncogénico. Las investigaciones avalan que la fisiopatología del cuadro es producto de una reacción inflamatoria de carácter autoinmune desencadenada por estas situaciones. El diagnóstico y el tratamiento oportuno favorecen la total recuperación de los síntomas. Sin embargo, es habitual que, frente al desconocimiento de la enfermedad y a la inoportuna consulta al especialista, personas jóvenes y económicamente productivas, queden gravemente secueladas. Por otro lado, la nula rehabilitación de los pacientes a nivel de la salud pública hace que el pronóstico sea aún más desfavorable.
Subject(s)
Humans , Acute Disease , Myelitis, Transverse/diagnosis , Myelitis, Transverse/etiology , Myelitis, Transverse/history , Myelitis, Transverse/therapy , Diagnosis, Differential , PrognosisABSTRACT
La siringomielia no comunicante ha sido descrita en asociación con diversas patologías medulares, pero raramente ha sido reportada en relación con lesiones desmielinizantes. Presentamos un paciente de 39 años, varón, con antecedentes de herpes zoster craneal en 1996 que evolucionó con omalgia izquierda y cervicalgia persistente. La resonancia magnética (RM) de médula cervical evidenció lesión intramedular focal a nivel C4-C5 de aspecto desmielizante, y la presencia de hidrosiringomielia nivel C6. El paciente rehusó nuevos procedimientos. En 1998 agrega signo de Lhermitte. Una nueva RM espinal mostró reducción de la lesión intramedular cervical con persistencia de la siringomielia no comunicante. La RM cerebral objetivó una única lesión puntiforme en el brazo posterior de la cápsula interna derecha. Las serologías para HIV, herpes, HTLV I-II, VDRL y potenciales evocados fueron normales. En septiembre de 1998 se encontraba asistomático, con examen neurológico normal y sin cambios en el control por imágenes. La evolución clínica y hallazgos neurorradiológicos sugieren una lesión primariamente desmielinizante versus un mecanismo postinfeccioso La patogénesis de la siringomielia no comunicante asociada alesiones desmielinizantes es discutida: se postula dilatación ependimaria mécanica por obstrucción al flujo del líquido cefalorraquídeo causado por el edema de la placa espinal versus dilatación ependimaria secundaria a mielomalacia. Pese a su baja prevalencia y a la dificultad diagnóstica que plantea la ausencia de un patrón radiológico característico, la patología desmielinizante debería considerarse entre los diagnósticos diferenciales de lesiones intramedulares asociadas a hidromielia, ya que en estos casos el abordaje quirúrgico no estaría indicado
Subject(s)
Humans , Male , Adult , Myelitis, Transverse/complications , Syringomyelia/etiology , Diagnosis, Differential , Magnetic Resonance Spectroscopy , Myelitis, Transverse/diagnosis , Syringomyelia/diagnosisABSTRACT
Magnetic resonance imaging findings in 13 patients with acute transverse myelitis are reviewed. In 12 cases centrally located high intensity signal extending over few spinal segments was noted. The lesion occupied more than two thirds of the cord's cross-sectional area in 8 patients. Central dot sign was noted in 7 patients. Variable cord enlargement was seen in 5 patients. Contrast study in one patient showed peripheral enhancement. The MR characteristics that help in differentiating transverse myelitis from spinal form of multiple sclerosis are discussed.
Subject(s)
Adolescent , Adult , Child , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/diagnosis , Myelitis, Transverse/diagnosisABSTRACT
Material y métodos. Se estudiaron, de marzo de 1996 al mismo mes de 1998, 22 pacientes (14 mujeres, 63.3 por ciento, y 8 hombres, 18.2 por ciento) hospitalizados en el Servicio de neurología con diagnóstico de mielopatía no traumática (MNT). Se les realizó una evaluación Neurológica completa, un estudio del líquido cefalorraquídeo (LCR) e imagen por resonancia magnética (IRM) o tomografía axial computada (TAC). Se evaluaron las causas de MNT, la evolución funcional al egreso y cada tres meses hasta completar un año. Resultados: el rango de edad fue de 17 a 78 años (media: 46.5 ñ 16.15); nueve pacientes (40.5 por ciento) tenían antecedentes de proceso infeccioso. El inicio de los síntomas varió de 3 a 330 h; en 91 por ciento fue torácica, 4.5 por ciento cervical y 4.5 por ciento lumbar; 59 por ciento tuvieron síndrome de sección medular y 86.4 por ciento afección de esfínteres. Se efectuó el estudio del LCR a 19 pacientes: 78.9 por ciento fue anormal, destacando pleocitosis e hiperproteinorraquia, BAAR en 3 y en uno se observaron amibas de vida libre: La IRM fue anormal en 90.4 por ciento. La evolución funcional tuvo tendencia hacia la mejoría, p< 0.001: los diagnósticos fueron: 50 por ciento mielitis transversa, 13.6 por ciento tuberculosis, 13.6 por ciento tumores, 13.6 por ciento esclerosis múltiple, 4.5 por ciento enfermedad vascular y 4.5 por ciento amibas de vida libre