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Cui Y, Chen Z, Kong Y, Wang Y, Wang Y, Zhang J, Wang L, Zhang J, Sun W, Wu L. Clinical features of COVID-19-related encephalitis: comparison with the features of herpes virus encephalitis and autoimmune encephalitis. Neurol Sci 2024:10.1007/s10072-024-07587-5. [PMID: 38772979 DOI: 10.1007/s10072-024-07587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Identifying coronavirus disease 2019 (COVID-19)-related encephalitis without clear etiological evidence is clinically challenging. The distinctions between this condition and other prevalent encephalitis types remain unknown. Therefore, we aimed to explore the similarities and differences in the clinical characteristics of COVID-19-related encephalitis and other encephalitis types. METHODS Adult patients with encephalitis admitted to the neurology department at Xuanwu Hospital were enrolled and categorized into the following six groups based on the results of metagenomic next-generation sequencing and autoimmune antibody detection in cerebrospinal fluid (CSF): COVID-19-related encephalitis (n = 36), herpes simplex virus type 1 encephalitis (HSV-1 encephalitis; n = 28), human herpesvirus 3 encephalitis (HHV-3 encephalitis; n = 10), NMDAR-antibody encephalitis (n = 18), LGI1-antibody encephalitis (n = 12), and GABAB-antibody encephalitis (n = 8). RESULTS The predominant characteristics of COVID-19-related encephalitis include a low incidence of seizures (38.9%), cognitive defects (30.6%), and meningeal irritation signs (8.3%). Compared with HSV-1 and HHV-3 encephalitis, COVID-19-related encephalitis exhibited lower white blood cell count (2.5 count/mm3), protein (32.2 mg/dL), and immunoglobulin M, G, and A levels (0.09, 3.2, and 0.46 mg/dL, respectively) in the CSF tests. Abnormal imaging findings were present in only 36.1% of COVID-19-related encephalitis cases, mostly showing diffuse inflammation scattered in various parts, which differed from HSV-1 encephalitis. Additionally, COVID-19-related encephalitis exhibited significant differences in clinical symptoms and CSF white blood cell counts compared with NMDAR-antibody encephalitis; however, it showed limited differences compared with LGI1-antibody and GABAB-antibody encephalitis. DISCUSSION COVID-19-related encephalitis and herpes virus or autoimmune encephalitis differ clinically. Symptoms and auxiliary examinations can be used as distinguishing tools.
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Affiliation(s)
- Yue Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingtao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yihao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiatang Zhang
- Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Chayanopparat S, Jitprapaikulsan J, Ongphichetmetha T. Catastrophic tumefactive acute disseminated encephalomyelitis in patient with dengue virus: a case report. J Neurovirol 2024:10.1007/s13365-024-01210-1. [PMID: 38778005 DOI: 10.1007/s13365-024-01210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Tumefactive demyelinating lesions (TDL) are a rare occurrence among inflammatory demyelinating diseases of the central nervous system, distinguished by tumor-like lesions exceeding 2 cm in diameter. While various etiologies have been associated with TDL, only a limited number of case reports document the coexistence of acute disseminated encephalomyelitis (ADEM) and TDL. Here, we present the case of a female diagnosed with dengue fever two weeks prior, who subsequently developed left hemiparesis and encephalopathy. Both her brain magnetic resonance imaging (MRI) and clinical course align with the characteristics of tumefactive ADEM.
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Affiliation(s)
| | - Jiraporn Jitprapaikulsan
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Tatchaporn Ongphichetmetha
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand.
- Siriraj Neuroimmunology Center, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Sicard M, Shor N, Davy V, Rouby JJ, Oquendo B, Maisonobe T, Puybasset L, Lehericy S, Lecarpentier A, Donadio C, Oasi C, Belmin J, Lubetzki C, Corvol JC, Grabli D, Saracino D. Cerebellar encephalitis and peripheral neuropathy with an atypical clinical and neuroimaging signature following Covid-19 vaccine: a report of two cases. J Neurol 2024:10.1007/s00415-024-12390-5. [PMID: 38704487 DOI: 10.1007/s00415-024-12390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Marin Sicard
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Natalia Shor
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
| | - Vincent Davy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Bruno Oquendo
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Thierry Maisonobe
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Louis Puybasset
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Stephane Lehericy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Amandine Lecarpentier
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Cristiano Donadio
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Christel Oasi
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Joël Belmin
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Catherine Lubetzki
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - David Grabli
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Dario Saracino
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Departement of Neurology, Reference Centre for Rare or Early Dementias, Paris, France.
- Paris Brain Institute - Institut du Cerveau (ICM), AP-HP - Hôpital Pitié-Salpêtrière, DMU Neurosciences, Département de Neurologie, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
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Businaro P, Currò R, Vegezzi E, Diamanti L, Bini P, Cosentino G, Alfonsi E, Farina LM, Colombo E, Tavazzi E, Cortese A, Scaranzin S, Gastaldi M, Marchioni E. Progressive post infectious neurological syndromes with a poor outcome: Long term follow-up and neurofilament light chain quantification. Mult Scler Relat Disord 2023; 76:104781. [PMID: 37295322 DOI: 10.1016/j.msard.2023.104781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Postinfectious neurological syndromes (PINS), among which acute disseminated encephalomyelitis (ADEM), are inflammatory and mostly monophasic disorders. We previously reported that PINS patients can show relapses, or even disease progression. Here we describe a cohort of patients with progressive-PINS and >5 years of follow-up, that developed a progressive worsening without radiological/cerebrospinal fluid analysis evidence of inflammation. At onset 5 patients fulfilled diagnostic criteria for ADEM and none for MS. Progression occurred after a median of 22 months from onset (in 4/7 after 1/more relapses), manifesting as ascending tetraparesis with bulbar functions involvement in 5/7. Five/7 patients received high dose steroids and/or IvIG and 6/7 Rituximab(n = 4) and/or cyclophosphamide(n = 2), with no impact on disease progression in 6/7. NfL levels were higher in patients with progressive-PINS compared to monophasic-ADEM (p = 0.023) and healthy controls (p = 0.004). Progression is rare, but possible, in PINS. Immunotherapy seems to be ineffective in these patients, and elevated serum NfL in serum suggest persistent axonal damage.
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Affiliation(s)
- Pietro Businaro
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Riccardo Currò
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paola Bini
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lisa Maria Farina
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Colombo
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Tavazzi
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Neuromuscular Diseases, University College London, London, United Kingdom
| | - Silvia Scaranzin
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy; Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
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Campbell D, Wong GS, Park H, McLeod G. An Adult Case of Adenovirus-Associated Acute Disseminated Encephalomyelitis. Case Rep Infect Dis 2023; 2023:5528198. [PMID: 37261248 PMCID: PMC10228215 DOI: 10.1155/2023/5528198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune neurological disease that predominately affects pediatric population. Only a single fatal adult case of adenovirus-associated ADEM has previously been published by Qamar et al. in 2021. Here, we present an adult case of adenovirus-associated ADEM, which was diagnosed early in her clinical course. The patient was treated with the prompt initiation of steroids, intravenous immune globulin (IVIG), and plasmapheresis (PLEX), and the patient recovered fully. This case highlights the importance of early accurate diagnosis for other clinicians to treat adenovirus-associated ADEM in a timely fashion to prevent a potentially fatal outcome.
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Affiliation(s)
- Dewayne Campbell
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Gordon S. Wong
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Hyun Park
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Gavin McLeod
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
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6
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Cole J, Choudry S, Kular S, Payne T, Akili S, Callaby H, Gordon NC, Ankcorn M, Martin A, Hobson E, Tunbridge AJ. Monkeypox encephalitis with transverse myelitis in a female patient. THE LANCET. INFECTIOUS DISEASES 2023; 23:e115-e120. [PMID: 36470282 PMCID: PMC9718539 DOI: 10.1016/s1473-3099(22)00741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 12/05/2022]
Abstract
The 2022 monkeypox outbreak has affected 110 countries worldwide, outside of classic endemic areas (ie, west Africa and central Africa). On July 23, 2022, the outbreak was classified by WHO as a public health emergency of international concern. Clinical presentation varies from mild to life-changing symptoms; neurological complications are relatively uncommon and there are few therapeutic interventions for monkeypox disease. In this Grand Round, we present a case of monkeypox with encephalitis complicated by transverse myelitis in a previously healthy woman aged 35 years who made an almost complete recovery from her neurological symptoms after treatment with tecovirimat, cidofovir, steroids, and plasma exchange. We describe neurological complications associated with orthopoxvirus infections and laboratory diagnosis, the radiological features in this case, and discuss treatment options.
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Affiliation(s)
- Joby Cole
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Infection, Immunity, and Cardiovascular Diseases, University of Sheffield, Sheffield, UK.
| | - Saher Choudry
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Saminderjit Kular
- Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Thomas Payne
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suha Akili
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Helen Callaby
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK
| | - N Claire Gordon
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK
| | - Michael Ankcorn
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew Martin
- Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Esther Hobson
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Anne J Tunbridge
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Wada T, Mori H, Kida K, Shindo K. Japanese spotted fever with post-infectious encephalitis. IDCases 2022; 31:e01658. [PMID: 36561293 PMCID: PMC9763843 DOI: 10.1016/j.idcr.2022.e01658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Japanese spotted fever (JSF) is a rickettsial disease caused by Rickettsia japonica. To the best of our knowledge, there have only been five reported cases of JSF involving the central nervous system. A 74-year-old man was admitted after 1 week of fever and maculopapular rash. JSF was definitively diagnosed by PCR; however, the patient showed mental disturbance and abnormal behavior. After intravenous immunoglobulin, his mental state and behavior improved. The findings of cerebrospinal fluid analysis, electroencephalography, and 99 mTcHM-PAO single photon computed emission tomography suggested post-infectious encephalitis. JSF causes post-infectious encephalitis and early treatment is recommended.
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Affiliation(s)
- Takafumi Wada
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan
| | - Hitoshi Mori
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan
| | - Kouji Kida
- Virology Section, Department of Health Science, Okayama Prefectural Institute for Environmental Science and Public Health, Japan, 739–1 Uchio, Okayama Minami-ku, Okayama, 701–0298 Japan
| | - Katsuro Shindo
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan,Corresponding author.
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Caffarelli C, Santamaria F, Piro E, Basilicata S, Delle Cave V, Cipullo M, Bernasconi S, Corsello G. New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine. Ital J Pediatr 2022; 48:189. [PMID: 36435791 PMCID: PMC9701393 DOI: 10.1186/s13052-022-01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022] Open
Abstract
In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine.
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Affiliation(s)
- Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Simona Basilicata
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valeria Delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marilena Cipullo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care G. D'Alessandro, University of Palermo, Palermo, Italy
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Mousa H, Patel TH, Meadows I, Ozdemir B. Acute Disseminated Encephalomyelitis (ADEM) After Consecutive Exposures to Mycoplasma and COVID Vaccine: A Case Report. Cureus 2022; 14:e26258. [PMID: 35911280 PMCID: PMC9312359 DOI: 10.7759/cureus.26258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/12/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system, commonly triggered by viral infections or after immunization. ADEM occurrences in adults are rare. Full spectrum of complications is unknown for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines. A previously healthy 44-year-old female presented to the emergency room (ER) with acute onset of tingling, numbness, and weakness of both lower extremities, urinary retention, blurred vision in right eye, and midline lower back pain. Physical examination revealed bilateral lower extremity weakness 1/5, absent deep tendon reflexes, and decreased sensation. She received the first dose of SARS-CoV-2 vaccine six days prior to presentation to ER. Imaging of her lumbar spine and head were consistent with an active demyelinating plaque consistent with demyelinating disease either multiple sclerosis (MS) or ADEM. The patient was started on SoluMedrol 500 mg IV twice daily for five days. Serological workup and CSF analysis were nonsignificant except for Mycoplasma pneumonia IgM, elevated myelin basic protein, and positive IgG, IgA, and IgM. Patient gradually improved and was transferred to rehabilitation. Repeat MRI brain and spine showed improvement in previous lesions. However, she had worsening left eye symptoms that prompted her transfer to another facility for plasmapheresis. Plasma exchange was done for five treatments for ADEM. Patient started noticing improvement in vision and was discharged on steroid taper. We report a case of a possible association between ADEM and SARS-CoV-2 mRNA vaccine. It should be considered in the differential diagnosis in any case suggestive of acute demyelination after COVID-19 vaccination.
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Abstract
Hintergrund Die akute disseminierte Enzephalomyelitis (ADEM) gehört zu den seltenen demyelinisierenden Erkrankungen, die meistens bei Kindern auftreten. ADEM gehört laut Leitlinien zu den Myelin-Oligodendrozyten-Glykoprotein(MOG)-assoziierten Krankheiten und manifestiert sich in der Regel nach febrilen Infektionen (auch nach SARS-CoV-2) oder, deutlich seltener, nach Impfungen. Fragestellung Inzidenz, Verlauf und klinische sowie radiologische Diagnostik sowie Entwicklung und Therapieoptionen von ADEM. Material und Methode Analyse und Auswertung der Literatur über ADEM sowie Analyse der bemerkenswerten Fälle und Leitlinien. Ergebnisse Zu den ersten Anzeichen von ADEM gehören Fieber, Nausea bis zum Erbrechen sowie Kopfschmerzen und Meningismus sowie per definitionem eine Enzephalopathie, die am Anfang wenig ausgeprägt sein kann und sich meistens als Schläfrigkeit und Verwirrung manifestiert. Die radiologische Diagnose wird in der Magnetresonanztomographie (MRT) gestellt. Hier sind asymmetrisch verteilte, unscharf abgrenzbare, tumorsimulierende Läsionen supra- und infratentoriell abgrenzbar. In der akuten Phase nehmen die Läsionen meistens ringförmig Kontrastmittel auf und zeigen eine Diffusionsrestriktion. Spinaler Befall der grauen Substanz mit dem typischen H‑Muster mit Myelitis transversa ist nicht selten. Die ADEM hat meistens einen monophasischen Verlauf, wobei eine rekurrierende Form („relapsing ADEM“) in 1–20 % der Fälle zu erwarten ist. Bei der Behandlung kommen Steroide und in schweren Fällen Immunsuppressiva zum Einsatz. Schlussfolgerung ADEM ist eine meist monophasische Erkrankung, deren Symptome nach einigen Wochen/Monaten abklingen sollten. Es ist wichtig, sie von anderen demyelinisierenden Krankheiten wie der multiplen Sklerose zu unterscheiden, um die nötige Therapie nicht zu verzögern.
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Affiliation(s)
- Malgorzata Wolska-Krawczyk
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Uniklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland.
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11
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Vegezzi E, Ravaglia S, Buongarzone G, Bini P, Diamanti L, Gastaldi M, Prunetti P, Rognone E, Marchioni E. Acute myelitis and ChAdOx1 nCoV-19 vaccine: Casual or causal association? J Neuroimmunol 2021; 359:577686. [PMID: 34392078 PMCID: PMC8325554 DOI: 10.1016/j.jneuroim.2021.577686] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
A 44-year-old previously healthy woman developed acute myelitis in close temporal relationship with ChAdOx1 nCoV-19 vaccine first-dose administration. The neurological involvement was mainly sensory with neuroimaging showing two mono-metameric lesions involving the posterior and lateral cord at dorsal level. Significant improvement was promptly recorded with high-dose intravenous steroids, with complete recovery within one month. The strict temporal relationship between vaccination and myelitis, together with the absence of clues pointing to alternative diagnoses, might suggest a conceivable role for anti-SARS-CoV-2 vaccine as immunological trigger, although a causal relationship has yet to be established and our preliminary observation suggests caution.
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Affiliation(s)
- Elisa Vegezzi
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Sabrina Ravaglia
- Emergency Neurology Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | | | - Paola Bini
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Luca Diamanti
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Matteo Gastaldi
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy; Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Paolo Prunetti
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Elisa Rognone
- Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Enrico Marchioni
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy.
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12
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Xu Y, Zhuang Y, Kang L. A Review of Neurological Involvement in Patients with SARS-CoV-2 Infection. Med Sci Monit 2021; 27:e932962. [PMID: 34145211 PMCID: PMC8221270 DOI: 10.12659/msm.932962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of the recent pandemic of coronavirus disease 19 (COVID-19). As the infection spreads, there is increasing evidence of neurological and psychiatric involvement in COVID-19. Headache, impaired consciousness, and olfactory and gustatory dysfunctions are common neurological manifestations described in the literature. Studies demonstrating more specific and more severe neurological involvement such as cerebrovascular insults, encephalitis and Guillain-Barre syndrome are also emerging. Respiratory failure, a significant condition that leads to mortality in COVID-19, is hypothesized to be partly due to brainstem impairment. Notably, some of these neurological complications seem to persist long after infection. This review aims to provide an update on what is currently known about neurological involvement in patients with COVID-19 due to SARS-CoV-2 infection. In this review, we demonstrate invasion routes of SARS-CoV-2, provide evidence to support the neurotropism hypothesis of the virus, and investigate the pathological mechanisms that underlie neurological complications associated with SARS-CoV-2.
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Affiliation(s)
- Yidan Xu
- Jiangxi Key Laboratory of Experimental Animals, Nanchang University, Nanchang, Jiangxi, P.R. China
- Queen Mary School, Medical Department, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yu Zhuang
- Jiangxi Key Laboratory of Experimental Animals, Nanchang University, Nanchang, Jiangxi, P.R. China
- Queen Mary School, Medical Department, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Lumei Kang
- Jiangxi Key Laboratory of Experimental Animals, Nanchang University, Nanchang, Jiangxi, P.R. China
- Department of Animal Science, Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China
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13
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Chang P, Tasch ES, Rapoport LN, Bakhadirov K. A Post-Infectious Steroid-Responsive Brainstem Lesion Associated With COVID-19. Neurohospitalist 2021; 11:152-155. [PMID: 33791060 PMCID: PMC7958677 DOI: 10.1177/1941874420959544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 51-year-old man developed coma, bilateral pupillary dilation, ophthalmoplegia and quadriplegia 4 weeks after testing positive for COVID-19. MRI demonstrated a symmetric midline pontine non-enhancing T2-FLAIR hyperintense lesion. The patient was treated with intravenous methylprednisolone, which resulted in improvement of his Glasgow Coma Scale (GCS) from 3 to 15 over the next 5 days. To our knowledge, this is the first case of a post-infectious steroid-responsive brainstem lesion associated with COVID-19. The clinical picture best fits in the family of a steroid-responsive encephalopathy and reminds us that COVID-19 may cause severe post-infectious neurological complications.
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Affiliation(s)
- Philip Chang
- Department of Neurology, Kaiser Permanente Santa Clara Medical Center, Assistant Professor of Neurology, Boston University Medical School, Santa Clara, CA, USA
| | - Edwin S. Tasch
- Department of Neurology, Kaiser Permanente Santa Clara Medical Center, Assistant Professor of Neurology, Boston University Medical School, Santa Clara, CA, USA
| | - Lisa N. Rapoport
- Departments of Emergency Medicine and Critical Care, Kaiser Permanente Santa Clara Medical Center, Clinical Assistant Professor (Affiliate), Stanford University Department of Emergency Medicine, Santa Clara, CA, USA
| | - Khamidulla Bakhadirov
- Department of Neurology, Kaiser Permanente Santa Clara Medical Center, Assistant Professor of Neurology, Boston University Medical School, Santa Clara, CA, USA
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14
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Fulminant ADEM treated with cyclophosphamide: Case report and review of the literature. Mult Scler Relat Disord 2021; 51:102882. [PMID: 33735630 DOI: 10.1016/j.msard.2021.102882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/05/2021] [Accepted: 03/04/2021] [Indexed: 10/22/2022]
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15
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Bozzola E, Spina G, Valeriani M, Papetti L, Ursitti F, Agostiniani R, Mascolo C, Ruggiero M, Di Camillo C, Quondamcarlo A, Matera L, Vecchio D, Memo L, Villani A. Management of pediatric post-infectious neurological syndromes. Ital J Pediatr 2021; 47:17. [PMID: 33494818 PMCID: PMC7836589 DOI: 10.1186/s13052-021-00968-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-Infectious Neurological Syndromes (PINS) are heterogeneous neurological disorders with post or para-infectious onset. PINS diagnosis is complex, mainly related to the absence of any recognized guidelines and a univocal definition. AIM OF THE STUDY To elaborate a diagnostic guide for PINS. MATERIALS AND METHODS We retrospectively analysed patients younger than 14 years old admitted to Bambino Gesù Children's Hospital in Rome for PINS from December 2005 to March 2018. Scientific literature using PubMed as research platform was analysed: the key words "Post-Infectious Neurological Syndromes" were used. RESULTS A polysymptomatic presentation occurred in a percentage of 88% of the children. Motor signs and visual disturbances the most observed symptoms/signs were the most detached, followed by fever, speech disturbances, sleepiness, headache and bradipsychism. Blood investigations are compatible with inflammation, as a prodromal illnesses was documented in most cases. Normal cerebral spinal fluid (CSF) characteristics has been found in the majority of the study population. Magnetic resonance imaging (MRI) was positive for demyelinating lesions. Antibiotics, acyclovir and steroids have been given as treatment. DISCUSSION We suggest diagnostic criteria for diagnosis of PINS, considering the following parameters: neurological symptoms, timing of disease onset, blood and CSF laboratory tests, MRI imaging. CONCLUSIONS We propose criteria to guide clinician to diagnose PINS as definitive, probable or possible. Further studies are required to validate diagnostic criteria.
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Affiliation(s)
| | | | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | | | | | | | | | | | | | | | - Luigi Memo
- Italian Pediatric Society, Florence, Italy
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16
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Averchenkov D, Volik A, Fominykh V, Nazarov V, Moshnikova A, Lapin S, Brylev L, Guekht A. Acute disseminated encephalomyelitis. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:119-128. [DOI: 10.17116/jnevro2021121111119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Guimarães MPM, Nascimento ACB, Alvarenga RMP. CLINICAL course of acute disseminated encephalomyelitis in adults from Rio de Janeiro: Retrospective study of 23 cases and literature review. Mult Scler Relat Disord 2020; 46:102424. [DOI: 10.1016/j.msard.2020.102424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 01/07/2023]
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18
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Martinelli-Boneschi F, Currò R, Santoro S, Berzero G, Sorosina M, Ferrè L, Mascia E, Peroni S, Comi G, Gugliemi A, Vegezzi E, Callegari I, Filippi M, Cortese A, Esposito F, Clarelli F, Marchioni E. Impact of multiple sclerosis risk loci in postinfectious neurological syndromes. Mult Scler Relat Disord 2020; 44:102326. [PMID: 32615529 DOI: 10.1016/j.msard.2020.102326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/22/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The genetic component of multiple sclerosis (MS) is now set to 200 autosomal common variants. However, it is unclear how genetic knowledge be clinically used in the differential diagnosis between MS and other inflammatory conditions like adult-onset postinfectious neurological syndromes (PINS). The aim of this study was to investigate whether PINS and MS have a shared genetic background using an updated polygenic risk scores. METHODS Eighty-eight PINS patients have been consecutively recruited between 1996 and 2016 at Mondino Foundation of Pavia, diagnosed according to clinical, MRI and CSF findings and followed-up for several years. Patients were typed using Illumina array, and genotypes imputed using the 1000 Genomes Project reference panel. A weighted genetic risk score (wGRS) has been calculated based on autosomal MS risk loci derived from large-scale studies, and an HLA genetic burden (HLAGB) was also calculated on loci associated to MS. RESULTS PINS occurred as an episode of myelitis in 44% of patients, encephalomyelitis in 44%, and encephalitis in remaining cases, with an involvement of peripheral nervous system in 41% of patients. Mean age of onset was 50.1 years, and female:male ratio was 1.4. Patients were followed-up for a mean of 7.2 years, and at last visit 55% had a low disability grade (mRS 0-1). Disease was monophasic in 67% of patients, relapsing in 18% and chronic-progressive in 15%. The wGRS of PINS cases was comparable to 370 healthy controls, while significantly lower compared to 907 bout-onset MS (BOMS) cases (wGRS= 20.9 vs 21.2; p<0.0001). The difference was even larger for PINS with peripheral nervous system involvement (wGRS=20.6) vs BOMS. CONCLUSION The distinction between MS and PINS is not easy to make in clinical practice. However, our study shows that the new set of MS risk alleles does not confer increased susceptibility to PINS. These data support the importance to discriminate these cases from MS with pathophysiological and therapeutic implications.
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Affiliation(s)
- Filippo Martinelli-Boneschi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy; Neurology Unit and MS Centre, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.
| | - Riccardo Currò
- Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy; Fondazione Istituto Neurologico Nazionale IRCCS Mondino, via Mondino 2, 27100 Pavia, Italy
| | - Silvia Santoro
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Giulia Berzero
- Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy; Fondazione Istituto Neurologico Nazionale IRCCS Mondino, via Mondino 2, 27100 Pavia, Italy
| | - Melissa Sorosina
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Laura Ferrè
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy; Neurology Unit, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Elisabetta Mascia
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Silvia Peroni
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Giancarlo Comi
- Neurology Unit, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Angelo Gugliemi
- Department of Surgical, Pediatric, and Diagnostic Sciences, University of Pavia, Viale Brambilla 74, 27100 Pavia, Italy; UOC Anestesia e Rianimazione, IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy; Fondazione Istituto Neurologico Nazionale IRCCS Mondino, via Mondino 2, 27100 Pavia, Italy
| | - Ilaria Callegari
- Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy; Fondazione Istituto Neurologico Nazionale IRCCS Mondino, via Mondino 2, 27100 Pavia, Italy
| | - Massimo Filippi
- Neurology Unit, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 48 - 20132 Milan, Italy; Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy; Neurophisiology Unit, IRCCS San Raffaele Scientific Institute, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy; Fondazione Istituto Neurologico Nazionale IRCCS Mondino, via Mondino 2, 27100 Pavia, Italy
| | - Federica Esposito
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy; Neurology Unit, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Ferdinando Clarelli
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Via Olgettina 48 - 20132 Milan, Italy
| | - Enrico Marchioni
- Fondazione Istituto Neurologico Nazionale IRCCS Mondino, via Mondino 2, 27100 Pavia, Italy
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19
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Scoppettuolo P, Borrelli S, Naeije G. Neurological involvement in SARS-CoV-2 infection: A clinical systematic review. Brain Behav Immun Health 2020; 5:100094. [PMID: 33521692 PMCID: PMC7832728 DOI: 10.1016/j.bbih.2020.100094] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Reports of neurological involvement during Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection course are increasingly described. The aim of this review is to provide a clinical approach of SARS-CoV-2 neurological complications based on the direct or indirect (systemic/immune-mediated) role of the SARS-CoV-2 in their genesis. METHODS A review of the current literature has been carried out up to May 20th 2020 according to the PRISMA guidelines. All case series and reports of adult neurological manifestations associated to SARS-CoV-2 published in English were considered. Review and fundamental research studies on Coronaviruses neuroinvasive potential were analyzed to support pathogenic hypothesis and possible underlying mechanisms. Clinical patterns were subdivided into three groups according to putative underlying mechanisms: direct invasion of central or peripheral nervous system, systemic disorders leading to acute CNS injuries and post-infectious neurological syndromes (PINS). RESULTS Sixteen case series and 26 case reports for a total of 903 patients were identified presenting with neurological involvement during SARS-CoV-2 infection. Hypo/anosmia and dys/ageusia were found in 826 patients and mainly attributed to direct viral invasion. Cerebrovascular complications occurred in 51 patients and related to viral infection associated systemic inflammation. PINS were described in only 26 patients. A wide heterogeneity of these reports emerged concerning the extension of the clinical examination and ancillary exams performed. CONCLUSIONS Neurological complications of SARS-CoV-2 are mainly related to olfactory and gustatory sensory perception disorders through possible direct nervous system invasion while cerebrovascular disease and PINS are rare and due to distinct and indirect pathophysiological mechanisms.
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Affiliation(s)
| | - Serena Borrelli
- Department of Neurology, CHU-Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, CHU-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of central nervous system (CNS). ADEM is most commonly seen in children, although adults can also be affected. The disease typically starts with an abrupt onset within day to weeks after a viral infection or immunization. Presenting features include an acute encephalopathy with multifocal neurologic signs and fever. ADEM generally has a monophasic course, although recurrent ADEM has also been described and is defined as multiphasic ADEM. MRI shows widespread lesions located in both brain and spinal cord. An involvement of basal ganglia and thalami has also been described. Analysis of cerebrospinal fluid (CSF) may reveal mild lymphocytic pleocytosis and increased proteins, whereas oligoclonal bands are usually negative. In the absence of specific biologic markers, ADEM remains a diagnosis of exclusion and it is still based on clinical manifestations, imaging, and laboratory features. Therapy is based on steroid administration and the prognosis is usually favorable.
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21
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Nicoletti A, García HH, Cicero CE, Portaro G, Giuliano L, Patti F, Sofia V, Noh J, Handali S, Zappia M. Lack of evidence for Toxocara infection in Italian myelitis patients. Neurol Sci 2020; 41:239-241. [PMID: 31332580 DOI: 10.1007/s10072-019-04017-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
Acute myelitis is a common neurological manifestation due to different causes, but in about 15-30% of cases its etiology remains unknown (idiopathic myelitis). Myelitis represents the most common manifestation of neurotoxocariasis, the infection of the human nervous system by larvae of the nematode Toxocara spp.; however, despite the high seroprevalence worldwide, its contribution to the burden of disease has not been assessed. We evaluated the presence of antibodies against Toxocara spp. in cerebrospinal fluid (CSF) from a sample of 28 patients with a diagnosis of idiopathic myelitis (N = 20) or encephalomyelitis (N = 8) who attended the Neurological Unit of the University Hospital of Catania, Sicily. Antibodies against Toxocara spp. were measured using a multiplex bead-based assay and Toxocara immunoblot using Toxocara canis excretory secretory antigens. All samples tested negative for the presence of anti-T. canis IgG antibodies. In this series, we found no evidence of a contribution of neurotoxocariasis to the burden of myelitis.
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Affiliation(s)
- Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Hector H García
- Department of Microbiology, School of Sciences, and Center for Global Health - Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru.,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Calogero Edoardo Cicero
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giacomo Portaro
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Loretta Giuliano
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Patti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Vito Sofia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - John Noh
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sukwan Handali
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Qiu K, He Q, Chen X, Liu H, Deng S, Lu W. Pregnancy-Related Immune Changes and Demyelinating Diseases of the Central Nervous System. Front Neurol 2019; 10:1070. [PMID: 31649614 PMCID: PMC6794637 DOI: 10.3389/fneur.2019.01070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022] Open
Abstract
Demyelinating diseases of the central nervous system comprise a heterogeneous group of autoimmune disorders characterized by myelin loss with relative sparing of axons occurring on a background of inflammation. Some of the most common demyelinating diseases are multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica spectrum disorders. Besides showing clinical, radiological, and histopathological features that complicate their diagnosis, demyelinating diseases often involve different immunological processes that produce distinct inflammatory patterns. Evidence of demyelination diseases derives mostly from animal studies of experimental autoimmune encephalomyelitis (EAE), a model that relies on direct antibody–antigen interactions induced by encephalitogenic T cells. Pregnancy is characterized by non-self-recognition, immunomodulatory changes and an altered Th1/Th2 balance, generally considered a Th2-type immunological state that protects the mother from infections. During pregnancy, the immune response of patients with autoimmune disease complicated with pregnancy is different. Immune tolerance in pregnancy may affect the course of some diseases, which may reach remission or be exacerbated. In this review, we summarize current knowledge on the immune status during pregnancy and discuss the relationship between pregnancy-related immune changes and demyelinating diseases of the central nervous system.
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Affiliation(s)
- Ke Qiu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiang He
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiqian Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Liu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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Wang Q, Cai LN, Wang XQ. Acute disseminated encephalomyelitis following varicella-zoster virus infection: Case report of effective treated both in clinical symptom and neuroimaging. Brain Behav 2019; 9:e01374. [PMID: 31342665 PMCID: PMC6749488 DOI: 10.1002/brb3.1374] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Acute disseminated encephalomyelitis (ADEM) is an idiopathic inflammatory demyelinating disorder of the central nervous system (CNS). Early treatment is the key for neurological recovery. METHODS A case of ADEM associated with varicella-zoster virus infection was presented, in which magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) examinations were included. RESULTS Magnetic resonance imaging of the brain revealed multiple hyperintense lesions at the subcortical level on fluid-attenuated inversion recovery (FLAIR), and MRI of the spinal cord revealed longitudinally segmented hyperintense lesions at the spinal cord on T2-weighted images. The patient was treated with methylprednisolone and gancyclovir, and had a favorable recovery. Subsequent MRI of the brain and cervical cord showed the previous abnormal hyperintensities had markedly disappeared. CONCLUSION A rare case of ADEM with longitudinal segmented hyperintense lesions at the spinal cord on T2-weighted images was presented. Excellent response to ADEM treatment with high-dose steroids was reported resulting in a remarkable neurological recovery. A long-term follow-up is needed for prognosis.
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Affiliation(s)
- Qi Wang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Li-Na Cai
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Xiang-Qing Wang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China
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Bakulin IS, Korzhova YE, Kozlova AO, Konovalov RN, Vasil'ev AV, Askarova LS, Zakharova MN. [Clinical characteristics and diagnosis of disseminated encephalomyelitis in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:36-41. [PMID: 31156239 DOI: 10.17116/jnevro20191192236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze clinical, neuroimaging and laboratory characteristics of acute disseminated encephalomyelitis (ODEM) in adults with an analysis of the frequency of diagnostic errors at the initial examination stage. MATERIAL AND METHODS The study included 23 patients hospitalized with a diagnosis of ODEM. The analysis of clinical characteristics, MRI results and cerebrospinal fluid (CSF) was performed. The diagnosis of the disease in each case was specified after a full examination and dynamic observation. RESULTS The diagnosis of ODEM was confirmed only in 16 cases. In 6 cases, the final diagnosis of multiple sclerosis (MS) was made, and one case of Susak syndrome, primary CNS lymphoma and levamisole-associated multifocal inflammatory leukoencephalopathy was also detected. It has been shown that ODEM in adults is characterized by the acute development of multifocal brain lesions in combination with clinical manifestations of encephalopathy, which in half of cases is preceded by an infectious disease. There were no specific clinical, neuroimaging and laboratory features, which could allow differentiation of ODEM from onset of MS. CONCLUSION To make a correct diagnosis in the first episode of acute multifocal brain lesion, a dynamic observation, including repeated MRI, is needed. The development of specific biomarkers may be of great importance for the early differential diagnosis of demyelinating diseases.
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Affiliation(s)
- I S Bakulin
- Research Center of Neurology, Moscow, Russia
| | | | - A O Kozlova
- Lomonosov Moscow State University, Moscow, Russia
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Aldamkh BA, Alamer AF, Altuwaijri MM, Alrumayyan MA, Alhaqbani AH, Alharthi NA, Aldamkh SA, Aldrees AS, Alrifai MT, Altuwaijri W, Alrumayyan A. Clinical Presentation and outcome of acute disseminated encephalomyelitis in Saudi Arabia. Tertiary Center Experience. ACTA ACUST UNITED AC 2019; 24:89-94. [PMID: 31056539 PMCID: PMC8015459 DOI: 10.17712/nsj.2019.2.20180017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives: To evaluate the clinical presenation of acute disseminated Encephalomyelitis (ADEM) in pediatric age group, treatments, and to asses the outcome at King Abdulaziz Medical City, Riyadh, Kingdom of Saudia Arabia. Methods: The medical records of all patients younger than 18 years of age with a diagnosis of ADEM and treated at King Abdulaziz Medical City from January 1996 to Decemeber 2016 were collected. A total of 20 patients were included. Results: Of 20 patients enrolled in our study, 13 (65%) were female. Autumn and summer were the most common seasons in which ADEM presented (60%); 19 (95%) patients had a history of preceding viral illnesses. The most common neurological deficits on presentation were weakness (85%), ataxia (45%), and nystagmus (45%). Cortical and subcortical lesions (60%) were the most common finding on cranial magnetic resonance imaging. Seventeen patients (85%) received steroid only. Only 16 patients continued with follow-up, with a mean duration of 7 months. All 16 patients improved: 11 patients were recovered and 5 patients still had a neurological deficit at the clinic visits. No patient had relapsed. Conclusion: Most of the patients in this case series have an excellent outcome and attended follow-up visits and no disease relapses were identified. Further exploration of the disease is recommended.
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Affiliation(s)
- Bander A Aldamkh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Tarai B, Das P. FilmArray® meningitis/encephalitis (ME) panel, a rapid molecular platform for diagnosis of CNS infections in a tertiary care hospital in North India: one-and-half-year review. Neurol Sci 2018; 40:81-88. [PMID: 30255486 DOI: 10.1007/s10072-018-3584-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/18/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute meningitis and encephalitis (AME) is a syndrome of central nervous system (CNS) infections, which could lead to neurological damage and fatality. This study evaluates the multiplex FilmArray® ME Panel which is aimed to diagnose agents causing suspect CNS infections in north India. METHODS A total number of 969 cerebrospinal fluid (CSF) samples collected between August 2016 and January 2018 from patients who showed clinical symptoms of CNS infections were analyzed using the FilmArray® ME Panel. Also a comparison of molecular diagnosis and various laboratory and radiological findings for Streptococcus pneumoniae, Enterovirus and Cryptococcus neoformans positive cases was done. RESULT Out of the 969 CSF samples, 101 cases were found to be positive for viral (n = 55), bacterial (n = 38), fungal (n = 7), and poly-microbial (n = 1) agents. Out of the 55 viral positive cases, the most detected pathogen was Enterovirus (n = 23) with predominance in the age group of 2-17 years, followed by Varicella Zoster virus (n = 14) and HSV1(n = 9) cases. Streptococcus pneumoniae (n = 26) was found to be the predominant bacterial pathogen, of which 17 were detected in the age group above 35 years. Cryptococcus neoformans was found in 7 cases. CONCLUSION The FilmArray® ME Panel aids in rapid detection of 14 pathogens directly from CSF. When compared to gram stain, culture, antigen detection, and CSF biochemical analysis, the FilmArray® ME Panel has detected more cases, some of which are difficult to diagnose by conventional methods. This rapid technology will help the clinicians in case of early patient management, outcomes and provide aid in antimicrobial stewardship.
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Affiliation(s)
- Bansidhar Tarai
- Institute of Lab Medicine, Max Superspeciality Hospital, Saket, New Delhi, 110017, India.
| | - Poonam Das
- Institute of Lab Medicine, Max Superspeciality Hospital, Saket, New Delhi, 110017, India
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Chen Y, Ma F, Xu Y, Chu X, Zhang J. Vaccines and the risk of acute disseminated encephalomyelitis. Vaccine 2018; 36:3733-3739. [PMID: 29784468 DOI: 10.1016/j.vaccine.2018.05.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is important to examine the risk of Acute disseminated encephalomyelitis (ADEM) after vaccination. METHODS We conducted a nested case-control study between January 2011 and December 2015. Four controls per case were matched for age, gender, address. An independent expert committee validated the diagnoses of cases and controls. Data on vaccinations were obtained from computerized vaccination records. The analyses were conducted with the use of conditional logistic regression. RESULTS The analyses include 272 cases of ADEM and 1096 controls. No increase in the risk of ADEM was observed for vaccination against hepatitis B, influenza, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, meningitis, hepatitis A, varicella and rabies vaccines. Vaccine was associated with a statistically significant increase in risk in the 31-60-day exposure interval (OR, 4.04 [95% CI, 1.07-12.69]), but not the 0-30 and 61-180-day interval. There was no association between vaccine received and the recurrence of ADEM. CONCLUSIONS Findings from the present study do not demonstrate an association of vaccines with an increased risk of ADEM and its recurrence among either paediatric (≤18 years) or adult (>18 years) individuals within the 180 days after vaccinations. The finding in children in the 31-60 day risk interval is likely coincidental and was not confirmed in separate self-control analyses.
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Affiliation(s)
- Yong Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China.
| | - Fubao Ma
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Yuanling Xu
- Department of Neurology, Nanjing Brain Hospital, China.
| | - Xuhua Chu
- Department of Neurology, Jiangsu Provincial People's Hospital, China.
| | - Jinlin Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China.
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Monticelli J, Geremia N, D'Agaro P, Petix V, Luzzati R. Aseptic central nervous system infections in adults: what predictor for unknown etiological diagnosis? Neurol Sci 2018; 39:863-870. [PMID: 29455403 DOI: 10.1007/s10072-018-3274-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
Despite the availability of nucleic acid amplification tests (NAATs), most of aseptic acute meningitides, encephalitides, and meningoencephalitides (AAMEMs) in adults remain of unknown etiology so far. To shed light on such topic, we aimed to evaluate potential predictors for AAMEMs of unknown origin. We collected retrospectively data from all consecutive cases of AAMEMs in adults discharged from an Italian referral hospital, from January 2004 to December 2016. Laboratory analysis included common immunometric methods and NAATs. Potential predictors for unknown etiology (age, seasonality, serum C-reactive protein value, antibiotic use before lumbar puncture, immunodeficiency conditions, clinical symptoms and signs) were evaluated by a logistic regression analysis model. A p value ≤ 0.05 was considered to indicate statistical significance. The study included 92 patients (median age 39 years; 54.3% males) affected by meningitis (n = 57), encephalitis (n = 25), and meningoencephalitis (n = 10). The identified agents that cause AAMEMs were herpesviruses (20.7%), enteroviruses (5.4%), tick-borne encephalitis virus (3.3%), influenza virus A (2.2%), West Nile virus (1.1%), and parvovirus B19 (1.1%), while 66.3% of cases were of unknown etiology. No predictor was found to be significantly associated with AAMEMs of unknown etiology. We suggest that potential infectious agents causing undiagnosed cases should be investigated among non-bacterial, non-opportunistic, and non-seasonal organisms.
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Affiliation(s)
- Jacopo Monticelli
- Infectious Disease Unit, University Hospital "Azienda Sanitaria Universitaria Integrata di Trieste", Piazza dell'Ospitale 2, 34125, Trieste, Italy.
| | - Nicholas Geremia
- Infectious Disease Unit, University Hospital "Azienda Sanitaria Universitaria Integrata di Trieste", Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Pierlanfranco D'Agaro
- Department of Reproductive, Developmental and Public Health Sciences, UCO Hygiene and Preventive Medicine, University of Trieste, Via dell'Istria 65, 34137, Trieste, Italy
| | - Vincenzo Petix
- Department of Reproductive, Developmental and Public Health Sciences, UCO Hygiene and Preventive Medicine, University of Trieste, Via dell'Istria 65, 34137, Trieste, Italy
| | - Roberto Luzzati
- Infectious Disease Unit, University Hospital "Azienda Sanitaria Universitaria Integrata di Trieste", Piazza dell'Ospitale 2, 34125, Trieste, Italy
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Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating syndrome with encephalopathy. ADEM typically affects young children, is often postinfectious, and is typically monophasic. MRI neuroimaging, which shows new lesions with poorly demarcated borders, but not old and established lesions, is essential to diagnosis. Autoantibodies against myelin oligodendrocyte glycoprotein (MOG) are found in ∼40% of ADEM patients, and these patients have different clinical and neuroimaging features to seronegative patients. Treatment in the acute phase is typically with high-dose corticosteroids and intravenous immunoglobulin or plasma exchange for refractory patients. Outcome is usually good, but residual cognitive, inattentive, and executive issues are likely underestimated. In patients who have a relapse, biomarkers and imaging should help differentiate multiphasic ADEM, neuromyelitis optica spectrum disorder, anti-MOG antibody–associated relapsing demyelination, and multiple sclerosis.
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Iro MA, Martin NG, Absoud M, Pollard AJ. Intravenous immunoglobulin for the treatment of childhood encephalitis. Cochrane Database Syst Rev 2017; 10:CD011367. [PMID: 28967695 PMCID: PMC6485509 DOI: 10.1002/14651858.cd011367.pub2] [Citation(s) in RCA: 10] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Encephalitis is a syndrome of neurological dysfunction due to inflammation of the brain parenchyma, caused by an infection or an exaggerated host immune response, or both. Attenuation of brain inflammation through modulation of the immune response could improve patient outcomes. Biological agents such as immunoglobulin that have both anti-inflammatory and immunomodulatory properties may therefore be useful as adjunctive therapies for people with encephalitis. OBJECTIVES To assess the efficacy and safety of intravenous immunoglobulin (IVIG) as add-on treatment for children with encephalitis. SEARCH METHODS The Cochrane Multiple Sclerosis and Rare Diseases of the CNS group's Information Specialist searched the following databases up to 30 September 2016: CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and the WHO ICTRP Search Portal. In addition, two review authors searched Science Citation Index Expanded (SCI-EXPANDED) & Conference Proceedings Citation Index - Science (CPCI-S) (Web of Science Core Collection, Thomson Reuters) (1945 to January 2016), Global Health Library (Virtual Health Library), and Database of Abstracts of Reviews of Effects (DARE). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing IVIG in addition to standard care versus standard care alone or placebo. DATA COLLECTION AND ANALYSIS Two review authors independently selected articles for inclusion, extracted relevant data, and assessed quality of trials. We resolved disagreements by discussion among the review authors. Where possible, we contacted authors of included studies for additional information. We presented results as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). MAIN RESULTS The search identified three RCTs with 138 participants. All three trials included only children with viral encephalitis, one of these included only children with Japanese encephalitis, a specific form of viral encephalitis. Only the trial of Japanese encephalitis (22 children) contributed to the primary outcome of this review and follow-up in that study was for three to six months after hospital discharge. There was no follow-up of participants in the other two studies. We identified one ongoing trial.For the primary outcomes, the results showed no significant difference between IVIG and placebo when used in the treatment of children with Japanese encephalitis: significant disability (RR 0.75, 95% CI 0.22 to 2.60; P = 0.65) and serious adverse events (RR 1.00, 95% CI 0.07 to 14.05; P = 1.00).For the secondary outcomes, the study of Japanese encephalitis showed no significant difference between IVIG and placebo when assessing significant disability at hospital discharge (RR 1.00, 95% CI 0.60 to 1.67). There was no significant difference (P = 0.53) in Glasgow Coma Score at discharge between IVIG (median score 14; range 3 to 15) and placebo (median 14 score; range 7 to 15) in the Japanese encephalitis study. The median length of hospital stay in the Japanese encephalitis study was similar for IVIG-treated (median 13 days; range 9 to 21) and placebo-treated (median 12 days; range 6 to 18) children (P = 0.59).Pooled analysis of the results of the other two studies resulted in a significantly lower mean length of hospital stay (MD -4.54 days, 95% CI -7.47 to -1.61; P = 0.002), time to resolution of fever (MD -0.97 days, 95% CI -1.25 to -0.69; P < 0.00001), time to stop spasms (MD -1.49 days, 95% CI -1.97 to -1.01; P < 0.00001), time to regain consciousness (MD -1.10 days, 95% CI -1.48 to -0.72; P < 0.00001), and time to resolution of neuropathic symptoms (MD -3.20 days, 95% CI -3.34 to -3.06; P < 0.00001) in favour of IVIG when compared with standard care.None of the included studies reported other outcomes of interest in this review including need for invasive ventilation, duration of invasive ventilation, cognitive impairment, poor adaptive functioning, quality of life, number of seizures, and new diagnosis of epilepsy.The quality of evidence was very low for all outcomes of this review. AUTHORS' CONCLUSIONS The findings suggest a clinical benefit of adjunctive IVIG treatment for children with viral encephalitis for some clinical measures (i.e. mean length of hospital stay, time (days) to stop spasms, time to regain consciousness, and time to resolution of neuropathic symptoms and fever. For children with Japanese encephalitis, IVIG had a similar effect to placebo when assessing significant disability and serious adverse events.Despite these findings, the risk of bias in the included studies and quality of the evidence make it impossible to reach any firm conclusions on the efficacy and safety of IVIG as add-on treatment for children with encephalitis. Furthermore, the included studies involved only children with viral encephalitis, therefore findings of this review cannot be generalised to all forms of encephalitis. Future well-designed RCTs are needed to assess the efficacy and safety of IVIG in the management of children with all forms of encephalitis. There is a need for internationally agreed core outcome measures for clinical trials in childhood encephalitis.
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Affiliation(s)
- Mildred A Iro
- University of Oxford and the NIHR Oxford Biomedical Research CentreDepartment of PaediatricsChurchill Hospital, Old Road, HeadingtonOxfordUK
| | - Natalie G Martin
- Christchurch School of Medicine, University of OtagoDepartment of PaediatricsChristchurchNew Zealand
| | - Michael Absoud
- Evelina London Children's Hospital, Guy's and St Thomas' Hospital, King's Health PartnersChildren's Neurosciences CentreWestminster Bridge RoadLondonUKSE1 7EH
| | - Andrew J Pollard
- Children's HospitalDepartment of Paediatrics, University of OxfordOxfordUKOX3 9DU
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Gastaldi M, Marchioni E, Banfi P, Mariani V, Di Lodovico L, Bergamaschi R, Alfonsi E, Borrelli P, Ferraro OE, Zardini E, Pichiecchio A, Cortese A, Waters P, Woodhall M, Ceroni M, Mauri M, Franciotta D. Predictors of outcome in a large retrospective cohort of patients with transverse myelitis. Mult Scler 2017; 24:1743-1752. [PMID: 28967297 DOI: 10.1177/1352458517731911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transverse myelitis (TM) is an inflammatory disorder that can be idiopathic or associated with central nervous system autoimmune/dysimmune inflammatory diseases, connective tissue autoimmune diseases, or post-infectious neurological syndromes. Prognosis of initial TM presentations is uncertain. OBJECTIVE To identify outcome predictors in TM. METHODS Retrospective study on isolated TM at onset. Scores ⩾3 on the modified Rankin scale (mRS) marked high disability. RESULTS A total of 159 patients were identified. TM was classified as follows: idiopathic (I-TM, n = 53), post-infectious (PI-TM, n = 48), associated with multiple sclerosis (MS-TM, n = 51), or neuromyelitis optica spectrum disorders/connective tissue autoimmune diseases/neurosarcoidosis ( n = 7). At follow-up (median, 55 months; interquartile range, 32-80), 42 patients were severely disabled, and patients with I-TM or PI-TM showed the worst outcomes. Predictors of disability were infectious antecedents, sphincter and pyramidal symptoms, high mRS scores, blood-cerebrospinal fluid barrier damage, lumbar magnetic resonance imaging (MRI) lesions on univariate analysis, and older age (odds ratio (OR), 1.1; 95% confidence interval (CI), 1.0-1.1), overt/subclinical involvement of the peripheral nervous system (PNS) (OR, 9.4; 95% CI, 2.2-41.0), complete TM (OR, 10.8; 95% CI, 3.4-34.5) on multivariate analysis. CONCLUSION Our findings help define prognosis and therapies in TM at onset. Infectious antecedents and PNS involvement associate with severe prognosis. Nerve conduction studies and lumbar MRI could improve the prognostic assessment of this condition.
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Affiliation(s)
- Matteo Gastaldi
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy/University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Enrico Marchioni
- Department of Neuro-Oncology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Valeria Mariani
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Laura Di Lodovico
- Department of Neuro-Oncology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Enrico Alfonsi
- Department of Neurophysiology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Borrelli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Ottavia Eleonora Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy; University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Andrea Cortese
- University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mauro Ceroni
- University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy/Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
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Kayal AK, Goswami M, Das M, Basumatary LJ, Bhowmick SS, Synmon B. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India. Ann Indian Acad Neurol 2017; 20:41-50. [PMID: 28298841 PMCID: PMC5341266 DOI: 10.4103/0972-2327.199904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM) and chronic myelopathy (CM). In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 151 patients (96 ASM and 55 CM) with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23), multiple sclerosis (MS) (8), systemic lupus erythematosus (1), Hashimoto's disease (1), postinfectious acute disseminated encephalomyelitis (6), postinfectious myelitis (8), infections (9), spinal cord infarct (5), and electrocution (1). The causes of CM were MS (1), probable or possible sarcoidosis (7), mixed connective tissue disease (1), Hashimoto's disease (2), infections (9), Vitamin B12 deficiency (4), folate deficiency (2), hepatic myelopathy (2), radiation (11), and paraneoplastic (1). No etiology could be found in 48 (31.8%) patients (34 ASM and 14 CM). In 21/96 (21.9%) patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria. Conclusion: Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of noncompressive myelopathy.
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Affiliation(s)
- Ashok Kumar Kayal
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Munindra Goswami
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Marami Das
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | | | | | - Baiakmenlang Synmon
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Gastaldi M, Zardini E, Franciotta D. An update on the use of cerebrospinal fluid analysis as a diagnostic tool in multiple sclerosis. Expert Rev Mol Diagn 2016; 17:31-46. [DOI: 10.1080/14737159.2017.1262260] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matteo Gastaldi
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
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Cortese A, Devaux JJ, Zardini E, Manso C, Taieb G, Carra Dallière C, Merle P, Osera C, Romagnolo S, Visigalli N, Piscosquito G, Salsano E, Alfonsi E, Moglia A, Pareyson D, Marchioni E, Franciotta D. Neurofascin-155 as a putative antigen in combined central and peripheral demyelination. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e238. [PMID: 27308303 PMCID: PMC4897982 DOI: 10.1212/nxi.0000000000000238] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Andrea Cortese
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Jérôme J Devaux
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Elisabetta Zardini
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Constance Manso
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Guillaume Taieb
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Clarisse Carra Dallière
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Philippe Merle
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Cecilia Osera
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Silvia Romagnolo
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Nicolò Visigalli
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Giuseppe Piscosquito
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Ettore Salsano
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Enrico Alfonsi
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Arrigo Moglia
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Davide Pareyson
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Enrico Marchioni
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
| | - Diego Franciotta
- IRCCS (A.C., E.Z., C.O., S.R., N.V., E.A., A.M., E.M., D.F.), C. Mondino National Neurological Institute, Pavia, Italy; CNRS (J.J.D., C.M.), CRN2M-UMR 7286, Aix-Marseille Université; Gui de Chauliac Hospital (G.T., C.C.D.), Montpellier University Hospital Center; CHU Amiens-Picardie (P.M.), France; IRCCS Foundation (G.P., E.S., D.P.), C. Besta Neurological Institute, Milan; and University of Pavia (E.Z., A.M.), Italy
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Cortese A, Franciotta D, Alfonsi E, Visigalli N, Zardini E, Diamanti L, Prunetti P, Osera C, Gastaldi M, Berzero G, Pichiecchio A, Piccolo G, Lozza A, Piscosquito G, Salsano E, Ceroni M, Moglia A, Bono G, Pareyson D, Marchioni E. Combined central and peripheral demyelination: Clinical features, diagnostic findings, and treatment. J Neurol Sci 2016; 363:182-7. [PMID: 27000248 DOI: 10.1016/j.jns.2016.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
Combined central and peripheral demyelination (CCPD) is rare, and current knowledge is based on case reports and small case series. The aim of our study was to describe the clinical features, diagnostic results, treatment and outcomes in a large cohort of patients with CCPD. Thirty-one patients entered this retrospective, observational, two-center study. In 20 patients (65%) CCPD presented, after an infection, as myeloradiculoneuropathy, encephalopathy, cranial neuropathy, length-dependent peripheral neuropathy, or pseudo-Guillain-Barré syndrome. Demyelinating features of peripheral nerve damage fulfilling European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria for CIDP were found in 23 patients (74%), and spatial dissemination of demyelinating lesions on brain MRI fulfilling the 2010 McDonald criteria for multiple sclerosis (MS) in 11 (46%). Two thirds of the patients had a relapsing or progressive disease course, usually related to the appearance of new spinal cord lesions or worsening of the peripheral neuropathy, and showed unsatisfactory responses to high-dose corticosteroids and intravenous immunoglobulins. The clinical presentation of CCPD was severe in 22 patients (71%), who were left significantly disabled. Our data suggest that CCPD has heterogeneous features and shows frequent post-infectious onset, primary peripheral nervous system or central nervous system involvement, a monophasic or chronic disease course, inadequate response to treatments, and a generally poor outcome. We therefore conclude that the current diagnostic criteria for MS and CIDP may not fully encompass the spectrum of possible manifestations of CCPD, whose pathogenesis remains largely unknown.
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Affiliation(s)
- A Cortese
- C. Mondino National Neurological Institute, Pavia, Italy.
| | - D Franciotta
- C. Mondino National Neurological Institute, Pavia, Italy
| | - E Alfonsi
- C. Mondino National Neurological Institute, Pavia, Italy
| | - N Visigalli
- C. Mondino National Neurological Institute, Pavia, Italy
| | - E Zardini
- C. Mondino National Neurological Institute, Pavia, Italy; University of Pavia, Pavia, Italy
| | - L Diamanti
- C. Mondino National Neurological Institute, Pavia, Italy; Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Italy
| | - P Prunetti
- C. Mondino National Neurological Institute, Pavia, Italy; Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Italy
| | - C Osera
- C. Mondino National Neurological Institute, Pavia, Italy
| | - M Gastaldi
- Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Italy; Ospedale di Circolo/Fondazione Macchi, Department of Neurology and Stroke Unit, Varese, Italy
| | - G Berzero
- C. Mondino National Neurological Institute, Pavia, Italy; Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Italy
| | - A Pichiecchio
- C. Mondino National Neurological Institute, Pavia, Italy
| | - G Piccolo
- C. Mondino National Neurological Institute, Pavia, Italy
| | - A Lozza
- C. Mondino National Neurological Institute, Pavia, Italy
| | - G Piscosquito
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - E Salsano
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - M Ceroni
- C. Mondino National Neurological Institute, Pavia, Italy; University of Pavia, Pavia, Italy
| | - A Moglia
- C. Mondino National Neurological Institute, Pavia, Italy; University of Pavia, Pavia, Italy
| | - G Bono
- Ospedale di Circolo/Fondazione Macchi, Department of Neurology and Stroke Unit, Varese, Italy; University of Insubria, Varese, Italy
| | - D Pareyson
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - E Marchioni
- C. Mondino National Neurological Institute, Pavia, Italy
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Berzero G, Cortese A, Ravaglia S, Marchioni E. Diagnosis and therapy of acute disseminated encephalomyelitis and its variants. Expert Rev Neurother 2015; 16:83-101. [DOI: 10.1586/14737175.2015.1126510] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Patients with viral encephalitis have a high incidence of morbidity and mortality. We analyze the clinical characteristics and outcome of patients with clinically diagnosed viral encephalitis to investigate possible predictors of prognosis. We retrospectively evaluated 1107 patients diagnosed with viral encephalitis in southwest China from 2009 to 2012 by evaluating their outcomes using the Glasgow Outcome Scale. We compared patient outcome at hospital discharge with long-term follow-up visits, and evaluated the prognostic indicators of the outcome. At hospital discharge, 375 (33.9 %) of the 1107 patients who survived made a full recovery, while 399 (36.0 %), 160 (14.5 %), and 145 (13.1 %) had mild, moderate or severe neurologic sequelae, respectively. Twenty-eight (2.5 %) of the patients died prior to discharge from the hospital. Of the 1027 patients who had follow-up assessments, 658 (64.1 %) made a full recovery, while 213 (20.7 %), 103 (10.0 %), and 19 (1.8 %) had mild, moderate or severe neurologic sequelae, respectively. Six (0.6 %) of the patients died after discharge from the hospital. Use of mechanical ventilation, lower Glasgow coma score, and concurrent seizures are predictors for a poor outcome in patients both at hospital discharge and at long-term follow-up visits.
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A Case of Acute Disseminated Encephalomyelitis in a Middle-Aged Adult. Case Rep Neurol Med 2015; 2015:601706. [PMID: 26180647 PMCID: PMC4477182 DOI: 10.1155/2015/601706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/02/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that is often preceded by infection or recent vaccination. Encephalopathy and focal neurological deficits are usually manifest several weeks after a prodromal illness with rapidly progressive neurologic decline. ADEM is most commonly seen in children and young adults, in which prognosis is favorable, but very few cases have been reported of older adults with ADEM and thus their clinical course is unknown. Methods. Here we present a case of ADEM in a middle-aged adult that recovered well after treatment. Results. A 62-year-old man presented with encephalopathy and rapid neurological decline following a gastrointestinal illness. A brain MRI revealed extensive supratentorial white matter hyperintensities consistent with ADEM and thus he was started on high dose intravenous methylprednisolone. He underwent a brain biopsy showing widespread white matter inflammation secondary to demyelination. At discharge, his neurological exam had significantly improved with continued steroid treatment and four months later, he was able to perform his ADLs. Conclusions. This case of ADEM in a middle-aged adult represents an excellent response to high dose steroid treatment with a remarkable neurological recovery. Thus it behooves one to treat suspected cases of ADEM in an adult patient aggressively, as outcome can be favorable.
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Acute disseminated encephalomyelitis: current controversies in diagnosis and outcome. J Neurol 2015; 262:2013-24. [DOI: 10.1007/s00415-015-7694-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
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41
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Iro MA, Martin NG, Absoud M, Pollard AJ. Intravenous immunoglobulin for the treatment of childhood encephalitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fujimori J, Nakashima I, Kuroda H, Fujihara K, Aoki M. Cerebrospinal fluid CXCL13 is a prognostic marker for aseptic meningitis. J Neuroimmunol 2014; 273:77-84. [PMID: 24907903 DOI: 10.1016/j.jneuroim.2014.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/16/2022]
Abstract
In exceptional cases, patients with aseptic meningitis eventually develop aseptic meningoencephalitis. To find a candidate marker for the development of aseptic meningoencephalitis in adult patients diagnosed with aseptic meningitis, we compared 12 different cytokines/chemokines in cerebrospinal fluid (CSF) from 5 patients with aseptic meningoencephalitis, 8 patients with aseptic meningitis, and 8 patients with control disease. Only the CXCL13 concentration was significantly elevated in the CSF of the group with aseptic meningoencephalitis compared with the group with aseptic meningitis. Thus, CSF CXCL13 may be a useful marker for predicting the prognosis of aseptic meningitis.
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Affiliation(s)
- Juichi Fujimori
- Department of Neurology, Tohoku Pharmaceutical University Hospital, Sendai, Japan.
| | - Ichiro Nakashima
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Affiliation(s)
- Pavan Bhargava
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield
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