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Sheiko GE, Belova AN, Rakhmanova EM, Boyko AN. [Combination of post-infectious optic neuritis and Guillain-Barré syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:106-110. [PMID: 37796076 DOI: 10.17116/jnevro2023123091106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The coexistence of optic neuritis and Guillain-Barré syndrome is a rare combination of neurological diseases. The trigger of an autoimmune inflammatory process is often a respiratory mycoplasma infection. Ignorance of such combination can lead to diagnostic and therapy mistakes. This article describes the case of a rare combination of overlapping optic neuritis and Guillain-Barré syndrome, associated with Mycoplasma pneumoniae and provides the short literature review. Further studies are required to identify common pathogenetic mechanisms of combined inflammatory lesions of the optic nerves and peripheral nervous system.
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Affiliation(s)
- G E Sheiko
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E M Rakhmanova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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2
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Co-occurrence of polyneuritis crainials and visual impairment: a case report and literature review. Neurol Sci 2022; 44:1563-1574. [PMID: 36585596 PMCID: PMC9803404 DOI: 10.1007/s10072-022-06580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Polyneuritis cranialis (PNC) with the disease characteristics of Guillain-Barré syndrome (GBS) in addition to both ocular and bulbar weakness in the absence of limb paralysis or ataxia is defined as an unusual variant of GBS. As evidence of central nervous system (CNS) involvement, visual impairment is an unusual finding complicating with GBS spectrum disorders and has never been reported in patients with PNC. METHODS We describe a very rare case who clinically presented with progressive multiple cranial nerve palsy and visual impairment. Furthermore, a literature search of concurrent GBS and optic neuritis (ON) as well as PNC attributed to GBS was conducted. RESULTS A diagnosis of PNC was considered due to the typical clinical characteristics as well as the presence of cerebrospinal fluid cytoalbumin dissociation and serum antibodies against gangliosides. The clinical manifestations and the bilateral optic nerve involvement in brain magnetic resonance imaging further suggested possible optic neuritis (ON). The patient received treatment with intravenous immunoglobulin followed by short-term use of corticosteroids and finally achieved a full recovery. Thirty-two previously reported cases (17 women, mean age 40) of concurrent GBS and ON and 20 cases of PNC (5 women, mean age 40) were analyzed. We further provided a comprehensive discussion on the potential etiologies, clinical features, therapeutic strategies, and prognosis. CONCLUSIONS This rare case with the co-occurrence of PNC and visual impairment and the related literature review may help clinicians advance the understanding of GBS spectrum disorders and make appropriate diagnoses and treatment decisions for the rare variants and CNS complications of GBS.
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Takeuchi Y, Inatomi Y, Nakajima M, Yonehara T. [Guillain-Barré syndrome with refractory optic neuropathy]. Rinsho Shinkeigaku 2019; 59:652-658. [PMID: 31564705 DOI: 10.5692/clinicalneurol.cn-001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 60-year-old woman with a 3-day history of ataxic gait, blurred vision, and upper extremity paresthesia was admitted to our hospital. She presented with severe visual disturbances (finger counting), ophthalmoplegia, neck weakness, and sensory ataxia. Serum anti-GQ1b antibody, anti-GM3 antibody, and anti-GD3 antibody were strongly positive, which might contribute to the pathogenesis. Since we suspected Guillain-Barré syndrome (GBS), intravenous immunoglobulin therapy (IVIg) and high-dose steroid therapy were administered; however, improvements in her visual acuity were minimal. Additional IVIg and high-dose steroid therapy resulted in limited visual acuity improvements. Therapeutic strategies for patients with GBS and refractory optic neuropathy remain controversial.
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Affiliation(s)
- Yosuke Takeuchi
- Department of Neurology, Saiseikai Kumamoto Hospital
- Department of Neurology, National Hospital Organization Kumamotominami National Hospital
| | | | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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4
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Matsunaga M, Kodama Y, Maruyama S, Miyazono A, Seki S, Tanabe T, Yoshimura M, Nishi J, Kawano Y. Guillain-Barré syndrome and optic neuritis after Mycoplasma pneumoniae infection. Brain Dev 2018; 40:439-442. [PMID: 29429558 DOI: 10.1016/j.braindev.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/09/2018] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
We report the case of a 12-year-old girl who developed Guillain-Barré syndrome (GBS) and optic neuritis (ON) following Mycoplasma pneumoniae infection. Her symptoms, including bilateral vision impairment and tingling in her hands and right foot, were resolved after methylprednisolone pulse therapy. Serum anti-galactocerebroside (Gal-C) IgM antibodies were detected in our patient. This is the first report of a child with GBS and ON associated with M. pneumoniae infection.
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Affiliation(s)
- Manaka Matsunaga
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuichi Kodama
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Shinsuke Maruyama
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akinori Miyazono
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shunji Seki
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takayuki Tanabe
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Michiyoshi Yoshimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Junichiro Nishi
- Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshifumi Kawano
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Baheerathan A, Ross Russell A, Bremner F, Farmer SF. A Rare Case of Bilateral Optic Neuritis and Guillain-Barré Syndrome Post Mycoplasma pneumoniae Infection. Neuroophthalmology 2017; 41:41-47. [PMID: 28228838 DOI: 10.1080/01658107.2016.1237975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022] Open
Abstract
Neurological complications are the most commonly encountered extra-pulmonary manifestation of infection with Mycoplasma pneumoniae (M. pneumoniae). Here the authors report the case of a 39-year-old woman who was admitted with acute-onset bilateral visual loss coinciding with ascending numbness. Clinical examination, neurological imaging, and nerve conduction studies revealed a syndrome of bilateral optic neuritis and Guillain-Barré syndrome (GBS). Serological testing confirmed recent exposure to M. pneumoniae. The patient did not experience any clinical benefit with pulsed intravenous methylprednisolone but demonstrated marked clinical and radiological improvement following 5 days of plasma exchange. This report will explore the diagnostic and therapeutic approach to patients with neuro-ophthalmological and neurological complications of M. pneumoniae infection in addition to discussing previously encountered cases.
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Affiliation(s)
- Aravindhan Baheerathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
| | - Amy Ross Russell
- Department of Neurology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
| | - Fion Bremner
- Department of Neuro-ophthalmology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
| | - Simon F Farmer
- Department of Neurology, National Hospital for Neurology and Neurosurgery , London, United Kingdom
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6
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Miller-Fisher syndrome associated with unilateral cerebral white matter lesions. Neurol Neurochir Pol 2015; 49:344-7. [PMID: 26377988 DOI: 10.1016/j.pjnns.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/23/2022]
Abstract
Miller-Fisher syndrome (MFS) is characterized by classical triad of ophthalmoplegia, ataxia and areflexia. The involvement of cerebral white matter in MFS is very rare. We report a typical MFS patient whose brain MRI showed unilateral and extensive involvement in cerebral white matter. We also found mild pleocytosis and raised protein concentration in cerebrospinal fluid. Deficits resolved completely after treatment with intravenous immunoglobulins. Subsequent brain MRI shows cavity formation in involved white matter.
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Mao Z, Hu X. Clinical characteristics and outcomes of patients with Guillain–Barré and acquired CNS demyelinating overlap syndrome: a cohort study based on a literature review. Neurol Res 2014; 36:1106-13. [DOI: 10.1179/1743132814y.0000000400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Acquired central and peripheral demyelination in the same patient is a very rare feature. We report a 52-year-male patient with the chronic autoimmune hepatitis (CAH) presenting with pure motor areflexic quadriparesis from 4 months and recent onset of drowsiness of 4 days duration. Studies of imaging and electrophysiology suggested central pontine myelinolysis and chronic inflammatory demyelinating polyradiculoneuropathy. Patient was effectively treated with high dose steroids. To the best of our knowledge, this is the first case of central and peripheral demyelination in a patient with CAH.
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Affiliation(s)
- Bindu Menon
- Department of Neurology, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, India
| | - Saranjeet Singh Bedi
- Department of Neurology, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, India
| | - G Uma Maheshwar Rao
- Department of Neurology, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, India
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10
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You Y, Gupta VK, Li JC, Klistorner A, Graham SL. Optic neuropathies: characteristic features and mechanisms of retinal ganglion cell loss. Rev Neurosci 2013; 24:301-21. [PMID: 23612594 DOI: 10.1515/revneuro-2013-0003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 02/23/2013] [Indexed: 11/15/2022]
Abstract
Optic neuropathy refers to dysfunction and/or degeneration of axons of the optic nerve with subsequent optic nerve atrophy. A common feature of different optic neuropathies is retinal ganglion cell (RGC) apoptosis and axonal damage. Glaucoma and optic neuritis are the two major degenerative causes of optic nerve damage. Here, we review the anatomy and pathology of the optic nerve, and etiological categories of optic neuropathies, and discuss rodent models that can mimic these conditions. Electrophysiology can reveal signature features of RGC damage using the pattern electroretinogram (PERG), scotopic threshold response (STR) and photopic negative response (PhNR). The amplitude of the visual evoked potential (VEP) also reflects RGC axonal damage. The neurotrophin-mediated survival pathways, as well as the extrinsic and intrinsic cell apoptotic pathways, play a critical role in the pathogenesis of RGC loss. Finally, promising neuroprotective approaches based on the molecular signaling are analyzed for the treatment of optic neuropathies.
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Affiliation(s)
- Yuyi You
- Department of Ophthalmology, Australian School of Advanced Medicine, Macquarie University, New South wales, Australia.
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Rezania K, Arnason BG, Soliven B. Patterns and significance of concomitant central and peripheral inflammatory demyelination. Neurol Res 2013; 28:326-33. [PMID: 16687061 DOI: 10.1179/016164106x98233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Inflammatory demyelinating diseases comprise a spectrum of disorders that affect central nervous system (CNS) and peripheral nervous system (PNS) myelin. Most individuals have demyelinating disease restricted to one or the other compartment but patients with concomitant CNS and PNS inflammatory inflammatory demyelinating processes have been reported not infrequently. In most such patients, involvement of either the CNS or the PNS predominates the clinical picture. Involvement of the other compartment is usually mild or subclinical with unclear prognostic and therapeutic implications. Similarly, while experimentally induced demyelinating disease in animal models is usually CNS or PNS predominant, varying degrees of pathology in the other system can occur depending on the species, type of immunogen, and genetic background of the immunized animal. When CNS and PNS demyelinating diseases occur concurrently, effective treatment for CNS disease can be safely combined with effective treatment for PNS disease.
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Affiliation(s)
- Kourosh Rezania
- Department of Neurology, The University of Chicago, IL 60637, USA.
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Topcu Y, Bayram E, Karaoglu P, Yis U, Guleryuz H, Kurul SH. Coexistence of myositis, transverse myelitis, and Guillain Barré syndrome following Mycoplasma pneumoniae infection in an adolescent. J Pediatr Neurosci 2013; 8:59-63. [PMID: 23772249 PMCID: PMC3680901 DOI: 10.4103/1817-1745.111428] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Guillain-Barré syndrome (GBS) and transverse myelitis may occur coexistently in the pediatric population. This may be explained by a shared epitope between peripheral and central nervous system myelin. Coexistent transverse myelitis, myositis, and acute motor neuropathy in childhood have not been previously described. We describe a 14-year-old female patient with transverse myelitis, myositis, and GBS following Mycoplasma pneumoniae infection. She presented with weakness and walking disability. Weakness progressed to involve all extremities and ultimately, she was unable to stand and sit. Based on the clinical findings, a presumptive diagnosis of myositis was made at an outside institution because of high serum creatine kinase level. The patient was referred to our institution for further investigation. Magnetic resonance imaging of spine revealed enhancing hyperintense lesions in the anterior cervicothoracic spinal cord. The electromyography revealed acute motor polyneuropathy. Serum M. pneumoniae IgM and IgG were positive indicating an acute infection. Repeated M. pneumoniae serology showed a significant increase in Mycoplasma IgG titer. The patient was given intravenous immunoglobulin for 2 days and clarithromycin for 2 weeks. She was able to walk without support after 2 weeks of hospitalization. This paper emphasizes the rarity of concomitant myositis, transverse myelitis, and GBS in children.
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Affiliation(s)
- Yasemin Topcu
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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13
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The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis: an update post application of the 2007 consensus criteria. Neuroimaging Clin N Am 2013; 23:245-66. [PMID: 23608688 PMCID: PMC7111644 DOI: 10.1016/j.nic.2012.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Karkare K, Sinha S, Taly AB, Rao S. Prevalence and profile of sleep disturbances in Guillain-Barre Syndrome: a prospective questionnaire-based study during 10 days of hospitalization. Acta Neurol Scand 2013; 127:116-23. [PMID: 22642612 DOI: 10.1111/j.1600-0404.2012.01688.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sleep disturbances in Guillain-Barre Syndrome (GBS), though common, have not received focused attention. OBJECTIVES To study frequency and nature of sleep disturbances in patients with GBS, using validated questionnaires, and analyze the contributing factors. MATERIALS AND METHODS This prospective study included 60 patients fulfilling National Institute of Neurological and Communicative Diseases and Stroke (NINCDS) criteria for GBS (mean age: 32.7 ± 12.9 years; median: 30 years; M:F = 46:14), evaluated from 2008 to 2010. Data regarding sleep were collected on 10 consecutive days following admission using Richard Campbell Sleep score, St Mary's Hospital Sleep Questionnaire, and Pittsburgh Sleep Quality Index (PSQI) and correlated with various possible contributing factors like pain, paresthesia, anxiety, depression, autonomic dysfunctions, severity of disease, and therapeutic interventions among others. OBSERVATIONS Qualitative and quantitative sleep disturbances were rather frequent and involved over 50% patients: abnormal PSQI - 13.3%, abnormal score on Richard scale - 51.6%, abnormal sleep onset latency - 35%, sleep fragmentation - 40%, and reduced sleep duration - 46.6%. The symptoms were severe during the first week of hospitalization and reduced thereafter. Sleep disturbances as scored on Richard scale significantly correlated with anxiety, pain, paresthesia, and severity of immobility (P < 0.05) but not with depression and use of analgesics or antineuritic drugs. CONCLUSIONS This study first of its kind suggests that sleep disturbance in GBS is frequent, multi-factorial, often disturbing, and varies during the course of illness. Routine enquiry into the sleep disturbances and timely intervention may reduce morbidity and improve their quality of life.
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Affiliation(s)
- K. Karkare
- Departments of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; Karnataka; India
| | - S. Sinha
- Departments of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; Karnataka; India
| | - A. B. Taly
- Departments of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; Karnataka; India
| | - S. Rao
- Departments of Biostatistics; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; Karnataka; India
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Galiè E, Acqua MLD, Maschio M, Koudriavtseva T, Marco ED, Jandolo B. Central and peripheral neurological involvement in monoclonal gammopathies of undetermined significance. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjns.2013.34038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Blindness, Weakness, and Tingling. Surv Ophthalmol 2012; 57:565-72. [DOI: 10.1016/j.survophthal.2011.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 09/29/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
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Güngör L, Güngör I, Oztürk HE, Onar MK. Visual evoked potentials in guillain-barré syndrome. J Clin Neurol 2011; 7:34-9. [PMID: 21519525 PMCID: PMC3079158 DOI: 10.3988/jcn.2011.7.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy with various clinical features. Optic neuritis occurs in rare cases. In this study we determined the incidence and patterns of visual evoked potential (VEP) abnormality in GBS in association with ophthalmologic findings. METHODS Thirty-two patients with a diagnosis of GBS were included in the study. The correlation between pathologic VEPs and categories of neurologic deficit and electrophysiological findings were examined statistically. RESULTS The patients ranged in age from 19 to 77 years. Five cases (16%) had abnormal VEPs. All five of these patients exhibited increased P100 latency differences between the two eyes. Other abnormalities were prolonged p100 latency, increased interocular amplitude difference, and distorted p100 configuration. Pathologic signs on ophthalmologic examination were observed in 80% of patients with abnormal VEPs. VEP abnormality was never present in pure axonal forms. There was no significant correlation between pathologic VEP and cerebrospinal fluid protein level or categories of neurologic deficits. CONCLUSIONS Involvement of the optic pathways is not a frequent finding in GBS. When present it is always asymmetric and generally accompanied with pathologic findings on ophthalmologic examination. VEPs may be abnormal in different clinical variants of GBS, and especially in demyelinating forms.
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Affiliation(s)
- Levent Güngör
- Department of Neurology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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18
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Liu GT, Volpe NJ, Galetta SL. Eyelid and facial nerve disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tomiyasu K, Ishiyama M, Kato K, Komura M, Ohnuma E, Inamasu J, Takahashi T. Bilateral retrobulbar optic neuritis, Guillain-Barré syndrome and asymptomatic central white matter lesions following adult measles infection. Intern Med 2009; 48:377-81. [PMID: 19252366 DOI: 10.2169/internalmedicine.48.1585] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 28-year-old woman presented with classic signs of measles and subsequently developed bilateral retro-bulbar optic neuritis and Guillain-Barré syndrome. Her radiographic and CSF findings were consistent with acute measles encephalitis. However, encephalopathy, such as behavioral changes and alteration in consciousness, was not presented. Improvements in the clinical, radiographic, and electrophysiological studies were observed during the steroid therapy. The overlap of CNS and PNS involvement as neurological complications of measles infection is very rare.
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Adamovic T, Riou EM, Bernard G, Vanasse M, Décarie JC, Poulin C, Gauvin F. Acute combined central and peripheral nervous system demyelination in children. Pediatr Neurol 2008; 39:307-16. [PMID: 18940553 DOI: 10.1016/j.pediatrneurol.2008.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
Reports of acute combined central and peripheral nervous system acquired inflammatory demyelination are rare in children. This study aimed to (1) define the clinical features and prognoses of patients with this entity; and (2) compare these patients with children presenting isolated acute central or peripheral nervous system demyelination. A retrospective chart review of 523 children with central or peripheral nervous system demyelination hospitalized between 1993-2006 was undertaken. Among these, 93 fulfilled criteria (clinical features and positive magnetic resonance imaging or electromyography/nerve conduction studies) for either acute central (n = 37; 39.8%) or peripheral (n = 43; 46%) nervous system demyelination, or a combination of the two (n = 13; 14%). Significant differences between groups were evident for age (median, 10 versus 7 versus 11 years, respectively; P = 0.047), admission to pediatric intensive care unit (8% versus 30% versus 58%, respectively; P = 0.001), length of hospital stay (median, 8 versus 9 versus 29 days, respectively; P < 0.001), treatment with steroids (52% versus 7% versus 75%, respectively; P < 0.001) and immunoglobulins (11% versus 81% versus 75%, respectively; P < 0.001), and poor evolution (3% versus 12% versus 54%, respectively; P = 0.002). This entity in children is not rare, and has a poorer outcome than isolated central or peripheral nervous system demyelination. Assessment is needed for a better understanding of risk factors, etiologies, management, and prognosis.
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Affiliation(s)
- Tanja Adamovic
- Department of Paediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
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Petratos S, Gonzales MF. Can antiglycolipid antibodies present in HIV‐infected individuals induce immune demyelination? Neuropathology 2008. [PMID: 11211050 PMCID: PMC7167963 DOI: 10.1111/j.1440-1789.2000.00356.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Steven Petratos
- Development and Neurobiology Group, Walter and Eliza Hall Institute of Medical Research and
| | - Michael F. Gonzales
- Neuropathology Research Laboratory, Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Abstract
Optic neuritis (ON) is an inflammatory disease whose etiology remains obscure. We report a case of ON attributable to Mycoplasma pneumoniae (MP). A 26-year-old man presented a sudden onset bilateral loss of visual acuity, without any history of pulmonary or ear-nose-throat infection. Diagnosis of optic neuritis was made on the basis of visual field loss, though optic disks and visual evoked potentials were normal. Color vision could not be assessed due to a congenital dyschromatopsia. The neurological examination was normal. On magnetic resonance imaging, there was no enhancement or enlargement of optic nerves, but a demyelinating lesion of the cervical spinal cord. Lumbar puncture revealed lymphocytic meningitis with 60 white blood cells, all of them being lymphocytes. Oligoclonal bands were presents in the CSF. With no evidence of any other infection or auto-immune disease, the diagnosis of Mycoplasma pneumoniae infection was established due to the presence of Mycoplasma pneumoniae specific IgM antibodies. Outcome was quite favorable within three months without treatment. Neurological symptoms--encephalitis, meningitis, polyradiculitis, or more rarely ON or cerebella ataxia--are the main extra pulmonary manifestations of Mycoplasma pneumoniae infection. Search for anti-Mycoplasma pneumoniae IgM antibodies should be performed routinely when On is diagnosed.
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Chapter 7 Inflammatory Optic Neuropathies Not Associated with Multiple Sclerosis. Neuroophthalmology 2008. [DOI: 10.1016/s1877-184x(09)70037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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An JY, Yoon B, Kim JS, Song IU, Lee KS, Kim YI. Guillain-Barré syndrome with optic neuritis and a focal lesion in the central white matter following Epstein-Barr virus infection. Intern Med 2008; 47:1539-42. [PMID: 18758131 DOI: 10.2169/internalmedicine.47.1224] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of Guillain-Barré syndrome (GBS) accompanied by optic neuritis and a central white matter lesion subsequent to Epstein-Barr virus (EBV) infection. A 49-year-old man presented with visual disturbance and hemiparesis one week after developing cold-like symptoms. T2- and diffusion-weighted brain MRI showed a high-signal intensity lesion in the left internal capsule. The patient's visual acuity improved during steroid pulse therapy, but his hemiparesis progressed to quadriparesis. Nerve conduction studies showed demyelination predominant in the distal nerve terminals, consistent with GBS. Serological testing suggested EBV reinfection. Our findings indicate that EBV-related central and peripheral demyelination can occur simultaneously and can be successfully treated with a combination of corticosteroids and immunoglobulin.
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Affiliation(s)
- Jae Young An
- Department of Neurology, College of Medicine, The Catholic University of Korea
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Hsing J, Welgampola M, Kiernan MC. Reversible myeloradiculopathy due to Mycoplasma pneumoniae. J Clin Neurosci 2007; 14:61-4. [PMID: 17092721 DOI: 10.1016/j.jocn.2005.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 08/14/2005] [Indexed: 10/23/2022]
Abstract
A 22-year-old man presented with flaccid paraparesis and a thoracic sensory level in the context of a recent respiratory illness. Investigations established cerebrospinal pleocytosis with elevated protein, and subsequent serological testing confirmed raised antibody titres to Mycoplasma pneumoniae. Nerve conduction studies established that H-reflexes were prolonged and somatosensory evoked responses were delayed from the lower limbs bilaterally. Although imaging of the spinal cord revealed no abnormality, clinical and neurophysiological findings were consistent with a myeloradiculopathy. The patient was treated with pulse intravenous methylprednisone and underwent complete recovery over a 4-week period.
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Affiliation(s)
- Joanna Hsing
- Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, Australia
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Garssen MPJ, Schillings ML, Van Doorn PA, Van Engelen BGM, Zwarts MJ. Contribution of central and peripheral factors to residual fatigue in Guillain–Barré syndrome. Muscle Nerve 2007; 36:93-9. [PMID: 17238173 DOI: 10.1002/mus.20739] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many patients with Guillain-Barré syndrome (GBS) suffer from severe residual fatigue that has an uncertain basis. We determined the relative contribution of peripheral and central factors during a 2-min fatiguing sustained maximal voluntary contraction (MVC) in 10 neurologically well-recovered GBS patients and 12 age- and sex-matched healthy controls. Physiological fatigue was defined as the decline of voluntary force during an MVC of the biceps brachii. Relative amounts of peripheral fatigue and central activation failure were determined combining voluntary force and force responses to electrical stimulation. Surface electromyography was used to determine muscle-fiber conduction velocity. During the first minute of sustained MVC, peripheral fatigue developed more slowly in patients than in controls. Central fatigue only occurred in patients. The muscle-fiber conduction velocity was higher in patients. The initial MVC, decrease of MVC, initial force response, and initial central activation failure did not significantly differ between the groups. Although peripheral mechanisms cannot be excluded in the pathogenesis of residual fatigue after GBS, these results suggest that central changes are involved. This study thus provides further insight into the factors contributing to residual fatigue in GBS patients.
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Affiliation(s)
- Marcel P J Garssen
- Department of Neurology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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Tsiodras S, Kelesidis T, Kelesidis I, Voumbourakis K, Giamarellou H. Mycoplasma pneumoniae-associated myelitis: a comprehensive review. Eur J Neurol 2006; 13:112-24. [PMID: 16490040 DOI: 10.1111/j.1468-1331.2006.01174.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myelitis is one of the most severe central nervous system complications seen in association with Mycoplasma pneumoniae infections and both acute transverse myelitis (ATM) as well as acute disseminated encephalomyelitis (ADEM) have been observed. We reviewed all available literature on cases of Mycoplasma spp. associated ATM as well as ADEM with dominant spinal cord pathology and classified those cases according to the strength of evidence implicating M. pneumoniae as the cause. A wide range of data on diagnosis, epidemiology, immunopathogenesis, clinical picture, laboratory diagnosis, neuroimaging and treatment for this rare entity is presented. The use of highly sensitive and specific molecular diagnostic techniques may assist in clearly elucidating the role of M. pneumoniae in ATM/ADEM syndromes in the near future. Immunomodulating therapies may have a role in treating such cases.
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MESH Headings
- Diagnosis, Differential
- Encephalomyelitis, Acute Disseminated/diagnosis
- Encephalomyelitis, Acute Disseminated/immunology
- Encephalomyelitis, Acute Disseminated/microbiology
- Encephalomyelitis, Acute Disseminated/therapy
- Humans
- Mycoplasma/pathogenicity
- Myelitis, Transverse/diagnosis
- Myelitis, Transverse/immunology
- Myelitis, Transverse/microbiology
- Myelitis, Transverse/therapy
- Peptides
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/immunology
- Pneumonia, Mycoplasma/microbiology
- Pneumonia, Mycoplasma/therapy
- PubMed/statistics & numerical data
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Affiliation(s)
- S Tsiodras
- Fourth Academic Department of Internal Medicine and Infectious Diseases, Attikon University Hospital, University of Athens Medical School, Athens, Greece.
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Delalande S, De Sèze J, Hurtevent JP, Stojkovic T, Hurtevent JF, Vermersch P. [Cortical blindness associated with Guillain-Barre syndrome: a complication of dysautonomia?]. Rev Neurol (Paris) 2005; 161:465-7. [PMID: 15924084 DOI: 10.1016/s0035-3787(05)85078-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report a case of a Guillain-Barre syndrome (GBS) with subarachnoid hemorrhage and regressive occipital white matter lesions. OBSERVATION A 62-year-old woman developed ascendant progressive paresthesia and weakness of arms and legs, 48 hours after enteritis infection. Neurological examination showed tetraparesia with loss of deep tendon reflexes and alteration of proprioception tests. Nerve conduction studies revealed polyradiculoneuritis. Then she presented an acute blindness and hypertension. Brain magnetic resonance imaging showed bilateral occipital lesions and subarachnoid hemorrhage. Cerebrospinal fluid analysis revealed an elevated protein level (1.54 g/l) and red blood cells without meningitis. Brain arteriography was normal. Intravenous immunoglobulins improved neurological symptoms. CONCLUSION Posterior localisation of reversible white matter lesions evoked a reversible posterior leukoencephalopathy. The implication of arterial hypertension caused by dysautonomia during GBS could be suspected.
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Affiliation(s)
- S Delalande
- Service de Neurologie D, Hôpital R. Salengro, Lille.
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29
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Igarashi O, Fujioka T, Kishi M, Normoto N, Iwasaki Y, Kurihara T. Guillain-Barre syndrome with optic neuritis and cytomegalovirus infection. J Peripher Nerv Syst 2005; 10:340-1. [PMID: 16221294 DOI: 10.1111/j.1085-9489.2005.10313.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Couratier P, Boukhris S, Magy L, Traoré H, Vallat JM. Sclérose en plaques et atteinte du système nerveux périphérique. Rev Neurol (Paris) 2004; 160:1159-63. [PMID: 15602361 DOI: 10.1016/s0035-3787(04)71160-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Multiple sclerosis is a demyelinating disease limited to the central nervous system, but the literature has provided recurring evidence which raises the question of associated peripheral nervous system abnormalities. The prevalence of peripheral neuropathy during multiple sclerosis remains controversial without prospective study. Nevertheless, some data have reported well documented case reports describing the co-occurrence of multiple sclerosis and radiculopathy or mononeuropathy or polyneuropathy in the same patients. By contrast, more frequent subtle nerve abnormalities may be found by using electrophysiological and neuropathological examinations. Some hypotheses have been proposed by Waxman to decipher the electrophysiological and neuropathological findings. The mechanisms for demyelinating disease and peripheral nerve pathophysiology may imply the antigenic properties or the presence of diffusing factors between peripheral nervous system and central nervous system myelin and the molecular plasticity of myelinated fibers.
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Tsugawa T, Nikaido K, Doi T, Koga M, Susuki K, Kubota T, Tsutsumi H. Guillain-Barre syndrome with meningoencephalitis after Campylobacter jejuni infection. Pediatr Infect Dis J 2004; 23:966-8. [PMID: 15602203 DOI: 10.1097/01.inf.0000141741.36367.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 14-year-old boy presented with progressive ascending muscle weakness, urinary retention and disturbed consciousness. Initially his cerebrospinal fluid showed pleocytosis, and protein-cellular dissociation developed later. Campylobacter jejuni was isolated from his stool and serum anti-ganglioside antibodies were positive. Our case suggests that coexistence of meningoencephalitis at an early stage of illness does not necessarily exclude the diagnosis of Guillain-Barre syndrome.
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Affiliation(s)
- Takeshi Tsugawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo 060-8543, Japan.
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Candler PM, Dale RC. Three cases of central nervous system complications associated with Mycoplasma pneumoniae. Pediatr Neurol 2004; 31:133-8. [PMID: 15301835 DOI: 10.1016/j.pediatrneurol.2004.02.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Accepted: 02/19/2004] [Indexed: 11/17/2022]
Abstract
We report three new cases of acute central nervous system disease occurring shortly after Mycoplasma pneumoniae infection. The clinical phenotypes were characterized by encephalopathy (n = 2), optic neuritis (n = 1), transverse myelitis (n = 1), and seizures (n = 1). Although there was strong supportive evidence of preceding M. pneumoniae infection, cerebrospinal fluid polymerase chain reaction for M. pneumoniae was negative in all three patients. We propose that these cases resulted from a para-infectious immune-mediated process rather than parenchymal invasion by the microorganism. The two patients treated with steroids improved rapidly, and all three patients have made a full recovery. We review the literature regarding M. pneumoniae central nervous system complications and discuss the proposed pathologic mechanisms; para-infectious immune-mediated disease and parenchymal invasion of the central nervous system. Systematic investigation to discriminate between these two processes will be essential to select appropriate antibiotic and immunomodulatory therapies.
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Affiliation(s)
- Paul M Candler
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
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Hawley RJ, Madrid R. Post-infectious central and peripheral nervous system diseases in patient with Devic's disease and Guillain-Barre syndrome. Eur J Neurol 2003; 10:600. [PMID: 12940848 DOI: 10.1046/j.1468-1331.2003.00659.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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Tan MJ, Chattophadyay AK, Griffiths PD, Baxter PS. Acute central and peripheral demyelination associated with Mycoplasma pneumoniae. Pediatr Neurol 2003; 29:239-41. [PMID: 14629909 DOI: 10.1016/s0887-8994(03)00218-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 7-year-old female presented with Mycoplasma pneumoniae pneumonitis and a progressive ascending limb paralysis. She developed severe respiratory distress, requiring ventilation, and became apparently unresponsive with fixed dilated pupils. Peripheral nerves were inexcitable in nerve-conduction studies. Magnetic resonance imaging of the brain revealed evidence of extensive demyelination. Anti-GM1 immunoglobulin M antibody titers were raised. She improved after a second course of intravenous immunoglobulin and eventually made a full recovery.
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Affiliation(s)
- Maw J Tan
- Sheffield Children's Hospital, Western Bank, UK
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Georgiou T, McKibbin M, Doran RML, George NDL. Bilateral third-nerve palsy with aberrant regeneration in Guillain-Barré syndrome. Eye (Lond) 2003; 17:254-6. [PMID: 12640420 DOI: 10.1038/sj.eye.6700310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Pfausler B, Engelhardt K, Kampfl A, Spiss H, Taferner E, Schmutzhard E. Post-infectious central and peripheral nervous system diseases complicating Mycoplasma pneumoniae infection. Report of three cases and review of the literature. Eur J Neurol 2002; 9:93-6. [PMID: 11784383 DOI: 10.1046/j.1468-1331.2002.00350.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three patients with a central and peripheral nervous system disease complicating a Mycoplasma pneumoniae (M. pn.) infection are presented. Patient 1 suffered from bilateral optic neuritis as well as acute Guillain-Barré syndrome recovering after plasmapheresis. The two other patients suffered from severe haemorrhagic leukoencephalitis (Hurst) which only could be contained by aggressive decompressive craniectomy with duraplasty. All three illnesses were clearly shown to be associated with M. pn. infection. Our three patients represent the full scale of central nervous (CNS) (cerebral and myelitic) as well as peripheral nervous system (PNS) (GBS, optic neuritis) manifestation of a disease caused by the same pathogenetic - post-infectious - mechanism; pathogenic CNS and PNS epitopes might be shared in post-infectious neurological disease following M. pn. infection.
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Affiliation(s)
- B Pfausler
- Department of Neurology, University Hospital Innsbruck, Innsbruck, Austria.
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Petratos S, Gonzales ME. Can antiglycolipid antibodies present in HIV-infected individuals induce immune demyelination? Neuropathology 2000; 20:257-72. [PMID: 11211050 PMCID: PMC7167963 DOI: 10.1046/j.1440-1789.2000.00356.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Of the eight clinically defined neuropathies associated with HIV infection, there is compelling evidence that acute and chronic inflammatory demyelinating polyneuropathy (IDPN) have an autoimmune pathogenesis. Many non-HIV infected individuals who suffer from sensory-motor nerve dysfunction have autoimmune indicators. The immunopathogenesis of demyelination must involve neuritogenic components in myelin. The various antigens suspected to play a role in HIV-seronegative IDPN include (i) P2 protein; (ii) sulfatide (GalS); (iii) various gangliosides (especially GM1); (iv) galactocerebroside (GalC); and (v) glycoproteins or glycolipids with the carbohydrate epitope glucuronyl-3-sulfate. These glycoproteins or glycolipids may be individually targeted, or an immune attack may be raised against a combination of any of these epitopes. The glycolipids, however, especially GalS, have recently evoked much interest as mediators of immune events underlying both non-HIV and HIV-associated demyelinating neuropathies. The present review outlines the recent research findings of antiglycolipid antibodies present in HIV-infected patients with and without peripheral nerve dysfunction, in an attempt to arrive at some consensus as to whether these antibodies may play a role in the immunopathogenesis of HIV-associated inflammatory demyelinating polyneuropathy.
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Affiliation(s)
- S Petratos
- Walter and Eliza Hall Institute of Medical Research, Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Gücüyener K, Simşek F, Yilmaz O, Serdaroğlu A. Methyl-prednisolone in neurologic complications of Mycoplasma pneumonia. Indian J Pediatr 2000; 67:467-9. [PMID: 10932970 DOI: 10.1007/bf02859473] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In patients with Mycoplasma pneumonia extrapulmonary manifestations such as encephalitis, meningitis, cerebellar and brain stem involvement, cranial nerve lesions, peripheral neuropathy, polymyositis have been observed. We report a 16-year-old girl with M. pneumonia infection, acute behavioral changes and coma. Treatment with high dose methyl-prednisolone and clarithromycin led to rapid clinical improvement.
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Affiliation(s)
- K Gücüyener
- Department of Paediatrics and Child Neurology, Gazi University, Medical School, Ankara, Turkey
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Abstract
Acute disseminated encephalomyelitis is a monophasic, immune-mediated disorder that produces multifocal demyelinating lesions within the central nervous system. It is characterized clinically by the acute onset of neurologic abnormalities, including varying degrees of mental state changes ranging from drowsiness to coma. It is unusual for the illness to present as an isolated acute psychosis. The case of a 14-year-old female with biopsy-confirmed acute disseminated encephalomyelitis, who was initially diagnosed with an acute psychiatric disorder, is presented, and published reports on this unusual manifestation are reviewed. A Medline database search was performed from 1965 to 1999, using the terms acute disseminated encephalomyelitis, postvaccinal encephalomyelitis, postinfectious encephalomyelitis, and measles encephalomyelitis, combined with the terms psychosis, psychiatric disorder, and behavioral disorder. Selected cross-referenced reports were also reviewed. Nine patients were identified who presented with acute psychosis. We conclude that, although rare, acute disseminated encephalomyelitis can present as an acute psychosis. This immune-mediated condition should be included in the differential diagnosis of neurologic disorders presenting as a psychiatric illness.
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Affiliation(s)
- J T Nasr
- Department of Neurology; State University of New York at Stony Brook, 11794, USA
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40
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Henderson RD, Ohlrich GD, Pender MP. Guillain-Barré syndrome and optic neuritis after Mycoplasma pneumoniae infection. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1998; 28:481-2. [PMID: 9777126 DOI: 10.1111/j.1445-5994.1998.tb02093.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute neuromuscular paralysis in developed countries. GBS is a significant cause of new long-term disability for at least 1,000 persons per year in the United States, and more elsewhere. Given the young age at which GBS sometimes occurs and the relatively long life expectancies following GBS, it is likely that at least 25,000 and perhaps 50,000 persons in the US are experiencing some residual effects of GBS. Approximately 40% of patients who are hospitalized with GBS will require admission to inpatient rehabilitation. For GBS persons necessitating admission to inpatient rehabilitation, the requirement of prior ventilator support most strongly predicts an extended length of stay on inpatient rehabilitation. Other issues that affect rehabilitation are dysautonomia, cranial nerve involvement, and various medical complications associated with GBS. Deafferent pain syndrome is common in the early stages of recovery. Multiple medical complications, including deep venous thrombosis, joint contractures, hypercalcemia of immobilization, and decubitii, may develop in the early stages of recovery and interfere with the rehabilitation program. Anemia is a frequent finding in the first few months of illness but does not appear to interfere with functional recovery. Therapy should not overfatigue the motor unit, which has been associated with paradoxical weakening. Little is known of the long-term implications of the disability caused by GBS. Work similar to that performed for postpolio syndrome and spinal cord injury should be started in the rehabilitation setting.
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Affiliation(s)
- J M Meythaler
- Spain Rehabilitation Center, and Department of Rehabilitation Medicine, University of Alabama School of Medicine, Birmingham 35233-7330, USA
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Miwa H, Yamaji Y, Abe H, Mizuno Y. Evaluation of the somatosensory evoked blink response in patients with neurological disorders. J Neurol Neurosurg Psychiatry 1996; 60:539-43. [PMID: 8778259 PMCID: PMC486367 DOI: 10.1136/jnnp.60.5.539] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The somatosensory evoked blink response (SBR) is a characteristic reflex blink elicited by electrical stimulation of peripheral nerves or other anatomical sites. METHODS 139 patients with neurological disorders were examined for presence of the SBR. Although the SBR was not usually elicitable, it was present in a subset of patients with Parkinson's disease and with hemifacial spasm. It was also present in a patient with Guillain-Barré syndrome before the recovery phase. The latency of the EMG activities responsible for the SBR was significantly shorter than that of the startle blink. CONCLUSIONS The SBR is not a variant of the startle blink, but is a release phenomenon transmitted via the brainstem reticular formation. This response may be clinically relevant in disorders associated with brainstem lesions and abnormal blinking.
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Affiliation(s)
- H Miwa
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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43
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Kinoshita A, Hayashi M, Miyamoto K, Oda M, Tanabe H. Inflammatory demyelinating polyradiculitis in a patient with acute disseminated encephalomyelitis (ADEM). J Neurol Neurosurg Psychiatry 1996; 60:87-90. [PMID: 8558159 PMCID: PMC486196 DOI: 10.1136/jnnp.60.1.87] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A patient with severe acute disseminated encephalomyelitis died 12 days after the first symptom. Necropsy showed widespread severe demyelination in the CNS and some foci of demyelination in the spinal roots. The lesions in the peripheral nervous system were characterised by myelin stripping and the presence of macrophages, being severest in the spinal nerve roots. Some axons were completely demyelinated, whereas the axons themselves were preserved. Pathologically established ongoing demyelination in both CNS and peripheral nervous systems raises the possibility of a shared pathological epitope.
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Affiliation(s)
- A Kinoshita
- Department of Neurology, Faculty of Medicine, Kyoto University, Japan
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