Acute Longitudinal Myelitis As The First Presentation in Child with Systemic Lupus Erythematosus Concurrent with Positive Antiphospholipid Antibody.

Systemic lupus erythematosus (SLE) is a multi-system auto-immune disorder that is characterized by widespread immune deregulation, formation of auto–antibodies, and immune complexes, resulting in infl ammation and potential damage to variety of organs. 25-95% it is complicated by neurological or neuropsychiatric symptoms, which is referred to as neuropsychiatric SLE (NPSLE). NPSLE contain both central and peripheral nervous systems, which includes transverse myelitis. We report our experience of concurrent manifestation of transverse myelitis as an initial presentation of SLE, which suggests the common immune-mediated mechanisms of diseases. We here report the case of a 7-year-old girl with SLE who fi rst presented with features of TM. Th e patient developed ascending weakness starting from low extremities, experienced diffi culty in voiding. An initial diagnosis of TM was made on the basis of clinical fi ndings and MRI spine, which displayed T2 weighted high signal intensities at thoracic level. She partially respond to intravenous immunoglobulin therapy, and serological analysis revealed the presence of anti-dsDNA, anti nuclear antibody with decreased level of complements. Th e diagnosis was revised to acute transverse myelitis resulting from SLE. Additional methylprednisolone pulse therapy led to rapid clinical improvement. Th is was followed by oral prednisolone and cyclophosphamide pulse therapy. Th e crossreactivity of auto-antibodies and increased susceptibility to infection owing to immunologic changes associated with lupus may form the basis of the association. Systemic Lupus Erytheromyitis should consider as an etiology of transverse myelitis. Aggressive treatment may alter the course and lead to a better outcome.

Neurological complications after H1N1 influenza vaccination: magnetic resonance imaging findings / Complicações neurológicas após vacinação para H1N1: achados de ressonância magnética.

Objective: To report 4 different neurological complications of H1N1 virus vaccination. Method: Four patients (9, 16, 37 and 69 years of age) had neurological symptoms (intracranial hypertension, ataxia, left peripheral facial palsy of abrupt onset, altered mental status, myelitis) starting 4-15 days after H1N1 vaccination. MRI was obtained during the acute period. Results: One patient with high T2 signal in the cerebellum interpreted as acute cerebellitis; another, with left facial palsy, showed contrast enhancement within both internal auditory canals was present, however it was more important in the right side; one patient showed gyriform hyperintensities on FLAIR with sulcal effacement in the right fronto-parietal region; and the last one showed findings compatible with thoracic myelitis. Conclusion: H1N1 vaccination can result in important neurological complications probably secondary to post-vaccination inflammation. MRI detected abnormalities in all patients. .

Objetivo: Relatar quatro diferentes complicações neurológicas da vacina contra o vírus H1N1. Método: Quatro pacientes (9, 16, 37 e 69 anos) tinham sintomas neurológicos (hipertensão intracraniana, ataxia, paralisia facial esquerda de inicio abrupto, estado mental alterado e mielite) iniciando-se 4 a 15 dias após vacinação contra H1N1. RM foi realizada em quatro pacientes na fase aguda e em um paciente na fase crônica. Resultados: Dos quatro pacientes, um apresentou hipersinal em T2 no cerebelo, interpretado como cerebelite aguda; um, com paralisia facial esquerda, tinha realce dos condutos auditivos internos, maior à direita; um tinha hipersinal em T2 no cortex parieto-occipital direito; um apresentou sinais compatíveis com mielite torácica. Conclusão: A vacinação contra o H1N1 pode resultar em importantes complicações neurológicas, provavelmente secundárias a inflamação pós-vacinal. A RM detectou anormalidades em todos os pacientes. .

Varicella-zoster virus longitudinally extensive myelitis in animmunocompetent patient / Mielite longitudinalmente extensa secundária ao vírus varicela-zóster em paciente imunocompetente

Longitudinally extensive myelitis is a severe rare complication of varicella-zoster virus infection. We report a case in a 20-year-oldimmunocompetent patient who presented with a two-week history of lower-limb paresis and paresthesia below dermatome T12, andsphincter dysfunction. He presented with a zoster rash a week prior tothe onset of neurological symptoms. Spinal cord magnetic resonanceimaging revealed a C5-T12 intramedullary lesion and cerebrospinalfluid showed lymphocytic pleocytosis and elevated varicella-zostervirus immunoglobulin G. Patient had not gained much improvement after acyclovir and pulse therapy with methylprednisolone, which prompted a five-day course of plasmapheresis. He partially recovered, but remained with sphincter impairment.

Mielite longitudinalmente extensa é uma rara e grave complicação da infecção pelo vírus varicela-zóster. Relatamos o caso de um pacientede 20 anos de idade, imunocompetente, que há duas semanas apresentou paresia de membros inferiores e parestesias abaixo dodermátomo T12, associadas com disfunção esfincteriana. Ele apresentouum rash cutâneo sugestivo de herpes uma semana antes do início dos sintomas neurológicos. A ressonância magnética de medula espinhal demonstrou uma lesão intramedular de C5 a T12, e o líquido cerebroespinhal revelou uma pleocitose linfocítica com aumento de imunoglobulina IgG para o vírus varicela-zóster. O paciente não apresentou melhora após uso de aciclovir e pulsoterapia com metilprednisolona, o que motivou um curso de cinco dias de plasmaférese.Houve recuperação parcial, porém ele permaneceu com distúrbio esfincteriano.

Feasibility and Efficacy of Stereotactic Ablative Radiotherapy for Barcelona Clinic Liver Cancer-C Stage Hepatocellular Carcinoma

The purpose of this study was to assess the feasibility and efficacy of stereotactic ablative radiotherapy (SABR) for liver tumor in patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 35 patients between 2003 and 2011. Vascular invasion was diagnosed in 32 patients, extrahepatic metastases in 11 and both in 8. Thirty-two patients were categorized under Child-Pugh (CP) class A and 3 patients with CP class B. The median SABR dose was 45 Gy (range, 30-60 Gy) in 3-5 fractions. The median survival time was 14 months. The 1- and 3-yr overall survival (OS) rate was 52% and 21%, respectively. On univariate analysis, CP class A and biologically equivalent dose > or = 80 Gy10 were significant determinants of better OS. Severe toxicity above grade 3, requiring prompt therapeutic intervention, was observed in 5 patients. In conclusion, SABR for BCLC-C stage HCC showed 1-yr OS rate of 52% but treatment related toxicity was moderate. We suggest that patients with CP class A are the best candidate and at least SABR dose of 80 Gy10 is required for BCLC-C stage.

Mielites infecciosas / Infeccious myelitis

As mielopatologias possuem etiologias variadas, incluindo: trauma, autoimunidade, neoplasia, vascular, hereditária, degenerativa, e infecciosa. Este artigo descreve as causas infecciosas mais comuns de disfunção da medula espinhal.

The pathologies of the spinal cord have different etiologies. Besides trauma, other common causes of myelopathy include also autoimmune, neoplastic, vascular, hereditary, degenerative and infectious diseases. Therefore, this article will review some of the most common infectious causes of dysfunction of the spinal cord and their pathogenesis, clinical manifestations and diagnosis correlate. Method: Scientific papers published in national and international medical journals available on CAPES, Pubmed and Uptodate, were reviewed.

Spinal cord response to altered fractionation and re-irradiation: radiobiological considerations and role of bioeffect models.

The aim of radiation oncologist is to implement an uncomplicated loco regional control of cancer by radiation therapy. The bioeffect of a physical dose depends on the nature of the tissue, fractionation scheme, dose rate and treatment time. The transformation of absorbed dose into a bioeffect dose is controlled by treatment variables and the radiobiological characteristics of the relevant tissue. Various bioeffect models have been proposed to predict the biological effect of radiotherapy treatments. Dale has proposed extrapolated response dose (ERD) equations for external beam therapy, intracavitary brachytherapy and interstitial brachytherapy. Within the context of the LQ model, the parameter which quantifies the overall biological effect on a given tissue is the biologically effective dose (BED) which is obtained by applying repopulation correction to ERD (Orton). Thames proposed the total effect (TE) concept based on the incomplete repair LQ model which accounts for the biological effect of a fractionated course of radiotherapy. Spinal cord myelitis limits the dose to tumours in the head and neck, thoracic and upper abdominal regions resulting in reduction of tumour control probability. Radiation myelopathy is one of the most devastating complications of clinical radiotherapy. Treatment techniques that are designed to minimize the risk of spinal cord injury are likely to underdose the tumour consequent failure to control the disease. Since radiation myelopathy results in severe and irreversible morbidity, it is important to establish the tolerance dose of the spinal cord. A number of patients have recently been reported to have developed radiation myelopathy following hyperfractionated accelerated radiotherapy. As the survival rates of patients increase, radiation oncologists are more frequently faced with the problem of treatment of late recurrence or second tumours situated within or close to previously treated site. A rationale for taking a decision in treating in such a condition is even more complex than the original condition and requires knowledge of the kinetics of decay of occult injury of the previous treatment. To test the validity of ERD, clinically reported data of altered fractionation to the spinal cord for 7 patients reported by Wong et al, Saunders et al and Bogaert et al, were analysed, ERD values were calculated and compared with compiled clinical literature data of 3233 patients for the incidence of spinal cord myelitis reported by Cohen and Creditor, Wara et al, Abbatucci et al and Jeremic et al for conventional fractionation. ERD values were estimated with alpha/beta of 2.5 Gy for the conventional and altered fractionation data. To test the validity of TE concept for clinical data of re-irradiation tolerance of the spinal cord, the data of the 22 patients compiled by Nieder et al were used. Clinical data compiled from the literature of Cohen and Creditor, Wara et al, Abbatucci et al and Jeremic et al, were used for comparison.

Chickenpox at a Moroccan adult

Chickenpox is a benign viral affection. But, that can have complications especially in late onset of the disease. We report a case who presented witha myelitis two days after having developed typical skin eruption of varicella, with fever. The clinical signs decreased after Aciclovir and corticosteroids treatment. We also discuss the mechanism and the treatment of this varicella myelitis especially in the late onset

Neurological complications of measles.

OBJECTIVE: To study the clinical features and course of neurological complications of measles. DESIGN: Prospective study. SETTING: Neurology Unit, Teaching Hospital, Kandy. PATIENTS: 10 patients admitted with neurological complications of measles during an outbreak. MEASUREMENTS: Assessment of clinical features and the neurological investigations. RESULTS: 6 had CSF IgM antibodies confirming a recent measles infection. 7 patients had encephalitis and 3 had myelitis. Complications had appeared 5 to 14 days after appearance of the rash. All patients with encephalitis had depressed level of consciousness (Glasgow coma scale 2 to 11) with seizures, 3 patients had lateralising signs, and assisted ventilation was required in 4. Cranial CTs were either normal or showed mild cerebral oedema. CSF analysis showed either normal or mildly raised protein without a cellular reaction. EEG in all 7 revealed diffuse delta activity. During the follow up period of 1 to 12 weeks, all showed a gradual improvement, except one who succumbed to respiratory complications of assisted ventilation. All others were left with some residual disability when last seen. Three patients with myelitis had symmetrical paraparesis. CSF protein was 60 to 80 mg/ml without a cellular reaction. All three improved without residual disability. CONCLUSIONS: Measles encephalitis is a life threatening complication. All three myelitis patients recovered completely within 5 to 8 weeks.

Granulomatose septique chronique chez une fillette revelee par une aspergilose pulmonaire invasive et une paraplegie flasque

The invasive Pulmonary Aspergillosis [lPA] is the principal cause of death in patients with chronic granulomatosis disease [CGD]. It can happen before age of one and can reveal the [CGD]. Usually, the transmission of GSD is linked to in 65% of cases. We report, the case of a girl aged 3 years issued from consanguine mariage referred to hospital for hemoptysia. We note that at 40 days she presents an suppurate adenitis. She is hypotrophic at 3DS without respiratory problem, she has a splenomegaly. The radiography chest note an alveolar and interstitiel opacity bilateral, apical right and basal left. There is a biological inflammatory syndrome. During the evolution, the child presents a paraplegia secondary to cornpression myelitis. A D5 laminectomy in urgency was done. The vertebral Biopsia, the serology and the culture isolate fumigatus aspergillus the GCD is evoqued confirmed by the NBT test who was negatif. In We have to look for GCD in front of pulmonary aspergillus The vertebra lesion is secondary to pulmonary lesion. Our observation is noticeable by the recessive autosomal transmission who was seen in 35% of cases, and by the neurologic complication rarely reported

Neuroesquistossomose mansônica: aspectos clínicos, laboratoriais e terapêuticos / Mansonic neuroschistosomiasis: clinical, laboratory and therapeutic aspects

Os autores relatam 16 casos de pacientes com forma meningomielorradicular da neuroesquistossomose mansônica, diagnosticados segundo critérios clinicos, laboratoriais e de imagem, acompanhados no Ambulatório de Neurologia-HUPES-UFBA no período de abril/91 a dezembro/93. Eles foram tratados com praziquantel associado a corticoterapia. O objetivo foi avaliar o grau de eficássia e de segurança da droga na regressao dos sinais e sintomas neurológicos.

Brucellosis and polyneuroradiculomyeloencephalitis: a case report

Reports on simultaneous central and peripheral nervous system involvement in a patient with brucellosis are very rare. We report of one young female patient with a long history of consumption of non-pasteurized dairy products in which clinical and laboratory findings confirmed the existence of an active brucellosis with nervous system impairment. Cerebrospinal fluid were negative. Elctrophysiology and positive findings on sural nerve biopsy complemented the diagnosis of polyneuroradiculomyelo encephalitis. Treatment with a combination of doxycycline and rifampin for 2 months was successfully applied. No relapse or sequelae occurred in the patient after 12 monts of follow up

Infectious etiologies of non-compressive myelopathy

This work was carried out to study various clinical presentations of myelopathy and clarify different suspected cord lesions. Twenty-nine males and nine females patients as well as ten age matched controls of both sex were chosen. All patients and controls were subjected for a set of laboratory investigation to verify different etiologies. About 47.4% of the cases had duration of illness less than three months and 36.8% had duration of illness more than six months. Over half of the patients were presented with a combination of motor, sensory and autonomic disturbance, while isolated motor affection was reported in 34.2% and about 55.3% of the studied cases had sensory level of hyposthesia [dorsal region in 34.2% and cervical region in 21.1%]. Serological and CSF laboratory studies revealed that most frequent organism was brucella [26.3%] especially among female patients, followed by bilharzia [15.8%]then toxoplasma and mycoplasma [10.5% for each] followed by cytomegalovirus [5.3%] and lastly infectious mono-nucleosis [2.6%]

Menigorradiculite esquistossomótica: estudo clínico-laboratorial de três casos tratados / Schistosomial meningoradiculitis: clinico-laboratory study of 3 treated cases

Os autores apresentam três casos de mielorradiculite por Schistosoma Mansoni, com avaliaçäo clínico-laboratorial, discutindo aspectos fisipatológicos e salientando que o esquema terapêutico mostrou-se eficaz

Paraparesia espástica tropical asociada a HTLV*I / Tropical spastic paraparesis asosciated HTLV-I infection

Reportamos el caso de un paciente con paraparesia espástica crónica, idiopática y no hereditaria en quien se encontró en los análisis de Western Blot la presencia de anticuerpos a Virus Linfotrópico T Humano de Tipo I (HTLV*I) en suero y en líquido cefaloraquídeo. Este es el primer caso de paraparesia espástica asociada a infección por HTLV*I detectado en nuestro Hospital y demuestra la urgente necesidad de realizar nuevos estudios para definir las características clínicas y epidemiológicas de esta enfermedad en nuestro país

Algunas complicaciones neurológicas de la brucelosis / Some neurological complications of the brucellosis

Se presenta tres casos de Brucelosis con alteraciones neurológicas, caracterizadas por meningoencefalitis, meningomielitis y poliradiculoneuritis. El diagnóstico se comprobó por títulos altos para Brucella en el suero para los tres casos y hemocultivo positivo en los dos primeros. Todos los pacientes presentaron LCR de carácter inflamatorio y evolución favorable cuando el tratamiento antibiótico fue el adecuado. En los tres casos el diagnóstico inicial fue rectificado posteriormente por las pruebas de laboratorio. Se revisa la literatura acerca del diagnóstico de las complicaciones neurológicas y se dan recomendaciones actualizadas para el tratamiento de las diversas formas de Neurobrucelosis