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Bogoch II, Wilson MR, Chad DA, Venna N. Acute lower motor neuron syndrome and spinal cord gray matter hyperintensities in HIV infection. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e113. [PMID: 26015990 PMCID: PMC4436596 DOI: 10.1212/nxi.0000000000000113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/02/2015] [Indexed: 11/30/2022]
Abstract
Objective: To describe a novel manifestation of lower motor neuron disease in patients with well-controlled HIV infection. Methods: A retrospective study was performed to identify HIV-positive individuals with acute, painful lower motor neuron diseases. Results: Six patients were identified with HIV and lower motor neuron disease. Two patients met the inclusion criteria of well-controlled, chronic HIV infection and an acute, painful, unilateral lower motor neuron paralytic syndrome affecting the distal portion of the upper limb. These patients had segmental T2-hyperintense lesions in the central gray matter of the cervical spinal cord on MRI. One patient stabilized and the second patient improved with immunomodulatory therapy. Conclusions: This newly described syndrome expands the clinical spectrum of lower motor neuron diseases in HIV.
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Affiliation(s)
- Isaac I Bogoch
- Divisions of Internal Medicine and Infectious Diseases (I.I.B.), University Health Network, Toronto, Ontario, Canada; Department of Medicine (I.I.B.), University of Toronto, Ontario, Canada; Department of Neurology (M.R.W.), University of California, San Francisco; Department of Neurology (D.A.C., N.V.), Massachusetts General Hospital, Boston, MA; and Harvard Medical School (D.A.C., N.V.), Boston, MA
| | - Michael R Wilson
- Divisions of Internal Medicine and Infectious Diseases (I.I.B.), University Health Network, Toronto, Ontario, Canada; Department of Medicine (I.I.B.), University of Toronto, Ontario, Canada; Department of Neurology (M.R.W.), University of California, San Francisco; Department of Neurology (D.A.C., N.V.), Massachusetts General Hospital, Boston, MA; and Harvard Medical School (D.A.C., N.V.), Boston, MA
| | - David A Chad
- Divisions of Internal Medicine and Infectious Diseases (I.I.B.), University Health Network, Toronto, Ontario, Canada; Department of Medicine (I.I.B.), University of Toronto, Ontario, Canada; Department of Neurology (M.R.W.), University of California, San Francisco; Department of Neurology (D.A.C., N.V.), Massachusetts General Hospital, Boston, MA; and Harvard Medical School (D.A.C., N.V.), Boston, MA
| | - Nagagopal Venna
- Divisions of Internal Medicine and Infectious Diseases (I.I.B.), University Health Network, Toronto, Ontario, Canada; Department of Medicine (I.I.B.), University of Toronto, Ontario, Canada; Department of Neurology (M.R.W.), University of California, San Francisco; Department of Neurology (D.A.C., N.V.), Massachusetts General Hospital, Boston, MA; and Harvard Medical School (D.A.C., N.V.), Boston, MA
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Fransz DP, Schönhuth CP, Postma TJ, van Royen BJ. Parsonage-Turner syndrome following post-exposure prophylaxis. BMC Musculoskelet Disord 2014; 15:265. [PMID: 25098693 PMCID: PMC4126347 DOI: 10.1186/1471-2474-15-265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 'Parsonage-Turner syndrome' (PTS) is a rare but distinct disorder with an abrupt onset of shoulder pain, followed by weakness and atrophy of the upper extremity musculature, and a slow recovery requiring months to years. To our best knowledge, this is the first case describing symptoms and signs of PTS following the administration of a post-exposure prophylaxis (PEP) regimen against possible human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. CASE PRESENTATION A 25-year-old Caucasian man presented with pain and unilateral scapular winging following PEP against possible HIV and HBV infection. Although atrophy and weakness were observed for the right supraspinatus muscle, a full range of motion was achievable. Neurological examination, plain radiography of the right shoulder and electromyography showed no additional abnormalities. The patient was diagnosed with post-vaccination PTS and treated non-operatively. During the following 15 months the scapular winging receded and full muscle strength was regained. CONCLUSION Parsonage-Turner syndrome is a rare clinical diagnosis. The precise pathophysiological mechanism of PTS remains unclear, but it seems to involve an interaction between genetic predisposition, mechanical vulnerability and an autoimmune trigger. An immunological event, such as - in this case - a vaccination as part of PEP treatment, can trigger the onset of PTS. The clinical presentation is distinctive with acute severe pain followed by patchy paresis, atrophy and sensory symptoms that persist for months to years. No currently available tests can provide a definite confirmation or exclusion of PTS. Routine blood examination, electromyography (EMG), and computed tomography (CT) or magnetic resonance imaging (MRI) serve mainly to exclude other disorders. The recovery can be quite lengthy, non-operative treatment is the accepted practice. Supplementary administration of oral prednisolone could shorten the duration of pain. Although the outcome is typically preferable, a substantial amount of patients are left with some residual paresis and functional impairment.
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Affiliation(s)
| | - Casper P Schönhuth
- Department of Orthopaedic Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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