Transverse Myelitis

An Interesting Case of Acute Transverse Myelitis Secondary to Hepatitis C and Tricuspid Valve Endocarditis: A Case Report

Acute transverse myelitis (ATM) is a neurological disorder characterized by inflammation of the spinal cord, often resulting in sensory, motor, and autonomic dysfunction. Herein, we present a unique case of acute transverse myelitis secondary to hepatitis C virus (HCV) infection complicating infective endocarditis (IE), a rarely reported association. A 29-year-old female presented with progressive lower extremity weakness, urinary retention, and sensory disturbances. Clinical examination revealed bilateral lower limb weakness with diminished deep tendon reflexes and sensory loss below the T8 level. Magnetic resonance imaging (MRI) of the spine demonstrated T2 hyperintensity spanning multiple spinal segments consistent with transverse myelitis. Further investigations revealed the presence of HCV infection with evidence of active viremia. Additionally, echocardiography demonstrated vegetation on the tricuspid valve consistent with IE. The patient underwent a thorough infectious workup, which confirmed the diagnosis of IE as blood cultures showed growth of methicillin-sensitive Staphylococcus aureus (MSSA). This case highlights the importance of considering acute transverse myelitis as a potential neurological complication of HCV infection, particularly in the context of IE.

Neurological Complications Associated With the Powassan Virus and Treatment Interventions

Powassan virus (POWV), a flavivirus transmitted by Ixodes ticks, poses significant neurological risks, including encephalitis and meningitis. Despite its growing geographical spread and severe clinical manifestations, no specific antiviral treatments are currently available. This review synthesizes the existing literature on POWV, focusing on its epidemiology, clinical manifestations, neurological impact, and current treatment approaches. The review also explores the molecular biology of POWV, highlighting its genomic structure and the role of nonstructural proteins in its pathogenesis. POWV infection can range from asymptomatic to severe neurological disorders such as encephalitis and meningitis, with the latter presenting less severe outcomes. The pathophysiology of the virus involves immune evasion and robust neuroinflammation, complicating treatment strategies. Current management is supportive, with efforts ongoing to repurpose existing antivirals and develop new therapeutic interventions. Prognostic disparities between POWV-induced meningitis and encephalitis are notable, with meningitis generally having more favorable outcomes. The review also identifies critical gaps in POWV research, particularly in understanding the long-term neurological impacts and developing specific antiviral therapies. This article collates existing relevant literature on the POWV and culminates in two strategic actions: firstly, in the absence of an existing vaccine, it proposes repurposing antiviral drugs designed for related flaviviruses to target shared molecular pathways, such as nonstructural proteins in the POWV. Secondly, the article advocates for longitudinal studies to explore the long-term neurological effects on individuals who have survived POWV infections.

Integrated Rehabilitation of Longitudinal Extensive Transverse Myelitis: Study of a Complex Case

Longitudinal extensive transverse myelitis (LETM) is a rare neurological disorder portrayed by inflammation of the spinal cord spanning three or more vertebral segments. It can lead to severe symptoms such as weakness, sensory abnormalities, and dysfunction in various parts of the body. LETM can be idiopathic or associated with autoimmune conditions like Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO). Diagnosis of LETM requires MRI imaging of the spine, and treatment often involves corticosteroids, intravenous immunoglobulins (IVIG), and plasma exchange. Physical therapy plays a crucial role in managing LETM, focusing on improving functional abilities, mobility, and quality of life. This study outlines a 62-year-old male who was admitted with a complaint of bilateral weakness of both upper and lower limbs, predominantly on the left side, seizures, falls, and stiffness of the left limbs. He also complained of a cough with sputum, cluster headache, bowels and bladder dysfunction, and impaired vision. Neurologic examination showed hypotonia and reduced muscle strength in all four limbs with impairment of the optic nerve. The following investigations were conducted: MRI, Chest X-ray, and ultrasound. He was advised for physiotherapy, after which he showed improvement in functional independence and a general recovery following the treatment.

Transverse Myelitis in a 72-Year-Old Male Presenting With Upper Extremity Weakness

Acute transverse myelitis (TM) is a rare, acquired neuro-immune spinal cord disorder that can be idiopathic or related to a secondary disease. Clinical signs and symptoms include motor weakness, sensory alterations, and bowel or bladder dysfunction. Often TM occurs in the younger population or middle-aged adults. This patient's presentation is unique in the fact that he does not fall into either of these age categories. In this case, a 72-year-old male with a past medical history of hypertension and type 2 diabetes mellitus presented to the emergency department due to a five-day history of worsening weakness of the upper extremities bilaterally. In addition, the patient reported a new onset of abdominal wall numbness. The patient reported being at a theme park a few days prior, denying any injuries and only complaining of neck discomfort during the car ride home. Labs and imaging were quickly ordered for diagnostic purposes. The patient was diagnosed with TM using magnetic resonance imaging (MRI), lumbar puncture, and clinical signs. The etiology was later discovered to be due to a new diagnosis of Sjögren's autoimmune disease. The patient was treated with high-dose intravenous steroids for five days while being monitored for any neurologic changes. The plan was to continue steroids by mouth once discharged from the hospital. Due to poor adherence to discharge instructions, the patient was readmitted after presenting to the emergency department with worsening symptoms. Physicians need to recognize and diagnose TM quickly, as some etiologies are treatable and can prevent further damage to the spinal cord.

Can SARS-CoV-2 trigger new onset of autoimmune disease in adults? A case-based review

Introduction

Although it has been proposed that SARS-CoV-2 can cause autoimmunity by inducing a transient immunodeficiency of both innate and acquired immunity components in which the immune system fails to identify autoantigens adequately, the exact mechanism that causes this disease remains unknown. We aim to systematically review of existing case reports for evidence of new autoimmune diseases in adults caused by SARS-CoV-2 infection.

Methods

PRISMA-P 2020 method was used to search for literature in "PubMed" databases using the string "COVID-19 AND autoimmune disease AND complication". We used JBI Critical Appraisal Checklist to assess the articles' quality.

Results

The literature search yielded 666 articles. 58 articles met our eligibility criteria. Based on our critical appraisal, we placed 35 articles in the good category and 23 articles in the medium category. Data was synthesized by grouping similar data into a table, including: gender, age, COVID-19 severity, types of autoimmune diseases, autoimmune profile and relevant findings, when autoimmune diseases are diagnosed, complications, and outcome to draw conclusions. The new onset of autoimmune disease in adult triggered by SARS-CoV-2 included Guillain-Barré syndrome and Miller Fisher syndrome, systemic lupus erythematosus, immune thrombocytopenia, autoimmune haemolytic anemia, latent autoimmune diabetes in adults, myositis, acute demyelinating encephalomyelitis, autoimmune encephalitis, central nervous system vasculitis, and autoimmune thyroid diseases.

Conclusion

SARS-CoV-2 can trigger new onset of a variety of autoimmune diseases. Doctors who take care patients infected by COVID-19 must be aware of the complications of autoimmune diseases. Future cohort or cross-sectional studies on SARS-CoV-2-related autoimmune disease should be conducted.

Non-invasive near-infrared spectroscopy assessment of the spinal neurovascular response in a patient with transverse myelitis: a case report

BACKGROUND

Transverse myelitis (TM) is characterized by acute development of motor, sensory and autonomic dysfunctions due to horizontally diffused inflammation in one or more segments of the spinal cord in the absence of a compressive lesion. The not well-known inflammation process induces demyelination resulting in neurological dysfunction.

CASE PRESENTATION

In this case report we used a functional Near-Infrared Spectroscopy (fNIRS) technique to evaluate changes in the peri-spinal vascular response induced by a peripheral median nerve electrical stimulation in a patient with chronic transverse myelitis (TM). fNIRS showed drastically reduced signal amplitude in the peri-spinal vascular response, compared to that obtained from a healthy control group throughout most of the C7-T1 and T10-L2 spinal cord segments.

CONCLUSION

The potential use of this relatively non-invasive fNIRS technology support the potential clinical application of this method for functional test of the spinal cord through the assessment of the spinal neurovascular response.

Viral Versus Vaccine-Associated Acute Transverse Myelitis With Neuromyelitis Optica Immunoglobulin G Antibody and Myelin Basic Protein: A Case Report

Transverse myelitis is a rare spinal cord disorder caused by local inflammation. Usually, this occurs as a complication from infection or autoimmune disease; however, there have been reported idiopathic causes such as vaccinations. A 73-year-old female with a medical history significant for Hashimoto’s thyroiditis presented with new-onset paresthesias in her lower extremities. Her symptom onset was about five weeks after receiving influenza and tetanus, diphtheria, and pertussis (TDaP) vaccines. Magnetic resonance imaging (MRI) of the spine revealed an increased T2 signal of the lower cervical and thoracic spine. Lumbar puncture was also performed, and cerebrospinal fluid (CSF) serology showed elevated myelin basic protein (MBP) at 108.3 ng/mL (reference range: 0-5.5 ng/mL). Serology panel revealed Coxsackie virus type B4 antibody at 1:80 (reference range: <1:10) and Echovirus type 6 antibody at 1:640 (reference range: <1:10). Neuromyelitis optica (NMO) immunoglobulin G (IgG) antibody was 24.6 U/mL (reference range: <2.9 U/mL). She was diagnosed with acute transverse myelitis (ATM) and treated with alternating steroids and plasma exchange (PLEX) therapy for five days each. This case highlights the possible associations of vaccines with transverse myelitis. Although ATM is a rare disorder with serious complications, it has a favorable prognosis in the setting of rapid detection and treatment. Vaccine-related ATM remains controversial, but patients with these adverse reactions need to be cautioned regarding potential recurrence risk.

The association between SARS-CoV-2 vaccines and transverse myelitis: A review

In late 2019, the emergence of a new viral strain, later referred to as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) took the shape of a global pandemic, affecting millions of lives and deteriorating economies around the globe. Vaccines were developed at an exceptional rate to combat the viral desolation, all of them being rolled out once they displayed sufficient safety and efficacy. However, assorted adverse events came into attention, one of them being Transverse Myelitis (TM), an infrequent, immune-mediated, focal disease of the spinal cord. This disorder can lead to severe neurological complications including autonomic, sensory, and motor deficits. The literature aims to shed light on TM and its various etiologies, specifically in line with the vaccine, and a comprehensive treatment plan. Discussing and reducing the number of vaccines related adverse events can help succor in bringing down the vaccine hesitancy and ultimately combatting the pandemic.

Radiation induced delayed transverse myelitis and neurological deficit at tertiary care center

Background

Transverse myelitis is a rare spinal cord inflammation with absence of a compression. It varies in presentation based on the pathology location, and mainly causes a combined deficit of motor, sensory, and autonomic functions. History, physical examination, and other diagnostic tests including blood tests and an MRI are important tools to establish a diagnosis.

A thorough neurological evaluation helps localize the affected region of the spinal cord. The management includes rehabilitation as any other spinal cord injury. If very severe, a multidisciplinary rehabilitation program will be required.

Presentation

We explain a case in which a 43-year-old male patient, known to have chronic myelogenous leukemia (CML), on Imatinib (a tyrosine kinase inhibitor), started complaining of back pain at the level of the 10th rib. Different tests were made including a PET-CT (Positron Emission Tomography-Computed Tomography) which showed hypermetabolic bony lytic lesion in the left mandible at the level of temporomandibular joint, destruction of the 10th rib, and no evidence of spinal cord compression. Other etiologies were excluded, making transverse myelitis due to radiation for the patient's CML on top of the differential diagnosis.

Conclusion

A thorough physical examination and diagnostic tests are important tools to exclude other etiologies of complex neurological deficit in a patient with CML.

•

Transverse myelitis can be a possible complication post-radiation for CML treatment.

•

Careful history taking, meticulous physical examination, and investigations are necessary.

•

Avoid delaying intervention once a diagnosis has been made to avoid neurological impairment.

Spinal cord stimulator for neuropathic pain in a patient with severe disability due to transverse myelitis

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.