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BACKGROUND AND PURPOSE: The early prediction of recurrence after an initial event of transverse myelitis helps to guide preventive treatment and optimize outcomes. Our aim was to identify MR imaging findings predictive of relapse and poor outcome in patients with acute transverse myelitis of unidentified etiology. MATERIALS AND METHODS: Spinal MRIs of 77 patients (mean age, 36.3 ± 20 years) diagnosed with acute transverse myelitis were evaluated retrospectively. Only the patients for whom an underlying cause of myelitis could not be identified within 3 months of symptom onset were included. Initial spinal MR images of patients were examined in terms of lesion extent, location and distribution, brain stem extension, cord expansion, T1 signal, contrast enhancement, and the presence of bright spotty lesions and the owl's eyes sign. The relapse rates and Kurtzke Expanded Disability Status Scale scores at least 1 year (range, 1-14 years) after a myelitis attack were also recorded. Associations of MR imaging findings with clinical variables were studied with univariate associations and binary log-linear regression. Differences were considered significant for P values < .05. RESULTS: Twenty-seven patients (35.1%) eventually developed recurrent disease. Binary logistic regression revealed 3 main significant predictors of recurrence: cord expansion (OR, 5.30; 95% CI, 1.33-21.11), contrast enhancement (OR, 5.05; 95% CI, 1.25-20.34), and bright spotty lesions (OR, 3.63; 95% CI, 1.06-12.43). None of the imaging variables showed significant correlation with the disability scores. CONCLUSIONS: Cord expansion, contrast enhancement, and the presence of bright spotty lesions could be used as early MR imaging predictors of relapse in patients with acute transverse myelitis of unidentified etiology. Collaborative studies with a larger number of patients are required to validate these findings.
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Imageamento por Ressonância Magnética/métodos , Mielite Transversa/diagnóstico por imagem , Adolescente , Adulto , Criança , Meios de Contraste , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/etiologia , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The specificity of the aquaporin-4 antibody to predict recurrent inflammatory central nervous system disease has led to the design of the 2015 neuromyelitis optica spectrum disorder criteria which capture all aquaporin-4 antibody seropositive patients. OBJECTIVE: The purpose of this study was to compare treatment outcomes in aquaporin-4 antibody seropositive patients who met the previous 2006 clinical criteria for neuromyelitis optica with patients who meet the 2015 neuromyelitis optica spectrum disorder criteria. METHODS: The study involved a three-center retrospective chart review of clinical outcomes among aquaporin-4 patients diagnosed with neuromyelitis optica and neuromyelitis optica spectrum disorder. RESULTS: Hazard ratios of relapse during immunosuppressive therapy, relative to pre-therapy, were not significantly different for patients who met the 2006 criteria of neuromyelitis optica versus the 2015 neuromyelitis optica spectrum disorder criteria among those treated with azathioprine ( p = 0.24), mycophenolate mofetil ( p = 0.63), or rituximab ( p = 0.97). CONCLUSION: Reductions in the hazard of relapse during treatment with immunosuppressive therapies, relative to average pre-treatment, were not different for aquaporin-4 antibody seropositive patients categorized using the 2006 criteria of neuromyelitis optica and the 2015 neuromyelitis optica spectrum disorder criteria. These therapeutic findings support the design of the 2015 neuromyelitis optica spectrum disorder criteria which capture all aquaporin-4 antibody seropositive patients.
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BACKGROUND AND PURPOSE: Neuromyelitis optica spectrum disorders are inflammatory demyelinating disorders with optic neuritis and/or longitudinally extensive transverse myelitis episodes. We now know that neuromyelitis optica spectrum disorders are associated with antibodies to aquaporin-4, which are highly concentrated on astrocytic end-feet at the blood-brain barrier. Immune-mediated disruption of the blood-brain barrier may manifest as contrast enhancement on brain MR imaging. We aimed to delineate the extent and frequency of contrast enhancement on brain MR imaging within 1 month of optic neuritis and/or longitudinally extensive transverse myelitis attacks and to correlate contrast enhancement with outcome measures. MATERIALS AND METHODS: Brain MRIs of patients with neuromyelitis optica spectrum disorders were evaluated for patterns of contrast enhancement (periependymal, cloudlike, leptomeningeal, and so forth). The Fisher exact test was used to evaluate differences between the proportion of contrast enhancement in patients who were seropositive and seronegative for aquaporin-4 antibodies. The Mann-Whitney test was used to compare the annualized relapse rate and disease duration between patients with and without contrast enhancement and with and without seropositivity. RESULTS: Brain MRIs of 77 patients were evaluated; 59 patients (10 males, 49 females) were scanned within 1 month of optic neuritis and/or longitudinally extensive transverse myelitis attacks and were included in the analysis. Forty-eight patients were seropositive, 9 were seronegative, and 2 were not tested for aquaporin-4 antibodies. Having brain contrast enhancement of any type during an acute attack was significantly associated with higher annualized relapse rates (P = .03) and marginally associated with shorter disease duration (P = .05). Having periependymal contrast enhancement was significantly associated with higher annualized relapse rates (P = .03). CONCLUSIONS: Brain MRIs of patients with neuromyelitis optica spectrum disorders with contrast enhancement during an acute relapse of optic neuritis and/or longitudinally extensive transverse myelitis are associated with increased annual relapse rates.
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Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/patologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , RecidivaRESUMO
BACKGROUND: Neuromyelitis optica (NMO) is a severe autoimmune disease of the central nervous system characterized by spinal cord and optic nerve involvement. Brainstem manifestations have recently been described. OBJECTIVE: To evaluate the time of occurrence, the frequency and the characteristics of brainstem symptoms in a cohort of patients with NMO according to the ethnic background and the serologic status for anti-aquaporin-4 antibodies (AQP4-abs). METHODS: We performed a multicenter study of 258 patients with NMO according to the 2006 Wingerchuk criteria and we evaluated prospectively the frequency, the date of onset and the duration of various brainstem signs in this population. RESULTS: Brainstem signs were observed in 81 patients (31.4%). The most frequently observed signs were vomiting (33.1%), hiccups (22.3%), oculomotor dysfunction (19.8%), pruritus (12.4%), followed by hearing loss (2.5%), facial palsy (2.5%), vertigo or vestibular ataxia (1.7%), trigeminal neuralgia (2.5%) and other cranial nerve signs (3.3%). They were inaugural in 44 patients (54.3%). The prevalence was higher in the non-Caucasian population (36.6%) than in the Caucasian population (26%) (p<0.05) and was higher in AQP4-ab-seropositive patients (32.7%) than in seronegative patients (26%) (not significant). CONCLUSIONS: This study confirms the high frequency of brainstem symptoms in NMO with a majority of vomiting and hiccups. The prevalence of these manifestations was higher in the non Caucasian population.
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Tronco Encefálico/fisiopatologia , Soluço/fisiopatologia , Neuromielite Óptica/fisiopatologia , Vômito/fisiopatologia , Adulto , Aquaporina 4/imunologia , Autoanticorpos/sangue , Biomarcadores/sangue , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/imunologia , Europa (Continente) , Feminino , Soluço/diagnóstico , Soluço/etnologia , Soluço/imunologia , Humanos , Japão , Imageamento por Ressonância Magnética , Masculino , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/etnologia , Neuromielite Óptica/imunologia , América do Norte , Prevalência , Fatores de Risco , Testes Sorológicos , Vômito/diagnóstico , Vômito/etnologia , Vômito/imunologiaRESUMO
A "Hard and Soft Tick" auto-tutorial that integrates basic knowledge of the parasite biology with practical aspects of tick identification, clinical presentation, pathology, disease transmission, treatment, and control was developed at the University of Wisconsin-Madison School of Veterinary Medicine. The purpose of this study was to assess impact of the auto-tutorial on parasitology test scores in four classes (1999, 2000, 2001, and 2002) of veterinary students. The analysis revealed a small but significant increase (p = 0.054) in mean percentage examination scores for students who used the tutorial over those who did not.
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Instrução por Computador , Educação em Veterinária/métodos , Avaliação Educacional , Humanos , Parasitologia/educação , WisconsinRESUMO
OBJECTIVE: To test the effectiveness of 3 topical sprays for treatment of papillomatous digital dermatitis (PDD) in dairy cattle. DESIGN: Prospective field trial. ANIMALS: 48 lactating cows with PDD randomly assigned to 4 groups of 12 cows each. PROCEDURE: For 3 weeks, cows in each group were treated topically with oxytetracycline solution (100 mg/ ml), acidified ionized copper solution, acidified sodium chlorite solution, or a placebo (tap water). Cows were milked 3 times daily, and at each milking, lesions were washed with a pressure hose and treatment solutions were sprayed on the lesions. Degree of lameness was graded before and after 3 weeks of treatment. RESULTS: Mean lameness score decreased (ie, cows were less lame) for all 3 treatment groups, but increased for the control group. CLINICAL IMPLICATIONS: Daily application of topical solutions was effective in decreasing degree of lameness associated with PDD in cattle tested.