Congestive myelopathy due to spinal dural arteriovenous fistula mimicking CNS demyelinating disease

Spinal dural arteriovenous fistula (SDAVF) is known for its ambiguous and various clinical presentations. Among these presentations, congestive myelopathy is one of the most common, yet it is challenging to correctly diagnose SDAVF at initial presentation. Several diseases present as myelopathy, including demyelinating diseases. Herein, we present two cases of congestive myelopathy due to SDAVF presenting to the emergency room (ER) with progressive quadriparesis. Even though the patients had a proper magnetic resonance imaging (MRI) examination from the initial presentation, there was a delay in making a final diagnosis. Both patients’ clinical presentation and MRI mimicked central nervous system (CNS) demyelinating disease initially, and a more thorough examination revealed SDAVF. Such a delay in diagnosis can result in more neurological deterioration and may result in more sequelae. Hence, SDAVF should always be considered as a differential diagnosis when examining patients with myelopathy.

CLOCC Patient after COVID-19 (BNT162b) Vaccine Improved by Steroid Treatment

Cytotoxic lesions of the corpus callosum (CLOCC) are secondary lesions on corpus callosum caused by cytokinopathy of callosal neurons and microglia. Fever, headache, and digestive disturbances are common symptoms. Reversible and hyperintense signals on fluid‐attenuated inversion recovery imaging, diffusion‐weighted imaging (DWI) and decreased apparent diffusion coefficient are typical features of magnetic resonance imaging. Herein, we report a rare case of CLOCC caused by COVID19 vaccination (BNT162b) and discharged without no neurologic symptoms due to prompt treatment.

A Case of POEMS Syndrome Previously Diagnosed with Extramedullary Plasmacytoma / 대한신경근육질환학회지

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) syndrome is a rare multisystem disorder associated with osteosclerotic myeloma. It is characterized by peripheral polyneuropathy, presence of monoclonal plasma cell proliferative disorder, and one or more of the following features – sclerotic bone lesions, Castleman disease, elevated levels of vascular endothelial growth factor, organomegaly, extravascular volume overload, endocrinopathy, skin changes, papilledema, and thrombocytosis. Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm that arises in isolated tissues without bone marrow involvement or systemic characteristics of multiple myeloma. Herein, we report a male patient who was previously diagnosed with EMP and later developed POEMS.