RESUMO
Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss infectious myelitis, mainly the patterns of spinal cord involvement caused by each infectious agent and the contribution of magnetic resonance imaging as a major tool to establish the specific diagnosis.
Assuntos
Mielite Transversa , Mielite , Humanos , Mielite/diagnóstico por imagem , Mielite/etiologia , Diagnóstico Diferencial , Imageamento por Ressonância Magnética/métodos , Mielite Transversa/complicações , Mielite Transversa/diagnóstico , Mielite Transversa/patologia , Medula Espinal/diagnóstico por imagemRESUMO
BACKGROUND: Vaccination in patients with neuromyelitis optica spectrum disorders (NMOSD) is challenging because there is a concern that vaccines can lead to clinical attacks. However, little is known about the risk and the characteristics of attacks occurring after vaccination. METHODS: We performed a systematic review and meta-analysis using PubMed and Embase databases to estimate a summary frequency of attacks occurring after vaccination and describe the clinical features of theses attacks. We defined attacks occurring after vaccination as typical NMOSD attacks that occurred up to 30 days after vaccine administration. For the frequency of attacks occurring after vaccination, we selected observational studies that reported the number of attacks and total number of patients that received vaccines; for the clinical description of the attacks, case reports and case series were also included. RESULTS: We included 377 participants from 5 studies to estimate the frequency of NMOSD attacks occurring after vaccination. We found a summary frequency of of 2% (95% CI 1-4%, I2 = 0%). We evaluated 17 studies to identify that 13 different vaccines were associated with NMOSD attacks. A higher-than-expected proportion of males, simultaneous optic neuritis and transverse myelitis attacks, and anti-aquaporin 4 antibody negative cases were identified in vaccine-associated attacks from 24 participants from 17 studies. Nearly two-thirds of attacks occurring after vaccination were an initial event of NMOSD. CONCLUSION: The frequency of NMOSD attacks occurring after vaccination is low and non-specific to different vaccine technologies. Our work reinforces the safety of vaccine recommendations in patients with NMOSD.
Assuntos
Mielite Transversa , Neuromielite Óptica , Neurite Óptica , Vacinas , Masculino , Humanos , Neuromielite Óptica/complicações , Mielite Transversa/complicações , Neurite Óptica/complicações , Vacinação/efeitos adversos , Vacinas/efeitos adversos , AutoanticorposRESUMO
Brucella melitensis is the main cause of human brucellosis worldwide and is considered the most virulent and neurotropic species. In Mexico, this species is considered endemic, being reported since the first decade of the 20th century. Here we present a case of subacute transverse myelitis with the isolation and identification of B. melitensis as the causative agent of Neurobrucellosis in a female patient from the coastal state of Guerrero, Mexico.
Assuntos
Brucella melitensis/isolamento & purificação , Brucelose/diagnóstico , Mielite Transversa/diagnóstico , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Brucelose/complicações , Brucelose/tratamento farmacológico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Infusões Intravenosas , Mielite Transversa/complicações , Mielite Transversa/tratamento farmacológicoRESUMO
Transverse myelitis is an inflammatory disease of the central nervous system that disrupts nerve signals' conduction. The illness is characterised by weakness in the lower limbs accompanied by paresthesia and urinary and bowel incontinence. The most disabling sequel is the onset of chronic neuropathic pain, which can severely limit the patient's independence and negatively affect her quality of life. We present the case of a patient who received a spinal neurostimulator after a failure of conventional medical treatment. Masking pain through paresthesia, a mechanism provided by the device significantly reduces pain perception. The treatment success in our patient represents an advance in pain therapy.
Assuntos
Terapia por Estimulação Elétrica , Mielite Transversa , Neuralgia , Feminino , Humanos , Mielite Transversa/complicações , Mielite Transversa/terapia , Neuralgia/etiologia , Neuralgia/terapia , Qualidade de Vida , Medula EspinalRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Mielite Transversa/complicações , Mielite Transversa/diagnóstico , Relatos de CasosRESUMO
OBJECTIVE: To analyze the clinical, radiologic, therapeutic, and developmental characteristics of transverse myelitis (TM) and antiphospholipid syndrome (APS). METHODS: We systematically searched English, Spanish, and Japanese articles on the subjects of TM and APS that had English abstracts in PubMed from 1966 to 2010. In addition, we reported on 4 patients with APS and TM that were treated by the Rheumatology Division of the Hospital das Clínicas da Faculdade de Medicina da Universidade in São Paulo, Brazil. RESULTS: Fourteen cases of patients with APS and TM were reviewed. The age of these patients ranged from 8 to 83, and cases of TM predominantly occurred among patients with primary APS (9/14). The clinical presentation of TM was characterized by effects on the thoracic spinal cord (9/14) that were associated with sphincter disturbances (8/14). The onset of symptoms was sudden in 8/14 cases, and the symptoms of myelitis were recurring in 3 cases. One case resulted in death. In most cases, treatment was based on corticosteroid pulse therapy (12/14), but some patients were treated with pulse cyclophosphamide (5/14), plasmapheresis (3/14), or rituximab (1/14). Generally, the therapeutic response was satisfactory, and complete improvement was seen in 9/14 patients. CONCLUSION: In light of the severe clinical presentation of TM and its morbidity and mortality, early diagnosis and aggressive treatment are vital for therapeutic success. We can verify the excellent therapeutic response, as we saw a complete improvement in 64% of patients.
Assuntos
Síndrome Antifosfolipídica/complicações , Mielite Transversa/complicações , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso de 80 Anos ou mais , Síndrome Antifosfolipídica/patologia , Síndrome Antifosfolipídica/terapia , Criança , Ciclofosfamida/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/patologia , Mielite Transversa/terapia , Plasmaferese , Resultado do TratamentoRESUMO
Las mielopatías agudas representan un grupo heterogéneo de enfermedades, de distintas etiologías, hallazgos clínicos y radiológicos diferentes, y particular pronóstico. La Mielitis transversa (MT), es el prototipo del grupo, en el cual, un proceso inmunitario causa el daño neural en la médula espinal, resultando en varios grados de paresia, alteraciones sensitivas, y disfunción autonómica. La MT puede existir como parte de una enfermedad del Sistema nervioso Central multifocal (Esclerosis múltiple) enfermedad multisistémica (Lupus Eritematoso Sistémico), o aislada, como una entidad idiopática. En este artículo, presentamos un caso clínico, y revisamos recientes esquemas diagnósticos, que permiten sistematizar el diagnóstico y tratamiento de los pacientes con mielopatía aguda. Adicionalmente, resumimos el estado actual del conocimiento acerca de la epidemiología, historia natural de la enfermedad, inmunopatogénesis, y estrategias terapéuticas para pacientes con Mielitis transversa. El conocimiento actual sobre la clasificación, diagnóstico, patogénesis y tratamiento de la Mielitis Transversa, ha sufrido recientemente cambios y nuevos aportes, especialmente con el desarrollo de la neuroinmunopatología. Actualmente podemos iniciar tratamientos oportunos para muchos de éstos pacientes, y mejorar el pronóstico a largo plazo de ésta rara, pero discapacitante noxa.
Assuntos
Humanos , Feminino , Adulto , Lúpus Eritematoso Sistêmico , Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/complicações , Mielite Transversa/etiologiaRESUMO
We report a 40 years old woman with chronic urticaria and acute transverse myelitis associated with systemic lupus erythematosus. The urticaria appeared in her adolescence and after 26 years was followed by photosensitivity, peripheral polyarthritis and acute transverse myelitis, with positive antiphospholipid and antinuclear antibodies. Both chronic urticaria and acute transverse myelitis have been described associated with or appearing as the first manifestation of systemic lupus erythematosus. Transverse myelitis is a rare and still poorly understood condition reported in about 2% of patients with systemic lupus.
Assuntos
Lúpus Eritematoso Sistêmico/patologia , Mielite Transversa/patologia , Urticária/patologia , Doença Aguda , Adulto , Anticorpos Antifosfolipídeos/análise , Biópsia , Doença Crônica , Eletromiografia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/complicações , Urticária/complicaçõesRESUMO
OBJECTIVES: To evaluate prognostic factors for second attack and for disability in children presenting with an initial episode of central nervous system (CNS) demyelination. STUDY DESIGN: A cohort of 296 children having a first episode of acute CNS inflammatory demyelination was studied by survival analysis. RESULTS: The average follow-up was 2.9+/-3 years. At the end of the follow-up, 57% of patients had a diagnosis of multiple sclerosis (MS), 29% had a monophasic acute disseminated encephalomyelitis, and 14% had a single focal episode. The rate of a second attack was (1). higher in patients with age at onset >or=10 years (hazard ratio, 1.67; 95% CI, 1.04-2.67), MS-suggestive initial MRI (1.54; 1.02-2.33), or optic nerve lesion (2.59; 1.27-5.29); and (2). lower in patients with myelitis (0.23; 0.10-0.56) or mental status change (0.59; 0.33-1.07). Of patients with a second attack, 29% had an initial diagnosis of acute disseminated encephalomyelitis. At the end of the follow-up period, 90% of patients had no or minor disability. Occurrence of severe disability was associated with a polysymptomatic onset (3.25; 1.16-11.01), sequelae after the first attack (26.65; 9.42-75.35), further relapses (1.49; 1.16-1.92), and progressive MS (3.57; 1.21-8.72). CONCLUSIONS: Risk of second attack of CNS demyelination is higher in older patients and lower in patients with mental status change. Risk of disability is higher in polysymptomatic and relapsing patients.
Assuntos
Doenças do Sistema Nervoso Central/complicações , Doenças Desmielinizantes/complicações , Doença Aguda , Adolescente , Idade de Início , Criança , Pré-Escolar , Transtornos Cognitivos/complicações , Estudos de Coortes , Avaliação da Deficiência , Encefalomielite Aguda Disseminada/diagnóstico , Encefalomielite Aguda Disseminada/etiologia , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/etiologia , Mielite Transversa/complicações , Neurite Óptica/complicações , Neurite Óptica/diagnóstico , Prognóstico , Recidiva , Análise de SobrevidaRESUMO
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
Assuntos
Humanos , Masculino , Adulto , Mielite Transversa/complicações , Siringomielia/etiologia , Diagnóstico Diferencial , Espectroscopia de Ressonância Magnética , Mielite Transversa/diagnóstico , Siringomielia/diagnósticoRESUMO
La Mielitis Transversa Aguda (MTS) es una infrecuente complicación del Lupus Eritemaso Sistémico (LES). Reportamos el caso de una joven de 17 años con LES quien desarrollo MTA, como forma inicial de presentación de LES. La paciente tenía bajos títulos de anticuerpos antifosfolípidos IgG. El líquido cerebroespinal reveló incremento de las proteínas, y disminución de la glucosa. La Resonancia Magnética Nuclear evidenció edema difuso e incremento de la intensidad de la señal en D8. La mejoría clínica fué observada luego de instaurar altas dosis de corticosteroides y ciclofosfamida en bolus intravenosos.
Assuntos
Adolescente , Humanos , Feminino , Lúpus Eritematoso Sistêmico , Mielite Transversa/complicaçõesRESUMO
La mielitis transversa aguda (MTA) es una entidad clínica de etiología multifactorial, que puede asociarse con neuritis óptica (NO) constituyéndose en una neuromielitis óptica (NMO) o síndrome de Devic, el cual es una variante de la esclerosis múltiple (EM). También presentamos los resultados de un ensayo terapéutico abierto de un grupo de diez mujeres con diagnóstico inicial de MTA que recibieron pulsos de metilprednisolona (1.5 gramos en 24 horas por vía endovenosa durante cinco días) y cursaron con una mejoría rápida, menor número de secuelas y una mejor calidad de recuperación en el 90 por ciento de los casos; el cual es mejor que el reportado en la literatura. Asimismo observamos el desarollo de NMO en siete pacientes en el primer semestre de seguimiento, lo cual permitió el diagnóstico de EM clínicamente definitivo y mostramos la sensibilidad de los estudios electrofisiológicos e inmunes en estadios subclínicos
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Feminino , Esclerose Múltipla/etiologia , Mielite Transversa/complicações , Mielite/complicações , Doença Aguda , Mielite Transversa/imunologia , Mielite Transversa/fisiopatologiaRESUMO
Os autores apresentam três casos de mielite transversa em pacientes portadores de Lúpus Eritematoso Sistêmico. Discutem seus aspectos clínicos e Laboratoriais e chamam a atençäo para o diagnóstico precipitado de outras patologias cuja terapêutica pode agravar e desencadear a atividade de colagenose. Referem a possibilidade de lesäo medular iniciar a sintomatologia do LES e advertem para a necessidade de se avaliar imunologicamente a presença do LES nessas ocasiöes. Insistem na pesquisa de marcadores imunológicos associados ao comprometimento do sistema nervoso central - imunecomplesxos e C3 elevados no LCR, assim como a presença do anti-Sm no soro em 80% dos indivíduos. A terapêutica a ser adotada permanece em estudos, devido a escassez de casos na literatura e as dificuldades de se correlacionar com a resposta terapêutica a variabilidade clínica de lesäo neurológica naqueles pacientes com anti-SM positivo, os autores ressaltam que em dois doentes, este anticorpo foi negativo, porém, deve se ter em mente a diminuta amostragem.
Assuntos
Criança , Adolescente , Pessoa de Meia-Idade , Humanos , Feminino , Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/complicaçõesRESUMO
The patient, a 30 year-old man, dentist, started having an influenza-like infection which lasted five days, with malaise, muscle pain throughout the body and fever. One day before the hospital admission he presented urinary retention followed in the next day by ataxia and numbness sensation in both feet and lower third of his legs. The neurological examination disclosed a thoracic spinal cord impairment at T9-T10 level and the diagnosis of a post- infectious transverse myelitis was made. The plain Rx of the spine showed a spina bifida oculta in the T7 vertebra, which is roughly at the same level of the T9-T10 spinal cord segment. An iodinated myelography showed no abnormalities. The CSF examination showed small increase in the white cells (6.4 cells/cu.mm). The patient received dexamethasone (4. 5g /day) and two weeks later was entirely free of symptoms. The authors think that the congenital bone defect (spina bifida) might have played a role in the development of the myelitis, probably because of an ontogenetically determined "vulnerable point" ("locus minor resistentia ") at that level, either anatomical or immunological.