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Almaghrabi N, Saab A. Adult onset acute disseminated encephalomyelitis: A case report. Radiol Case Rep 2021; 16:2469-2473. [PMID: 34257782 PMCID: PMC8260756 DOI: 10.1016/j.radcr.2021.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 11/26/2022] Open
Abstract
Acute disseminated encephalomyelitis is an immune mediated demyelinating disorder of the central nervous system, it predominantly affects children in the age group between of 5-8 years. Is most widely thought to be a post-viral, post-vaccination autoimmune phenomenon. We present a case of 40 years old Pakistani male arrived to ER agitated with decrease level of consciousness and delirium, develop tonic-clonic convulsion and it was relieved by DIAZEPAM. This is the first attack to the patient with no past medical history of similar presentation. MRI showed supra and infratentorial white matter high T2/FLAIR signal abnormalities, involving supratentorial cortical and subcortical parito-occipital region, also to less extent at deep white matter predominantly right tempro-occipital region in asymmetric pattern. Involvement of juxta cortical and U fibers. MRI raised the possibility of adult onset Acute disseminated encephalomyelitis, after exclusion of other causes of juxta cortical and U fibers involvement (based on imaging analysis with consideration of clinical presentation and available lab results).
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Affiliation(s)
- Nizar Almaghrabi
- Radiology resident, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Abeer Saab
- Neuroradiology Consultant, King Abdulaziz Hospital, Makkah, Saudi Arabia
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Kini S, Bhat RY, Karegowda LH. Micturition Disturbance: A Predominant Feature of Acute Disseminated Encephalomyelitis. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1722617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractUrinary retention in children can have varied etiology ranging from anatomic to functional causes. Functional causes include neuropathies, including rare central nervous system (CNS) involvement, such as acute disseminated encephalomyelitis (ADEM). ADEM is usually preceded by acute viral infection and commonly presents with multifocal neurological deficits. The ADEM diagnosis is mainly based on the clinical presentation and its correlation with characteristic CNS findings on magnetic resonance imaging (MRI). Here, we report an adolescent boy who presented with acute urinary retention preceded by an acute febrile illness. The patient was worked up thoroughly, including an MRI of the brain and spine, which revealed ADEM's characteristic features. The bladder function was evaluated periodically. The voiding dysfunction persisted for a long time. Treatment with steroids and other supportive therapy ultimately lead to a complete recovery over 6 months.
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Affiliation(s)
- Sandesh Kini
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education University, Manipal, Karnataka, India
| | - Ramesh Y. Bhat
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education University, Manipal, Karnataka, India
| | - Lakshmikanth Halegubbi Karegowda
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education University, Manipal, Karnataka, India
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3
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Lim V, Mac-Thiong JM, Dionne A, Begin J, Richard-Denis A. Clinical Protocol for Identifying and Managing Bladder Dysfunction during Acute Care after Traumatic Spinal Cord Injury. J Neurotrauma 2020; 38:718-724. [PMID: 33121377 DOI: 10.1089/neu.2020.7190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bladder dysfunction is widespread following traumatic spinal cord injury (TSCI). Early diagnosis of bladder dysfunction is crucial in preventing complications, determining prognosis, and planning rehabilitation. We aim to suggest the first clinical protocol specifically designed to evaluate and manage bladder dysfunction in TSCI patients during acute care. A retrospective cohort study was conducted on 101 patients admitted for an acute TSCI between C1 and T12. Following spinal surgery, presence of voluntary anal contraction (VAC) was used as a criterion for removal of indwelling catheter and initiating trial of void (TOV). Absence of bladder dysfunction was determined from three consecutive post-void bladder scan residuals ≤200 mL without incontinence. All patients were reassessed 3 months post-injury using the Spinal Cord Independence Measure (SCIM). A total of 74.3% were diagnosed with bladder dysfunction during acute care, while 57.4% had a motor-complete TSCI. Three months later, 94.7% of them reported impaired bladder function. None of the patients discharged from acute care after a functional bladder was diagnosed reported impaired bladder function at the 3-month follow-up. A total of 95.7% patients without VAC had persisting impaired bladder function at follow-up. The proposed protocol is specifically adapted to the dynamic nature of neurogenic bladder function following TSCI. The assessment of VAC into the protocol provides major insight on the potential for reaching adequate bladder function during the subacute phase. Conducting TOV using bladder scan residuals in patients with VAC is a non-invasive and easy method to discriminate between a functional and an impaired bladder following acute TSCI.
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Affiliation(s)
- Victor Lim
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada
| | - Antoine Dionne
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean Begin
- Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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Repić-Buličić A, Filipović-Grčić P, Jadrijević E, Jurinović P, Titlić M. SUCCESSFUL TREATMENT OF ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) BY PROMPT USAGE OF IMMUNOGLOBULINS - CASE REPORT AND REVIEW OF THE LITERATURE. Acta Clin Croat 2019; 58:173-179. [PMID: 31363340 PMCID: PMC6629195 DOI: 10.20471/acc.2019.58.01.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.
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Affiliation(s)
| | | | - Eni Jadrijević
- Department of Neurology, Split University Hospital Centre, Split, Croatia
| | - Pavao Jurinović
- Department of Neurology, Split University Hospital Centre, Split, Croatia
| | - Marina Titlić
- Department of Neurology, Split University Hospital Centre, Split, Croatia
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Sakakibara R. Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders. Clin Auton Res 2018; 29:313-320. [DOI: 10.1007/s10286-018-0551-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/23/2018] [Indexed: 01/29/2023]
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Yamagami K, Kakuta N, Seki K, Nakamura R, Hanioka Y, Nakamura T, Goto H. Acute Urinary Retention Induced by Chemical Meningitis Which Occurred Due to a Ruptured Dermoid Cyst. Intern Med 2018; 57:729-731. [PMID: 29151533 PMCID: PMC5874349 DOI: 10.2169/internalmedicine.9486-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Meningitis retention syndrome (MRS), a rare complication of aseptic meningitis, can present with acute urinary retention. The rupture of a dermoid cyst, which is a benign intracranial tumor, can sometimes induce chemical meningitis. We herein present a case of chemical meningitis and acute urinary retention that was induced by the rupture of a dermoid cyst. The patient experienced urinary retention for approximately 60 days, and then made a complete recovery thereafter. This is the first reported case of acute urinary retention due to the rupture of a dermoid cyst.
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Affiliation(s)
- Keiko Yamagami
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Naoko Kakuta
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Kaori Seki
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Ryota Nakamura
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Yusuke Hanioka
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | | | - Hitoshi Goto
- Department of Internal Medicine, Osaka City General Hospital, Japan
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Yenli E, Aboah K, Gyasi-Sarpong C, Azorliade R, Arhin A. Acute and chronic urine retention among adults at the urology section of the Accident and Emergency Unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2014.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Shimoni Z, Fruger E, Froom P. Measurement of post-void residual bladder volumes in hospitalized older adults. Am J Med 2015; 128:77-81. [PMID: 25193275 DOI: 10.1016/j.amjmed.2014.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/05/2014] [Accepted: 08/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is commonly recommended to catheterize or closely follow up patients with post-void residual volumes of 150 mL or more, but the frequency of such findings in geriatric hospitalized patients and the need for intervention are unclear. METHODS Post-void residual volumes were measured by ultrasound examination within 14 hours of admission in 464 patients aged 70 years or more who were hospitalized in a regional hospital general internal medicine department. Outcome variables included the need for an indwelling catheter and complications of urinary retention during the hospitalization. RESULTS Post-void residual volumes of ≥150 mL were common (23.9%; 111/464) and had the following distribution: 150 to 299 mL, 13.1% (61/464); 300 to 499 mL, 6.4% (30/464); and 500 mL or more, 6% (28/464). The rate of indwelling catheters was 3.2% (15/464). Results of post-void residual volumes did not predict the need for indwelling catheters in those without other criteria, although those with indications for indwelling catheters had a significantly higher frequency of post-void residual volumes ≥500 mL (P < .001) compared with those without such indications. CONCLUSIONS We conclude that urinary retention in hospitalized geriatric patients is common, but measurements of post-void residual volumes did not have definite clinical utility. However, the study had limited power to determine the benefits or potential harms of urinary catheterization for elevated post-void residual volumes.
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Affiliation(s)
- Zvi Shimoni
- Internal Medicine B, Laniado Hospital, Netanya, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ela Fruger
- Internal Medicine B, Laniado Hospital, Netanya, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Paul Froom
- School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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9
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Asimakopoulos AD, De Nunzio C, Kocjancic E, Tubaro A, Rosier PF, Finazzi-Agrò E. Measurement of post-void residual urine. Neurourol Urodyn 2014; 35:55-7. [DOI: 10.1002/nau.22671] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/01/2014] [Indexed: 11/08/2022]
Affiliation(s)
| | - Cosimo De Nunzio
- Department of Urology; Sant'Andrea Hospital; Faculty of Health Sciences “La Sapienza” University of Rome; Rome Italy
| | - Ervin Kocjancic
- Director division of Pelvic Health and Reconstructive Urology; Department of Urology; University of Illinois at Chicago; Chicago Illinois
| | - Andrea Tubaro
- Department of Urology; Sant'Andrea Hospital; Faculty of Health Sciences “La Sapienza” University of Rome; Rome Italy
| | - Peter F. Rosier
- University Medical Centre Utrecht; Department of Urology; Utrecht The Netherlands
| | - Enrico Finazzi-Agrò
- Unit for Functional Urology; Policlinico Tor Vergata; Department of Experimental Medicine and Surgery; Tor Vergata University of Rome; Rome Italy
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11
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Sternberg Z. Autonomic dysfunction: A unifying multiple sclerosis theory, linking chronic cerebrospinal venous insufficiency, vitamin D3, and Epstein-Barr virus. Autoimmun Rev 2012; 12:250-9. [DOI: 10.1016/j.autrev.2012.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/22/2012] [Indexed: 12/18/2022]
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12
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Sakakibara R, Kishi M, Tsuyusaki Y, Tateno A, Tateno F, Uchiyama T, Yamamoto T, Yamanishi T, Yano M. "Meningitis-retention syndrome": a review. Neurourol Urodyn 2012; 32:19-23. [PMID: 22674777 DOI: 10.1002/nau.22279] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/03/2012] [Indexed: 11/09/2022]
Abstract
AIMS A peculiar combination of acute urinary retention and aseptic meningitis has been described. This combination is referred to as meningitis-retention syndrome (MRS), since patients with this syndrome exhibited no other abnormalities, except for mild pyramidal involvement. We aimed to delineate this syndrome by reviewing literatures. METHODS We performed a systematic review of the literature to identify the frequency, clinical symptoms, urodynamic findings, putrative underlying pathology, and management of this syndrome. RESULTS Patients with MRS have typical symptoms of fever, headache, stiff neck, and minor pyramidal signs, together with acute urinary retention. The bladder is initially areflexic, but soon becomes either normal or overactive in the repeated urodynamics during the course of the disorder. MRS is thought to be a very mild form of acute disseminated encephalomyelopathy (ADEM), with increased cell count, total protein, and occasional myelin basic protein in the cerebrospinal fluid. Proper management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. The effectiveness of immune treatments (e.g., steroid pulse therapy) in shortening the urinary retention period awaits further study. CONCLUSIONS Although rare, MRS is a disorder that both urologists and neurologists may encounter. MRS should be listed in the differential diagnosis of acute urinary retention.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
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Hoshino T, Uchiyama Y, Ito E, Osawa S, Ohashi T. Simultaneous development of acute disseminated encephalomyelitis and Guillain-Barré syndrome associated with H1N1 09 influenza vaccination. Intern Med 2012; 51:1595-8. [PMID: 22728497 DOI: 10.2169/internalmedicine.51.7132] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 36-year-old man was admitted to our hospital because of urinary retention and muscle weakness affecting all 4 limbs after receiving a H1N1 09 influenza vaccination. Magnetic resonance imaging demonstrated multiple lesions in his brain and spinal cord. Furthermore, nerve conduction study showed acute sensorimotor neuropathy, and anti-GM2 antibodies were detected in his serum. Based on the temporal association and exclusion of alternative etiologies, we made a diagnosis of acute disseminated encephalomyelitis (ADEM) and Guillain-Barré syndrome (GBS). To our knowledge, this is the first case of co-morbid ADEM and GBS after influenza vaccination with positive anti-ganglioside antibodies.
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Affiliation(s)
- Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University, Japan.
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14
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Alexander M, Murthy JMK. Acute disseminated encephalomyelitis: Treatment guidelines. Ann Indian Acad Neurol 2011; 14:S60-4. [PMID: 21847331 PMCID: PMC3152158 DOI: 10.4103/0972-2327.83095] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Indexed: 11/09/2022] Open
Affiliation(s)
- M Alexander
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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Kitami M, Kubo SI, Nakamura S, Shiozawa S, Isobe H, Furukawa Y. Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report. J Med Case Rep 2011; 5:159. [PMID: 21507219 PMCID: PMC3095552 DOI: 10.1186/1752-1947-5-159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 04/20/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion present with relatively mild central nervous system disturbances. Although the exact etiology of the condition remains poorly understood, it is thought to be associated with infective agents. We present a case of a patient with mild encephalitis/encephalopathy with a reversible splenial lesion, who had the unusual feature of acute urinary retention. CASE PRESENTATION A 23-year-old Japanese woman developed mild confusion, gait ataxia, and urinary retention seven days after onset of fever and headache. Magnetic resonance imaging demonstrated T2 prolongation in the splenium of the corpus callosum and bilateral cerebral white matter. These magnetic resonance imaging abnormalities disappeared two weeks later, and all of the symptoms resolved completely within four weeks. Except for the presence of acute urinary retention (due to underactive detrusor without hyper-reflexia), the clinical and radiologic features of our patient were consistent with those of previously reported patients with mild encephalitis/encephalopathy with a reversible splenial lesion. To the best of our knowledge, this is the first report of acute urinary retention recognized in a patient with mild encephalitis/encephalopathy with a reversible splenial lesion. CONCLUSION Our findings suggest that mild encephalitis/encephalopathy with a reversible splenial lesion can be associated with impaired bladder function and indicate that acute urinary retention in this benign disorder should be treated immediately to avoid bladder injury.
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Affiliation(s)
- Makiko Kitami
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto, Tokyo 136-0075, Japan.
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Tateno F, Sakakibara R, Sugiyama M, Takahashi O, Kishi M, Ogawa E, Uchiyama T, Yamamoto T, Yamanishi T, Yano H, Suzuki H. Meningitis-retention syndrome: first case of urodynamic follow-up. Intern Med 2011; 50:1329-32. [PMID: 21673471 DOI: 10.2169/internalmedicine.50.4747] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The combination of acute urinary retention and aseptic meningitis has not been well recognized. This combination can be referred to as meningitis-retention syndrome (MRS), when accompanied by no other abnormalities. However, the responsible site of lesions for urinary retention in MRS remains obscure, despite the areflexic detrusor at the time of urinary retention. We recently encountered a man with MRS in whom a urodynamic study was performed twice. In that case, an initially areflexic detrusor became overactive after a 4-month period, suggesting an upper motor neuron bladder dysfunction.
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Affiliation(s)
- Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan
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TAKAHASHI O, SAKAKIBARA R, KISHI M, OGAWA E, TSUNOYAMA K, SUGIYAMA M, TOMARU T, UCHIYAMA T, YAMANISHI T. Pelvic Autonomic Dysfunction without Tetraparesis: A Sequel of Rubella-related Acute Longitudinal Myelitis. Low Urin Tract Symptoms 2009. [DOI: 10.1111/j.1757-5672.2009.00054.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martín-Merino E, García-Rodríguez LA, Massó-González EL, Roehrborn CG. Do Oral Antimuscarinic Drugs Carry an Increased Risk of Acute Urinary Retention? J Urol 2009; 182:1442-8. [DOI: 10.1016/j.juro.2009.06.051] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Claus G. Roehrborn
- Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, Texas
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Panicker JN, Nagaraja D, Kovoor JME, Nair KPS, Subbakrishna DK. Lower urinary tract dysfunction in acute disseminated encephalomyelitis. Mult Scler 2009; 15:1118-22. [DOI: 10.1177/1352458509106614] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Lower urinary tract dysfunction (LUTD) in multiple sclerosis has been well documented. However, its occurrence and outcome in acute disseminated encephalomyelitis (ADEM) has only been variably reported. Objective To evaluate LUTD in ADEM, correlation with other neurological deficits, and outcome. Methods Patients with ADEM having significant LUTD were evaluated. LUTD was evaluated by symptom analysis, ultrasonography, and urodynamics. Storage symptoms were managed using antimuscarinics and significant voiding dysfunction by catheterization. Results Of 61 patients, 20 (33%) had LUTD. Voiding dysfunction was more common and 16 patients were in urinary retention. Cystometry demonstrated detrusor overactivity in four patients and underactivity in four patients. Incontinence was reported more often in patients with frontoparietal white matter changes in MR imaging. LUTD was found to be associated with occurrence of paraparesis or tetraparesis, though did not predict functional outcome at discharge. At 3 months follow up, five patients continued to have LUTD and urgency and hesitancy were commonest symptoms. Conclusion LUTD is common in ADEM, especially in patients with lower limb pyramidal involvement and its causes multifactorial. Presence of LUTD does not influence the functional outcome of patients with ADEM. Recovery may be incomplete and symptoms may persist even after recovery of other neurological deficits.
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Affiliation(s)
- JN Panicker
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - D Nagaraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - JME Kovoor
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - KPS Nair
- Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - DK Subbakrishna
- Department of Biostatistics, National Institute of Mental Health and Neurosciences Bangalore, India
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Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary Retention and Post-Void Residual Urine in Men: Separating Truth From Tradition. J Urol 2008; 180:47-54. [DOI: 10.1016/j.juro.2008.03.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Steven A. Kaplan
- Department of Urology, Weill Medical College, Cornell University, New York, New York
| | - Alan J. Wein
- Division of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David R. Staskin
- Section of Voiding Dysfunction, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York
- Department of Urology, Weill Medical College, Cornell University, New York, New York
- Department of Obstetrics/Gynecology, Weill Medical College, Cornell University, New York, New York
| | - Claus G. Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William D. Steers
- Department of Urology, University of Virginia Medical School, Charlottesville, Virginia
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Sakakibara R, Yamanishi T, Uchiyama T, Hattori T. Acute urinary retention due to benign inflammatory nervous diseases. J Neurol 2006; 253:1103-10. [PMID: 16680560 DOI: 10.1007/s00415-006-0189-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 12/13/2005] [Indexed: 10/24/2022]
Abstract
Both neurologists and urologists might encounter patients with acute urinary retention due to benign inflammatory nervous diseases. Based on the mechanism of urinary retention, these disorders can be divided into two subgroups: disorders of the peripheral nervous system (e.g., sacral herpes) or the central nervous system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities include increased herpes virus titers in sacral herpes, and increased myelin basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic abnormality in both conditions is detrusor areflexia; the putative mechanism of it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal shock in MRS. There are few cases with CSF abnormality alone. Although these cases have a benign course, management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. Clinical features of sacral herpes or MRS differ markedly from those of the original "Elsberg syndrome" cases.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Chiba University, 1-8-1 Inohana Chuo-ku, 260-8670 Chiba, Japan.
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Sasaki M, Ohara S, Hayashi R, Iwahashi T, Tsuyuzaki J. Aseptic meningo-radiculo-encephalitis presenting initially with urinary retention: a variant of acute disseminated encephalomyelitis. J Neurol 2006; 253:908-13. [PMID: 16502219 DOI: 10.1007/s00415-006-0131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Revised: 07/21/2005] [Accepted: 09/07/2005] [Indexed: 10/25/2022]
Abstract
We report three male patients with aseptic meningoencephalo- radiculitis presenting with acute urinary retention. Viral antibody titers for herpes types I and II and the PCR studies were negative. The cerebrospinal fluid revealed elevated myelin basic protein. The serum antibodies against a panel of gangliosides, some of which are known to be associated with acquired demyelinating neuropathies, were all negative. The magnetic resonance imaging (MRI) studies revealed spotty T2 high intensities in the basal ganglia, thalamus and brainstem in two patients. In one patient,meningeal gadolinium enhancement of the conus and cauda equina of the spinal cord was recognized. On urodynamic studies, all patients showed features of atonic bladder with or without detrusor hyperactivity. They were treated conservatively without using steroids or immunoglobulins, and made a remarkable functional recovery with the disappearance of abnormal MRI findings.However, all three were left with erectile dysfunction, and two continued to use self-intermittent catheterization at more than 3-year follow-up. There was no recurrence of symptoms. The underlying causes remain unclear, though they may represent a variant of acute disseminated encephalomyelitis.
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Affiliation(s)
- M Sasaki
- Department of Neurology, National Chushin-Matsumoto Hospital, 811 Kotobuki, Matsumoto, Japan
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Silvia MT, Licht DJ. Pediatric central nervous system infections and inflammatory white matter disease. Pediatr Clin North Am 2005; 52:1107-26, ix. [PMID: 16009259 DOI: 10.1016/j.pcl.2005.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article reviews the immunology of the central nervous system and the clinical presentation, diagnosis, and treatment of children with viral or parainfectious encephalitis. The emphasis is on the early recognition of treatable causes of viral encephalitis (herpes simplex virus), and the diagnosis and treatment of acute disseminated encephalomyelitis are described in detail. Laboratory and imaging findings in the two conditions also are described.
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Affiliation(s)
- Mary T Silvia
- Division of Neurology, The Children's Hospital of Philadelphia, 34th & Civic Center Boulevard, Philadelphia, PA 19104, USA
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Sakakibara R, Uchiyama T, Liu Z, Yamamoto T, Ito T, Uzawa A, Suenaga T, Kanai K, Awa Y, Sugiyama Y, Hattori T. Meningitis-retention syndrome. An unrecognized clinical condition. J Neurol 2005; 252:1495-9. [PMID: 16021353 DOI: 10.1007/s00415-005-0897-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 03/23/2005] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND A combination of acute urinary retention and aseptic meningitis has not been well known. This combination can be referred to as meningitis-retention syndrome (MRS), when accompanied by no other abnormalities. OBJECTIVE To describe the results of a uro-neurological assessment in our patients with MRS. METHODS In three patients (two men, one woman; age, 34-68 years), we performed urodynamic studies and relevant imaging and neurophysiological tests, in addition to cerebrospinal fluid (CSF) examination. RESULTS All three patients developed acute urinary retention along with headache, fever and stiff neck. None had obvious neurological abnormalities, other than a slightly brisk reflex in the lower extremities. One had previously experienced generalized erythematous eruptions, but none had pain, hypalgesia or skin eruptions in the sacral dermatomes suggestive of Elsberg syndrome (infectious sacral polyradiculitis; mostly genital herpes). Brain/spinal/lumbar plexus MRI scans and nerve conduction studies were normal. CSF examination showed mild mononuclear pleocytosis, increased protein content, and normal to mildly decreased glucose content in all patients; increased myelin basic protein suggestive of central nervous system demyelination in one; and increased viral titers in none. Urodynamic study revealed, during the voiding phase, an underactive detrusor in all patients and an unrelaxing sphincter in one. These clinical manifestations were ameliorated within 3 weeks. CONCLUSIONS We reported three cases of MRS, a peculiar syndrome that could be regarded as a mild variant of acute disseminated encephalomyelitis (ADEM). Urinary retention might reflect acute shock phase of this disorder. Although MRS has a benign and self-remitting course, management of the acute urinary retention is necessary.
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Affiliation(s)
- Ryuji Sakakibara
- Dept. of Neurology, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
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Tsukamoto Y, Yamamoto T, Okado H, Nibu KI, Terashima T. Retrograde labeling of mouse spinal descending tracts by a recombinant adenovirus. ACTA ACUST UNITED AC 2004; 66:209-20. [PMID: 14527162 DOI: 10.1679/aohc.66.209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present study tested whether a gene-transfer based upon the retrograde axonal transport of the lacZ adenovirus is effective in the spinal descending tracts of the adult mouse. A small volume of a replication-defective recombinant adenovirus encoding E. coli beta-galactosidase was injected into the upper lumbar cord, and, seven days later, the mice were transcardially perfused by a fixative solution. X-gal staining of coronal or sagittal sections of the spinal cord and the brain revealed that many sites of origin for rubrospinal, vestibulospinal, and reticulospinal tracts were retrogradely labeled, whereas few of the corticospinal tract neurons were retrogradely labeled. Ependymal cells surrounding the central canal of the spinal cord, which were located far from the injection site, showed a high expression of beta-galactosidase activity. Motoneurons around the injection site were strongly stained by X-gal staining, and their axons in the ventral root were anterogradely labeled. Afferent fibers in the dorsal root were labeled by the transganglionic transport of beta-galactosidase. To examine the efficacy of the uptake and retrograde transport of HRP and adenovirus, we injected a mixed solution of 10% HRP and recombinant adenovirus. The number of HRP-labeled corticospinal neurons overwhelmed the number of X-gal stained ones, while the numbers of HRP-labeled rubrospinal and subcoeruleus-spinal neurons were smaller in comparison with the numbers of beta-galactosidase-positive counterparts. The present study revealed that the origins for the spinal descending tracts except for corticospinal neurons could be efficiently gene-transferred by the retrograde infection of a recombinant adenovirus. Such a difference in efficacy of retrograde infection among the spinal descending tracts is practically important when an adenovirus-mediated gene transfer is designed to treat certain neurological diseases affecting the spinal descending tracts.
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Affiliation(s)
- Yasuhiro Tsukamoto
- Department of Anatomy and Developmental Neurobiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Sakakibara R, Hattori T, Fukutake T, Mori M, Yamanishi T, Yasuda K. Micturitional disturbance in a patient with adrenomyeloneuropathy (AMN). Neurourol Urodyn 2000; 17:207-12. [PMID: 9590472 DOI: 10.1002/(sici)1520-6777(1998)17:3<207::aid-nau5>3.0.co;2-h] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a case of adrenomyeloneuropathy (AMN) in which serial urodynamic studies showed neurogenic bladder dysfunction. The patient was in good health until the age of 12, when he began to lose his hair. At age 25 he started to have urinary urgency, difficulty in voiding, occasional fecal incontinence, erectile impotence, and progressive gait disturbance. In his first admission to our hospital age 31, he was intelligent but childish. He showed diffuse baldness, spastic paraparesis, and disturbed vibratory sensation. Serum cortisol response to corticotropin (ACTH) was low and serum levels of very long chain fatty acids were increased. Nerve conduction studies and sural nerve biopsy showed the presence of peripheral neuropathy. These findings confirmed the diagnosis of AMN. The first urodynamic study showed residual urine volume of 50 ml, impaired bladder sensation, and detrusor hyperreflexia. At age 38 he needed diapers because he became apathetic and demented, and could no longer stand by himself. MRI disclosed high signal intensities in the bilateral cerebral white matter. The second urodynamic study showed residual urine volume of 200 ml and decreased bladder capacity with marked detrusor hyperreflexia. Demyelinating lesions of the peripheral nerve and white matter of the spinal cord and the cerebrum may be mainly responsible for the micturitional disturbance in our patient with AMN.
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Affiliation(s)
- R Sakakibara
- Department of Neurology, Chiba University School of Medicine, Japan
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