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pediatric transverse myelitis

Masataka Fukuoka, Ichiro Kuki, Hisashi Kawawaki, Kiyohiro Kim, Yuka Hattori, Hitomi Tsuji, Asako Horino, Megumi Nukui, Shin Okazaki
An 11-year-old boy presented with progressive leg hypesthesia but no history of trauma. Dysuria and constipation appeared subsequent to gait difficulty. He was admitted 8days after onset. Spinal magnetic resonance imaging (MRI) revealed longitudinal hyperintensity with cord swelling and hypointensity on T2-weighted images, suggesting severe inflammation and microbleeding change, respectively. Gadolinium contrast-enhanced MRI demonstrated mild enhancement in the lesions. Platelet count and coagulation findings were normal, and cerebrospinal fluid analysis showed no pleocytosis...
September 26, 2016: Brain & Development
Michael Absoud, Benjamin M Greenberg, Ming Lim, Tim Lotze, Terrence Thomas, Kumaran Deiva
Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some...
August 30, 2016: Neurology
Jessica Kammer, Stefan Ziesing, Lukas Aguirre Davila, Eva Bültmann, Sabine Illsinger, Anibh M Das, Dieter Haffner, Hans Hartmann
Objective In this retrospective study, we aimed to assess frequency, types, and long-term outcome of neurological disease during acute Mycoplasma pneumoniae (M. pneumoniae) infection in pediatric patients. Materials and Methods Medical records of patients hospitalized with acute M. pneumoniae infection were reviewed. Possible risk factors were analyzed by uni- and multivariate regression. Patients with neurological symptoms were followed up by expanded disability status score (EDSS) and the cognitive problems in children and adolescents (KOPKJ) scale...
October 2016: Neuropediatrics
Barbara Girard, Chrystèle Bonnemains, Emmanuelle Schmitt, Emmanuel Raffo, Claire Bilbault
BACKGROUND: Metabolic and inflammatory conditions may lead to neurological disorders. Neuromyelitis optica spectrum disorders (NMOSDs) refer to a rare group of demyelinating diseases of the central nervous system which essentially involve the optic nerves and spinal cord. METHODS: We report a case of biotinidase deficiency (BD) initially misdiagnosed as NMOSD in a pediatric patient. RESULTS: An 8-year-old girl was initially diagnosed with NMOSD on the basis of optic neuritis (ON) associated with three episodes of longitudinally extensive transverse myelitis (LETM)...
May 6, 2016: Multiple Sclerosis: Clinical and Laboratory Research
J de Sèze, L Kremer, N Collongues
The relationship between neuromyelitis optica (NMO) and multiple sclerosis (MS) has long been controversial. NMO was previously considered a form of MS involving predominantly the spinal cord and optic nerve. However, since the discovery of NMO-IgG/aquaporin-4 (AQP4) antibody, an NMO-specific autoantibody to AQP4, some unique clinical features, and magnetic resonance imaging (MRI) and other laboratory findings in NMO, have been further clarified. AQP4 antibody is now the most important laboratory finding for the diagnosis of NMO...
April 2016: Revue Neurologique
Salini Thulasirajah, Daniela Pohl, Jorge Davila-Acosta, Sunita Venkateswaran
Under the umbrella of pediatric-acquired demyelinating syndromes, there is a multitude of disorders, including optic neuritis, transverse myelitis, acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), and neuromyelitis optica spectrum disorders (NMOSD). Due to overlapping clinical and magnetic resonance imaging (MRI) features, it can be challenging to provide an accurate diagnosis. In view of therapeutic and prognostic implications, an early and reliable diagnosis is however of utmost importance...
August 2016: Neuropediatrics
Megan M Langille, Talat Islam, Margaret Burnett, Lilyana Amezcua
Multiple sclerosis can affect pediatric patients. Our aim was to compare characteristics between pediatric-onset multiple sclerosis and adult-onset multiple sclerosis in Hispanic Americans. This was a cross-sectional analysis of 363 Hispanic American multiple scleroses cases; demographic and clinical characteristics were analyzed. A total of 110 Hispanic patients presented with multiple sclerosis before age 18 and 253 as adult multiple sclerosis. The most common presenting symptoms for both was optic neuritis...
July 2016: Journal of Child Neurology
Miguel Chuquilin, Naresh Mullaguri, Brian Weinshenker
Neuromyelitis optica causes bilateral optic neuritis and longitudinal extensive transverse myelitis. Although usually sporadic, 3% of cases of neuromyelitis optica are familial. The interval over which attacks continue and the long term prognosis for pediatric-onset neuromyelitis optica are not well defined. We describe two patients with pediatric familial neuromyelitis optica with the longest clinical follow-up of a pediatric case reported in the literature to our knowledge. One woman developed blindness with bilateral eye involvement within a few weeks at age 3...
July 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Sudarshini Ramanathan, Russell C Dale, Fabienne Brilot
Myelin oligodendrocyte glycoprotein (MOG) is a protein exclusively expressed on the surface of oligodendrocytes and myelin in the central nervous system. MOG has been identified as a putative candidate autoantigen and autoantibody target in demyelination for almost three decades, with extensive literature validating its role in murine models of experimental autoimmune encephalomyelitis. Seminal studies using murine anti-MOG antibodies have highlighted the fact that antibodies that target epitopes of native MOG in its conformational state, rather than linearized or denature`d MOG, are biologically relevant...
April 2016: Autoimmunity Reviews
Philippe Horellou, Min Wang, Vixra Keo, Pascale Chrétien, Ché Serguera, Patrick Waters, Kumaran Deiva
Acquired demyelinating syndromes (ADS) in children evolve either as a monophasic disease diagnosed as acute demyelinating encephalomyelitis (ADEM), transverse myelitis (TM) or optic neuritis (ON), or a multiphasic one with several relapses most often leading to the diagnosis of multiple sclerosis (MS) or neuromyelitis optica (NMO). These neuroinflammatory disorders are increasingly associated with autoantibodies against proteins such as aquaporin-4 in rare instances, and more frequently against myelin oligodendrocyte glycoprotein (MOG)...
December 15, 2015: Journal of Neuroimmunology
Katarzyna Mazur-Melewska, Iwona Breńska, Katarzyna Jończyk-Potoczna, Paweł Kemnitz, Ilona Pieczonka-Ruszkowska, Anna Mania, Wojciech Służewski, Magdalena Figlerowicz
We retrospectively analyzed the medical documentation of 194 children infected with Epstein-Barr virus. The diagnosis was based on clinical symptoms and the presence of the viral capsid antigen IgM antibody. Patients with severe neurologic complications also underwent neurologic examination, magnetic resonance imaging (MRI), and electroencephalography (EEG). There were 2 peaks in incidence of infection; the first one in young children aged 1 to 5 years represented 62.0% of cases. The second peak (24.6% of patients) occurred in teenagers...
May 2016: Journal of Child Neurology
Nadia Barakat, Mark P Gorman, Leslie Benson, Lino Becerra, David Borsook
Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination...
2015: NeuroImage: Clinical
J Nicholas Brenton, Brenda L Banwell
Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions...
January 2016: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
Sana Khan, Neeraj Singh, Amanda Dow, Adolfo Ramirez-Zamora
Lyme neuroborreliosis has several different clinical manifestations in children, of which facial nerve palsies, meningitis and radiculopathies are the most common. Transverse myelitis (TM) secondary to Lyme disease has been reported in rare occasions, typically presenting with severe weakness, sensory abnormalities and autonomic dysfunction. We present the case of a 16-year-old male who developed acute left peripheral facial palsy and longitudinal extensive TM secondary to Lyme disease. Remarkably, the patient reported only mild symptoms with severe back pain in the absence of profound signs of myelopathy...
May 2015: Case Reports in Neurology
Wu Yun, Zhang Weihua, Ren Xiaotun, Li Jiuwei, Yang Xinying, Lyu Junlan, Ding Changhong, Chen Chunhong, Ren Haitao, Cui Liying, Fang Fang
OBJECTIVE: To analyze the clinical characteristics of pediatric neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD). METHOD: A retrospective analysis was performed evaluating clinical and laboratory characteristics of ten NMO and NMOSD children who were seen in our hospital from December 2010 to May 2014. Median age at onset was 8.9 years (range 0.8-13.8 years). Seven cases were female and three were male. Median disease duration was 1...
April 2015: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Maria Vânia Sousa, Isabel Lopes de Carvalho, Maria Sofia Núncio, Carla Conceição, Rita Silva, Catarina Gouveia
We report a pediatric case of Lyme neuroborreliosis-associated meningomyeloradiculitis with atypical manifestations and negative initial cerebrospinal fluid borrelial antibodies. Transverse myelitis and painful radiculoneuritis have rarely been described in pediatric neuroborreliosis. Clinical manifestations are wide ranging and nonspecific, and the serologic diagnosis is often delayed in the acute phase.
October 2015: Pediatric Infectious Disease Journal
Julia O'Mahony, Ruth Ann Marrie, Audrey Laporte, E Ann Yeh, Amit Bar-Or, Cathy Phan, David Buckley, David Callen, Mary B Connolly, Daniela Pohl, Marie-Emmanuelle Dilenge, Geneviève Bernard, Anne Lortie, Noel Lowry, E Athen MacDonald, David Meek, Guillaume Sébire, Sunita Venkateswaran, Ellen Wood, Jerome Yager, Brenda Banwell
BACKGROUND: Few prospective studies have systematically evaluated the extent of recovery from incident acquired demyelinating syndromes (ADS) of the central nervous system in children. METHODS: In a national cohort study of pediatric ADS, severity of the incident attack and extent of recovery by 12 months were evaluated. Annual evaluations were used to determine current diagnoses (monophasic ADS or multiple sclerosis [MS]) and new deficits. RESULTS: Of 283 children, 244 (86%) required hospitalization for a median (interquartile range [IQR]) of 6 (3-10) days, and 184 had moderate or severe deficits; 41 children were profoundly encephalopathic, 129 were unable to ambulate independently, and 59 with optic neuritis (ON) had moderately or severely impaired vision...
July 2015: Pediatrics
M Absoud, J Gadian, J Hellier, P A Brex, O Ciccarelli, G Giovannoni, J Kelly, P McCrone, C Murphy, J Palace, A Pickles, M Pike, N Robertson, A Jacob, M Lim
INTRODUCTION: Transverse myelitis (TM) is an immune-mediated disorder of the spinal cord which causes motor and sensory disturbance and limited recovery in 50% of patients. Standard treatment is steroids, and patients with more severe disease appear to respond to plasma exchange (PLEX). Intravenous immunoglobulin (IVIG) has also been used as an adjunct to steroids, but evidence is lacking. We propose the first randomised control trial in adults and children, to determine the benefit of additional treatment with IVIG...
2015: BMJ Open
Stephen Canon, Annashia Shera, Nhan Marc Hieu Phan, Lynne Lapicz, Tanya Scheidweiler, Lori Batchelor, Christopher Swearingen
INTRODUCTION: Autonomic dysreflexia (AD) is a well-established association of high spinal cord injury (SCI), particularly in those occurring above T6. When a noxious stimulus is encountered, the body responds by stimulating an increase in blood pressure, which is then countered by vasodilation. In patients with autonomic dysreflexia, the patient is unable to vasodilate below the level of spinal injury due to interruption of the autonomic innervation below the injury. This then leads to persistently elevated blood pressure causing uncoordinated autonomic responses such as headache, flushing, sweating, and even hypertensive crisis...
February 2015: Journal of Pediatric Urology
Sona Narula, Grant T Liu, Robert A Avery, Brenda Banwell, Amy T Waldman
BACKGROUND: Cerebrospinal fluid opening pressure is elevated with central nervous system infection and vasculitis, but has not been studied in inflammatory demyelinating disease. This retrospective study sought to determine whether children with demyelinating disease demonstrate elevated cerebrospinal fluid opening pressure, and to explore possible clinical and radiologic correlates. METHODS: Pediatric patients with acute disseminated encephalomyelitis, multiple sclerosis, or a clinically isolated syndrome (including optic neuritis and transverse myelitis) who had a lumbar puncture within 1 month of presentation were eligible for inclusion, and were compared with a reference cohort of healthy children from the same institution...
April 2015: Pediatric Neurology
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