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Kitazaki Y, Ueno A, Maeda K, Asano R, Satomi H, Nishio T, Nakamoto Y, Hamano T. A case of longitudinally extensive transverse myelitis with an isolated pontine lesion following epidural and spinal anesthesia for cesarean section. eNeurologicalSci 2020; 21:100264. [PMID: 32885056 PMCID: PMC7452523 DOI: 10.1016/j.ensci.2020.100264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022] Open
Abstract
Severe neurologic complications following epidural and spinal anesthesia rarely occur. Transverse myelitis has been reported as a rare complication of epidural or spinal anesthesia. We report a case of longitudinally extensive transverse myelitis and an isolated pontine lesion, which responded to immunotherapy. The patient was a 31-year-old pregnant woman who underwent elective cesarean section under epidural and spinal anesthesia. Though the insertions of the epidural and spinal catheters were smooth, she experienced back pain and transient hearing loss during epidural anesthesia. Postoperatively, she exhibited severe motor weakness in both lower extremities, neuralgia below the level of Th10 dermatome, and urinary retention. Magnetic resonance imaging showed longitudinally extensive transverse myelitis from T6 to T10 with a ring-shaped enhanced lesion and an isolated pontine lesion. These findings on magnetic resonance imaging were suggestive of autoimmune diseases such as neuromyelitis optica. The patient was diagnosed with an immunoreactive disease triggered by epidural or spinal anesthesia and was administered high-dose methylprednisolone, which led to the improvement in clinical symptoms. Clinicians should be aware of the possibility of the development of longitudinally extensive transverse myelitis and isolated pontine lesions after cesarean section under epidural and spinal anesthesia.
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Key Words
- AQP4, anti-aquaporin-4
- Autoimmune diseases
- CSF, cerebrospinal fluid
- DWI, Diffusion-weighted imaging
- Epidural anesthesia
- Immunotherapy
- LETM, Longitudinally extensive transverse myelitis
- Longitudinally extensive transverse myelitis
- MMT, manual muscle tests
- MRI, Magnetic resonance imaging
- MS, Multiple sclerosis
- NBD, Neuro-Behcet's disease
- NMO, neuromyelitis optica
- PCEA, Patient-controlled epidural analgesia
- POD, Postoperative day
- PSL, prednisolone
- Pontine lesion
- STIR, Short TI-inversion recovery
- Spinal anesthesia
- TM, Transverse myelitis
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Affiliation(s)
- Yuki Kitazaki
- Department of Neurology, Fukui-ken Saiseikai Hospital, Fukui, Japan.,Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Asako Ueno
- Department of Neurology, Fukui-ken Saiseikai Hospital, Fukui, Japan.,Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenichiro Maeda
- Department of Neurology, Fukui-ken Saiseikai Hospital, Fukui, Japan.,Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Rei Asano
- Department of Neurology, Fukui-ken Saiseikai Hospital, Fukui, Japan.,Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyuki Satomi
- Department of Obstetrics and Gynecology, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Taro Nishio
- Department of Anesthesiology, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tadanori Hamano
- Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Aging and Dementia, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Wu Y, Zhong L, Geng J. Neuromyelitis optica spectrum disorder: Pathogenesis, treatment, and experimental models. Mult Scler Relat Disord 2018; 27:412-418. [PMID: 30530071 DOI: 10.1016/j.msard.2018.12.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/21/2018] [Accepted: 12/02/2018] [Indexed: 01/10/2023]
Abstract
Neuromyelitis optica (NMO) and NMO spectrum disorder (NMOSD) are inflammatory CNS syndromes mainly involving the optic nerve and/or spinal cord and characterized by the presence of serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). The pathology of NMOSD is complicated, while therapies for NMOSD are limited and only partially effective in most cases. This review article focuses on the main pathology of NMOSD involving AQP4-IgG and lymphocyte function. We also review the existing therapeutic methods and potential new treatments. Experimental NMO animal models are crucial for further research into NMO pathology and treatment. However, no AQP4-IgG-immunized animals have been reported. The establishment of NMO models is therefore difficult and primarily depends on the generation of transgenic mice or transcranial manipulation using human or monoclonal mouse anti-AQP4 antibodies. Advantages and disadvantages of each model are discussed.
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Key Words
- APC, antigen-presenting cell
- Abbreviations: ADCC, antibody-dependent cellular cytotoxicity
- Aqp4, aquaporin 4
- Aquaporin-4
- BAFF, b-cell activating factor
- BBB, blood-brain barrier
- BCR, b cell receptor
- CDD, complement-dependent cytotoxicity
- CFA, complete freund's adjuvant
- CSF, cerebrospinal fluid
- CXCL, c-x-c motif chemokine ligand
- EAE, experimental autoimmune encephalomyelitis
- ECD, extracellular domain
- Experimental animal models
- IGG, immunoglobulin g
- IVMP, methylprednisolone pulse
- LETM, longitudinally extensive transverse myelitis
- MAB, monoclonal antibody
- MBP, myelin-binding protein
- MOG, myelin oligodendrocyte glycoprotein
- MOG-Ab, anti-MOG antibody
- NF-H, neurofilament heavy chain
- NMO, neuromyelitis optica
- NMO-IgG, NMO with serum AQP4-IgG
- NMOSD, NMO spectrum disorder
- Neuromyelitis optica
- Neuromyelitis optica spectrum disorder
- PB, plasmablast
- PP, plasmapheresis
- Remyelination
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Affiliation(s)
- Yan Wu
- Department of Neurology, Xichang Road No.295, Kunming 650000, China.
| | - Lianmei Zhong
- Department of Neurology, Xichang Road No.295, Kunming 650000, China
| | - Jia Geng
- Department of Neurology, Xichang Road No.295, Kunming 650000, China
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Kariya Y, Kariya Y, Saito T, Nishiyama S, Honda T, Tanaka K, Yoshida M, Fujihara K, Hashimoto Y. Increased cerebrospinal fluid osteopontin levels and its involvement in macrophage infiltration in neuromyelitis optica. BBA Clin 2015; 3:126-34. [PMID: 26673877 DOI: 10.1016/j.bbacli.2015.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neuromyelitis optica (NMO) is an inflammatory disease of the central nervous system that predominantly affects the optic nerves and spinal cord. Although NMO has long been considered a subtype of multiple sclerosis (MS), the effects of interferon-β treatment are different between NMO and MS. Recent findings of NMO-IgG suggest that NMO could be a distinct disease rather than a subtype of MS. However, the underlying molecular mechanism of NMO pathology remains poorly understood. METHODS OPN in the cerebrospinal fluid and brain of patients with NMO and with MS, as well as of patients with other neurologic disease/idiopathic other neurologic disease was examined using Western blotting, ELISA, immunohistochemistry and Boyden chamber. RESULTS Here we show that osteopontin is significantly increased in the cerebrospinal fluid of NMO patients compared with MS patients. Immunohistochemical analyses revealed that osteopontin was markedly elevated in the cerebral white matter of NMO patients and produced by astrocytes, neurons, and oligodendroglia as well as infiltrating macrophages. We also demonstrate that the interaction of the cerebrospinal fluid osteopontin in NMO patients with integrin αvβ3 promoted macrophage chemotaxis by activating phosphoinositide 3-kinase and MEK1/2 signaling pathways. CONCLUSION These results indicate that osteopontin is involved in NMO pathology. GENERAL SIGNIFICANCE Thus therapeutic strategies that target osteopontin signaling may be useful to treat NMO.
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Key Words
- AQP4, aquaporin-4
- Ab, antibody
- Abs, antibodies
- Biomarker
- CNS, central nervous system
- CSF, cerebrospinal fluid
- Cerebrospinal fluid
- EAE, experimental autoimmune encephalomyelitis
- GFAP, glial fibrillary acidic protein
- IFN, interferon
- Integrin
- MS, multiple sclerosis
- Multiple sclerosis
- NMO, neuromyelitis optica
- Neuromyelitis optica
- OPN, osteopontin
- Osteopontin
- PI3K, phosphoinositide 3-kinase
- RGD, Arg–Gly–Asp
- RGE, Arg–Gly–Glu
- TRAP, tartrate-resistant form of acid phosphatase
- mAb, monoclonal antibody
- pAb, polyclonal antibody
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