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Broomall E, Taylor JM, Peariso K. A 2-Year-Old Boy With Difficulty Waking After Bone Marrow Transplantation. Semin Pediatr Neurol 2018; 26:120-123. [PMID: 29961501 DOI: 10.1016/j.spen.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a 2-year-old boy who was evaluated for difficult waking during prolonged intensive care unit admission associated with bone marrow transplant for Wiskott-Aldrich syndrome. Neurologic examination was found to be abnormal, with nuchal rigidity initially, then decreased extremity movement and areflexia developing over several days. Electromyogram showed length-dependent, axonal, sensorimotor polyneuropathy. Cerebrospinal fluid showed albuminocytologic dissociation suggestive of Guillain-Barre syndrome or acute motor and sensory axonal neuropathy variant. The patient was treated with immunotherapy and slowly showed signs of motor recovery over several months. A review of Wiskott-Aldrich syndrome, Guillain-Barre syndrome, immune-mediated complications of bone marrow transplantation, and acute weakness in the intensive care unit is provided in this case report.
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Affiliation(s)
- Eileen Broomall
- From the Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - John Michael Taylor
- From the Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Katrina Peariso
- From the Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Rebai I, Ben Achour N, El Mabrouk E, Kraoua I, Ben Youssef-Turki I. Letter to the editor: "A case of Guillain-Barré syndrome with meningeal irritation". Brain Dev 2017; 39:815. [PMID: 28533076 DOI: 10.1016/j.braindev.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Ibtihel Rebai
- Research Unit UR12 SP24 and Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia.
| | - Nedia Ben Achour
- Research Unit UR12 SP24 and Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia
| | - Emna El Mabrouk
- Research Unit UR12 SP24 and Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia
| | - Ichraf Kraoua
- Research Unit UR12 SP24 and Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia
| | - Ilhem Ben Youssef-Turki
- Research Unit UR12 SP24 and Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia
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Ashikari Y, Kobayashi S, Tago A, Yoneyama M, Ito M, Fukuda K, Mizuno Y, Tsunoda Y, Shimizu S, Yokoi K, Kamioka N, Hamajima N, Suzuki S. Reply to the letter: "A case of Guillain-Barré syndrome with meningeal irritation". Brain Dev 2017; 39:816. [PMID: 28668234 DOI: 10.1016/j.braindev.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Yuka Ashikari
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Satoru Kobayashi
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan.
| | - Akari Tago
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Mizuki Yoneyama
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Midori Ito
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Keiko Fukuda
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Yoshifumi Mizuno
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Yuko Tsunoda
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Seiki Shimizu
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Kyoko Yokoi
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Naomi Kamioka
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Naoki Hamajima
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
| | - Satoshi Suzuki
- Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Japan
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Platt MP, Agalliu D, Cutforth T. Hello from the Other Side: How Autoantibodies Circumvent the Blood-Brain Barrier in Autoimmune Encephalitis. Front Immunol 2017; 8:442. [PMID: 28484451 PMCID: PMC5399040 DOI: 10.3389/fimmu.2017.00442] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/30/2017] [Indexed: 12/11/2022] Open
Abstract
Antibodies against neuronal receptors and synaptic proteins are associated with autoimmune encephalitides (AE) that produce movement and psychiatric disorders. In order to exert their pathological effects on neural circuits, autoantibodies against central nervous system (CNS) targets must gain access to the brain and spinal cord by crossing the blood–brain barrier (BBB), a tightly regulated gateway formed by endothelial cells lining CNS blood vessels. To date, the pathogenic mechanisms that underlie autoantibody-triggered encephalitic syndromes are poorly understood, and how autoantibodies breach the barrier remains obscure for almost all AE syndromes. The relative importance of cellular versus humoral immune mechanisms for disease pathogenesis also remains largely unexplored. Here, we review the proposed triggers for various autoimmune encephalopathies and their animal models, as well as basic structural features of the BBB and how they differ among various CNS regions, a feature that likely underlies some regional aspects of autoimmune encephalitis pathogenesis. We then discuss the routes that antibodies and immune cells employ to enter the CNS and their implications for AE. Finally, we explore future therapeutic strategies that may either preserve or restore barrier function and thereby limit immune cell and autoantibody infiltration into the CNS. Recent mechanistic insights into CNS autoantibody entry indicate promising future directions for therapeutic intervention beyond current, short-lived therapies that eliminate circulating autoantibodies.
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Affiliation(s)
- Maryann P Platt
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Dritan Agalliu
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA.,Department of Pharmacology, Columbia University Medical Center, New York, NY, USA.,Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, NY, USA
| | - Tyler Cutforth
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, NY, USA
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