RESUMO

Abstract Background: Transverse myelitis (TM) is a demyelinating inflammatory disease that presents with motor, sensory, and autonomic dysfunction, which may be acute or subacute. COVID-19-associated TM has been described in a scarce number of patients. Clinical case: A 15-year-old previously healthy male patient with respiratory disease before his neurological deterioration presented to the emergency room after developing a complete medullary syndrome located at the cervical-dorsal level, with ascending and symmetric paraparesis that rapidly progressed to paraplegia, with sensory dysfunction from the T3 level, sphincter dysfunction and sudden ventilatory deterioration that required mechanical ventilation. Magnetic resonance imaging was compatible with acute TM. Inflammatory and non-inflammatory etiologies were discarded. In addition, a positive severe acute respiratory syndrome coronavirus 2 test was obtained. Treatment included steroid pulses and plasmapheresis, with an insidious evolution. Conclusion: COVID-19 is an infrequent cause of TM and should be suspected when other etiologies have been ruled out.

Resumen Introducción: La mielitis transversa (MT) es una enfermedad inflamatoria desmielinizante que se presenta con disfunción motora, sensitiva y autonómica, de forma aguda o subaguda. La MT asociada al COVID-19 se ha escrito en un escaso número de pacientes. Caso clínico: Se presenta el caso de un masculino de 15 años previamente sano, quien cursaba con un cuadro respiratorio y que desarrollo un deterioro neurológico súbito que involucro un síndrome medular completo localizado en el nivel cérvico dorsal, con paraparesia simétrica que progreso a la paraplejia, con disfunción sensitiva desde el nivel medular de T3, disfunción de esfínteres y deterioro ventilatorio que requirió manejo avanzado de la vía aérea. Su resonancia magnética fue compatible con mielitis transversa aguda. Se descartaron causas inflamatorias y no inflamatorias de la patología. Además, se obtuvo un resultado positivo de SARS-COV-2. Se inició tratamiento con pulsos de metilprednisolona y plasmaféresis, con una evolución insidiosa. Conclusión: El COVID-19 es una causa infrecuente de MT y debe sospecharse cuando otras causas han sido descartadas.

RESUMO

BACKGROUND: Transverse myelitis (TM) is a demyelinating inflammatory disease that presents with motor, sensory, and autonomic dysfunction, which may be acute or subacute. COVID-19-associated TM has been described in a scarce number of patients. CLINICAL CASE: A 15-year-old previously healthy male patient with respiratory disease before his neurological deterioration presented to the emergency room after developing a complete medullary syndrome located at the cervical-dorsal level, with ascending and symmetric paraparesis that rapidly progressed to paraplegia, with sensory dysfunction from the T3 level, sphincter dysfunction and sudden ventilatory deterioration that required mechanical ventilation. Magnetic resonance imaging was compatible with acute TM. Inflammatory and non-inflammatory etiologies were discarded. In addition, a positive severe acute respiratory syndrome coronavirus 2 test was obtained. Treatment included steroid pulses and plasmapheresis, with an insidious evolution. CONCLUSION: COVID-19 is an infrequent cause of TM and should be suspected when other etiologies have been ruled out.

INTRODUCCIÓN: La mielitis transversa (MT) es una enfermedad inflamatoria desmielinizante que se presenta con disfunción motora, sensitiva y autonómica, de forma aguda o subaguda. La MT asociada al COVID-19 se ha escrito en un escaso número de pacientes. CASO CLÍNICO: Se presenta el caso de un masculino de 15 años previamente sano, quien cursaba con un cuadro respiratorio y que desarrollo un deterioro neurológico súbito que involucro un síndrome medular completo localizado en el nivel cérvico dorsal, con paraparesia simétrica que progreso a la paraplejia, con disfunción sensitiva desde el nivel medular de T3, disfunción de esfínteres y deterioro ventilatorio que requirió manejo avanzado de la vía aérea. Su resonancia magnética fue compatible con mielitis transversa aguda. Se descartaron causas inflamatorias y no inflamatorias de la patología. Además, se obtuvo un resultado positivo de SARS-COV-2. Se inició tratamiento con pulsos de metilprednisolona y plasmaféresis, con una evolución insidiosa. CONCLUSIÓN: El COVID-19 es una causa infrecuente de MT y debe sospecharse cuando otras causas han sido descartadas.

Assuntos

RESUMO

Background: Myelitis is the inflammation of the spinal cord parenchyma alone, whereas meningitis is the inflammation of the meninges. Steroid-responsive meningitis-arteritis (SRMA) is a meningomyelitis in which the major lesions involve the meninges, not the spinal cord parenchyma, and respond well to glucocorticoid treatment. However, myelitis in dogs has rarely been reported, and myelitis with a good response to glucocorticoid treatment without relapse has not been reported. This report describes 5 cases of steroid-responsive myelitis (SRM) in dogs. Cases: Case 1. A 8-year-old intact female Cocker Spaniel presented with progressive nonambulatory paraplegia. Whole spinal parenchymal lesions were identified using magnetic resonance imaging (MRI) scan. Mononuclear pleocytosis with increased total protein levels was the only abnormal finding on cerebrospinal fluid (CSF) analysis. Prednisolone (PDS) was administered followed by dose tapering according to therapeutic response. Cyclosporine was administered until the termination of PDS. Since then, no recurrence of neurological symptoms has been observed. Follow-up MRI and CSF analysis revealed resolution of previously observed abnormal findings. Case 2. A 2-year-old intact female Maltese presented with non-progressive paraparesis. A spinal parenchymal lesion in the lumbosacral region was observed on MRI. PDS was administered and slowly tapered at approximately 3-week intervals. No recurrence of neurological symptoms was observed after the treatment. Case 3. A 6-year-old intact female Miniature Pinscher presented with neck pain, along with leukocytosis and neutrophilia. Cervical spinal parenchyma lesions were revealed through MRI. Increased total protein concentration with mixed cell pleocytosis was observed on CSF analysis. Immunomodulatory therapy, similar to that in case 2, was initiated. A second MRI and CSF analysis revealed an improvement in the previously observed abnormalities. Case 4. A 2-year-old, intact female Toy Poodle presented with acute paraplegia and back pain. Lesions were observed in the spinal parenchyma at the T12-L3 levels on MRI. The treatment was conducted as in case 2. During treatment, neurological symptoms, including paraplegia and back pain, were not observed. Follow-up MRI revealed improvement in the spinal lesion. Case 5. A 6-month-old, castrated male Standard Poodle presented with progressive paraparesis. On MRI, lesions were observed in the T11-T13 regions. Immunomodulation therapy, similar to that in case 2, was initiated. No recurrence of neurological symptoms was observed after treatment initiation Discussion: SRM is similar to SRMA in terms of good steroid-responsiveness and noninfectious inflammation etiology; however, it does not exactly satisfy the diagnostic criteria for SRMA, nor does it progress similarly. The characteristics of SRM that do not satisfy the diagnostic criteria of SRMA include the absence of fever, C-reactive protein elevation, hyperglobulinemia, and relapse, and the presence of spinal parenchymal lesions without parenchymal or meningeal enhancement on MRI. It is also a seemingly different from spinal cord-only meningoencephalomyelitis of unknown origin due to its better treatment response and prognosis. However, the dogs in the present report with SRM satisfied the diagnostic criteria for transverse myelitis in human patients. Therefore, SRM, including good steroid responsiveness and good prognosis without relapse, may represent a novel type of meningomyelitis.

Assuntos

RESUMO

This paper aims to report clinical, laboratory, radiographic, and pathological features in a case of cervical vertebral stenotic myelopathy (CVSM) affecting a 4-month-old Nelore calf for the first time. During physical examination, the calf could stand if assisted when lifting by the tail but fallen to the ground when trying to walk. Attempts to flex and extend the neck to the right side failed. Radiographs findings consisted of reduced intervertebral spaces, and misalignments between the endplates, more evident between the C3 and C4 vertebrae, resulting in narrowing of the spinal canal and compression of the spinal cord. Grossly, C4 showed cranial articular surface malformation, abnormal metaphyseal growth plate development, reduced vertebral body size and deformity. Histologically, C4 showed an abnormal vertebral bone development characterized by moderate replacement of trabecular bone by fibrous tissues, multifocal areas of dystrophic hyaline cartilage development, and cartilaginous growth failure along the metaphyseal growth plate. Cervical spinal cord within the stenotic vertebral canal showed swollen neurons with central chromatolysis, areas of Wallerian degeneration, and necrotic debris. In contrast with the well-known Wobbler syndrome in horses, the etiology of CVSM in cattle remains undetermined, and further genetic and pathological studies must be conducted to elucidate it.

RESUMO

La siringomielia supone un desafío diagnóstico, ya que es una entidad poco reconocida si no se tiene conciencia de su existencia. Al ser un cuadro progresivo, cuya clínica puede presentarse de forma larvada y ser coincidente con otras patologías neurológicas tales como la esclerosis múltiple, su detección suele realizarse en etapas tardías sobre todo en población adulta y más aún cuando se presenta de forma adquirida. Por lo que el estudio imagenológico con Resonancia Magnética adquiere especial relevancia, permitiendo identificar y clasificar la enfermedad, lo que brindará la base para decidir terapía.

Syringomyelia is a diagnostic challenge, since it is a poorly recognized disease, especially if its existence remains unknown. Being a progressive disease, whose clinic can present in a latent way and be coincident with other neurological pathologies such as multiple sclerosis, its detection is usually conducted in late stages, especially in the adult population and even more when it presents in an acquired way. Therefore, the imaging study with Magnetic Resonance acquires special relevance, allowing to be identified and classified, which will provide the basis for deciding on therapy

Assuntos

RESUMO

Objetivo: caracterizar a los pacientes con diagnóstico de mielitis transversa (MT) en un hospital de referencia del sur de Colombia durante los años 2007 a 2013. Materiales y métodos: Estudio transversal. Se incluyeron todos los pacientes con diagnóstico de MT, según los criterios The Transverse Myelitis Consortium Working Group. Resultados: En total 21 casos de MT (1,3 casos/10 000 ingresos), el 66,7% en edades entre 15-30 años, 57,1% de género femenino; 81,0% agudos. Todos presentaron déficit motor, 52,4% disfunción vesical autonómica, 81,0% nivel sensitivo. Se documentaron hallazgos imagenológicos de MT en resonancia magnética nuclear en el 71,4% de los casos e hiperproteinorraquia en 50%. En el 66,7% la etiología fue desconocida, en los casos en quienes se logró determinar la etiología fue: herpes simple tipo 1 (9,5%), varicela zoster (9,5%), leucemia mieloide aguda (4,8%), lupus eritematoso sistémico (4,8%) y deficiencia de vitamina B12 (4,8%). Conclusiones: La MT es un importante problema de salud pública, es necesario considerar sus características clínicas, establecer las formas idiopáticas y reconocer etiologías infecciosas dado el impacto terapeutico y pronóstico

Objective: To characterize patients with a diagnosis of transverse myelitis (TM) in a referral hospital in southern Colombia during years 2007 to 2013. Material and methods: This is a crosssectional study. All patients with a TM diagnosis were included, according to the criteria set by the Transverse Myelitis Consortium Working Group. Results: We had a total number of 21 cases of TM (1.3 cases/10,000 admissions). Two thirds (66,7%) of all patients were between 15-30 years of age, 57,1% were female; 81.0% had an acute presentation, 100% had motor deficit, 52.4% had autonomic bladder dysfunction, and 81.0% had sensitive level. MT findings were documented using magnetic resonance imaging in 71.4% of cases and 50% by high protein levels in the cerebrospinal fluid. Two thirds (66.7%) of the cases had an unknown etiology. In those cases in which their origin could be identified, the etiologies were: Type I Herpes Simplex (9.5%); Varicella Zoster (9.5%), acute myeloid leukemia (4.8%), systemic lupus erythematosus (4.8%) and vitamin B12 deficiency. Conclusion: MT is a major public health problem, and it is necessary to consider its clinical features, to establish its idiopathic forms and to recognize its infectious causes given their therapy impact and prognosis

RESUMO

Os autores apresentam casos de cistos epidurais, dentre eles os cistos sinoviais, discais, do ligamento amarelo e relacionados a bursite interespinhosa, todas essas condições determinando compressão radicular, do saco dural ou estenose do canal vertebral. Descrevem as características de imagem e localização na ressonância magnética nessas diferentes afecções.

The authors describe some cases of epidural cysts, namely synovial, discal, ligamentum flavum cysts, and cysts secondary to interspinous bursitis, all of these conditions determining radicular, dural sac compression or spinal canal stenosis. Magnetic resonance imaging findings and localization of these entities are described.

Assuntos

RESUMO

A AIDS é causada pelo vírus da imunodeficiência humana (HIV), um retrovírus que foi descoberto em 1983. Este estudo avaliou a associação do treinamento dos músculos inspiratórios e do treinamento de condicionamento físico à fisioterapia motora, em um paciente HIV positivo com o diagnóstico de mielopatia vacuolar e acometimento medular no nível de T7. A fisioterapia motora consistiu de exercícios de fortalecimento, equilíbrio e atividades funcionais. O protocolo de treinamento da fisioterapia respiratória consistiu de duas fases: treinamento da musculatura inspiratória e condicionamento físico realizado por meio de propulsão da cadeira de rodas. Foram realizadas as medidas da pressão inspiratória máxima (PImáx), pressão expiratória máxima (PEmáx), pico do fluxo expiratório (PFE) e a distância total de propulsão em cadeira de rodas durante 6 minutos, pré, após a quarta e a oitava semana de treinamento. A Escala de Borg Modificada foi utilizada para a avaliação da sensação de dispnéia. Antes do treinamento, os valores das medidas respiratórias foram PImáx 60 cm/H2O, PEmáx 90 cm/H2O e PFE 270l/min e a distância total de propulsão em cadeira de rodas durante 6 minutos foi de 100,2 metros. Na oitava semana os valores foram PImáx 120cm/H2O, PEmáx 100cm/H2O, PFE 350l/min e a distância total de propulsão em cadeira de rodas durante 6 minutos foi de 120m. Concluiu-se que a associação do protocolo de treinamento adotado à fisioterapia motora melhorou a força dos músculos respiratórios e o condicionamento físico do paciente.

AIDS is caused by human immunodeficiency virus (HIV), a retrovirus discovered in 1983. This study evaluated the association between inspiratory muscles training and physical conditioning training to motor physiotherapy in a patient with AIDS and vacuolar myelopathy diagnosis, at T7 level. Motor physiotherapy comprised strengthening exercises, balance and functional activities. The respiratory physiotherapy training protocol included: inspiratory muscle training and aerobic conditioning by wheelchair propulsion. The visual analog modified Borg scale was applied, before and after inspiratory muscle training and before and after wheelchair propulsion training, in order to measure the dyspnea levels at fourth and eighth week of training. The measures presented before training protocols were MIP 60cm/H2O, MEP 90cm/H2O, PEF 270l/min and the 6-minute total wheelchair propulsion resulted in a distance of 100.2 meters. After eight week, the following results were observed: MIP 120cm/H2O, MEP 100cm/H2O, PEF 350l/min, the 6-minute total wheelchair propulsion resulted in a distance of 120 meters. Inspiratory and expiratory muscles may be specifically trained in order to improve the muscle strength. Thus, we observed important increase of respiratory measures, total wheelchair propulsion and improvement of dyspnea sensation during functional activities after the treatment. Concluding, the association between the adopt training protocol to motor physiotherapy improved the respiratory muscle strength and physical conditioning in this patient.

Assuntos

RESUMO

A 6 month old female siamese cat presented since birth spastic paraplegy associated to urinary and fecal incontinence. The neurological examination showed paralysis, analgesia, increased reflexes and damage of the postural reaction in pelvic limbs. Simple and contrasted (myelography) radiography of the thoracolumbar vertebral column showed a lumbar vertebral canal stenosis and narrowing of the spinal cord on thoracic and lumbar vertebrae. On necropsy and histopathology examination it was observed a segmental hypoplasia characterized for narrowing of the spinal cord in T4-T6 and L2-L3, neuronal depletion in gray substance, and nervous filaments connecting the cranial and caudal parts that was covered for entire and dense dura mater. This alteration characteristic a multiple segmental myelodysplasia.

Relata-se o caso de uma gata Siamês de seis meses de idade que desde o nascimento apresentava paraplegia espástica associada à incontinência fecal e urinária. No exame neurológico, exibia paralisia, analgesia, hiperreflexia e perda das reações posturais nos membros posteriores. Radiografias simples e contrastadas (mielografia) da coluna vertebral toracolombar evidenciaram estreitamentos do canal vertebral na região lombar e da medula espinhal, vértebras torácicas e lombares. Na necropsia e exame histopatológico, verificou-se hipoplasia segmentar caracterizada pelo afinamento localizado da medula espinhal em T4-T6 e L2-L3, depleção neuronal na substância cinzenta e filetes nervosos interligando as partes craniais e caudais, todos recobertos por dura mater íntegra e espessada. Essas alterações permitiram concluir o diagnóstico de mielodisplasia segmentar múltipla.

RESUMO

A 6 month old female siamese cat presented since birth spastic paraplegy associated to urinary and fecal incontinence. The neurological examination showed paralysis, analgesia, increased reflexes and damage of the postural reaction in pelvic limbs. Simple and contrasted (myelography) radiography of the thoracolumbar vertebral column showed a lumbar vertebral canal stenosis and narrowing of the spinal cord on thoracic and lumbar vertebrae. On necropsy and histopathology examination it was observed a segmental hypoplasia characterized for narrowing of the spinal cord in T4-T6 and L2-L3, neuronal depletion in gray substance, and nervous filaments connecting the cranial and caudal parts that was covered for entire and dense dura mater. This alteration characteristic a multiple segmental myelodysplasia.

Relata-se o caso de uma gata Siamês de seis meses de idade que desde o nascimento apresentava paraplegia espástica associada à incontinência fecal e urinária. No exame neurológico, exibia paralisia, analgesia, hiperreflexia e perda das reações posturais nos membros posteriores. Radiografias simples e contrastadas (mielografia) da coluna vertebral toracolombar evidenciaram estreitamentos do canal vertebral na região lombar e da medula espinhal, vértebras torácicas e lombares. Na necropsia e exame histopatológico, verificou-se hipoplasia segmentar caracterizada pelo afinamento localizado da medula espinhal em T4-T6 e L2-L3, depleção neuronal na substância cinzenta e filetes nervosos interligando as partes craniais e caudais, todos recobertos por dura mater íntegra e espessada. Essas alterações permitiram concluir o diagnóstico de mielodisplasia segmentar múltipla.