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Selvam S, Youron P, Singh H, Shree R, Suri V, Goyal M, Modi M, Bhalla A. A case series of post-infectious chikungunya myeloradiculoneuropathy. J Neurol Sci 2024; 459:122955. [PMID: 38593523 DOI: 10.1016/j.jns.2024.122955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
Chikungunya fever is an arboviral illness caused by chikungunya virus (CHIKV) and transmitted by the bite of Aedes aegypti and Aedes albopictus. It is an RNA virus belonging to the genus Alphavirus and family Togaviridae. We present a case series of three patients with chikungunya illness developing para/post-infectious myeloradiculoneuropathy.These patients developed neurological symptoms in the form of bilateral lower limb weakness with sensory and bowel involvement after the recovery from the initial acute episode of chikungunya fever. Clinical examination findings suggested myeloradiculoneuropathy with normal Magnetic Resonance Imaging of the Spine, with the nerve conduction study showing sensorimotor axonal polyneuropathy. All the patients were treated with 1 g of methylprednisolone once a day for five days, and case 2 was given intravenous immunoglobulin also. In the follow-up, cases 1 and 2 showed complete recovery without recurrence, and case 3 did not show improvement at one month.
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Affiliation(s)
- Suresh Selvam
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Padma Youron
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Harpreet Singh
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Ritu Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vikas Suri
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manoj Goyal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashish Bhalla
- Division of Clinical Infectious Diseases, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Fraiman PHA, Freire M, Fernandes B, Palitot F, Mota N, Sequerra E, Santos G, Dourado ME, Godeiro-Junior CDO, Moreira-Neto M. "Clock dial pattern", a radiologic clue to neuro-chikungunya diagnosis: a case series. Arq Neuropsiquiatr 2024; 82:1-6. [PMID: 38286430 PMCID: PMC10824593 DOI: 10.1055/s-0044-1779033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/13/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases. OBJECTIVE This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya. METHODS Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded. RESULTS Patients showed different neuroimaging patterns. Six patients exhibited a "clock dial pattern" with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI. CONCLUSION The "clock dial pattern" observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.
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Affiliation(s)
- Pedro Henrique Almeida Fraiman
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Neurologia, Natal RN, Brazil.
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Mariana Freire
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.
| | - Bruno Fernandes
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Neurologia, Natal RN, Brazil.
| | - Felipe Palitot
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.
| | - Nathalia Mota
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.
| | - Eduardo Sequerra
- Universidade Federal do Rio Grande do Norte, Instituto do Cérebro, Natal RN, Brazil.
| | - Glauco Santos
- Hospital Giselda Trigueiro, Divisão de Infectologia, Natal RN, Brazil.
| | - Mario Emilio Dourado
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Neurologia, Natal RN, Brazil.
| | | | - Manuel Moreira-Neto
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.
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Leidersnaider CL, Sztajnbok FR, Coutinho ESF, Vaz JLP, Porangaba M, Hamdan PC, Martins PH, Constantino CPL, Ancillotti RV, Messeder AM, Monteiro DG, Folly MM, Mogami R. Chikungunya Fever: Comparison Study of Synovitis and Tenosynovitis of the Hands and Wrists Using Physical Examination, Ultrasound, and MRI Findings. J Ultrasound Med 2022; 41:865-873. [PMID: 34170018 DOI: 10.1002/jum.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.
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Affiliation(s)
| | | | | | - João Luiz Pereira Vaz
- Department of Rheumatology, Federal University of the State of Rio de Janeiro, Brazil
| | - Marina Porangaba
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Cesar Hamdan
- Department of Rheumatology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Mayara Malta Folly
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Roberto Mogami
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Corrêa DG, Dos Santos RQ, da Cruz LCH. Isolated substantia nigra lesions in encephalitis: A specific MRI pattern? Acta Neurol Belg 2020; 120:1433-1435. [PMID: 32240533 DOI: 10.1007/s13760-020-01346-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Diogo Goulart Corrêa
- Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, 2640-102, Brazil.
| | - Roberto Queiroz Dos Santos
- Hospital dos Servidores do Estado, Rua Sacadura Cabral, 178, Saúde, Rio de Janeiro, RJ, 20221-903, Brazil
| | - Luiz Celso Hygino da Cruz
- Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, 2640-102, Brazil
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Blettery M, Brunier L, Banydeen R, Derancourt C, de Bandt M. Management of acute-stage chikungunya disease: Contribution of ultrasonographic joint examination. Int J Infect Dis 2019; 84:1-4. [PMID: 30930186 DOI: 10.1016/j.ijid.2019.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Chikungunya (CHIKV) is an arbovirus that causes acute, debilitating polyarthritis. Its diagnosis can be difficult for clinicians not used to managing joint diseases or detecting synovitis. Joint Doppler ultrasonography (DUS) is a simple, non-invasive examination, able to visualize synovitis. Its diagnostic and prognostic value in rheumatoid arthritis is well-established. METHODS Patients with serologically proven acute arbovirosis where included. Clinical examination and joint count were performed (DAS score). Ultrasound examination was performed by another clinician - experienced in joint DUS - who also performed ultrasound joint score. Joints were examined by DUS in B-mode looking for: subcutaneous infiltration, effusion, tenosynovitis, erosion and Doppler signal. RESULTS In our experience, joint DUS is able to detect effusions in 92.8% of painful joints, with 28.3% of the effusions emitting a high-power Doppler signal. No erosion was observed. Subcutaneous inflammatory infiltration of the ankles (aseptic cellulitis) was found in 28.6% of patients. CONCLUSION Joint DUS is able to detect objective signs responsible for joint pain, which can be useful for practitioners not accustomed to this type of pathology. It also makes possible distinction between articular and periarticular manifestations.
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Affiliation(s)
- Marie Blettery
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Lauren Brunier
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Rishika Banydeen
- Unit of Epidemiology and Biostatistics (USMR), Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Christian Derancourt
- Unit of Epidemiology and Biostatistics (USMR), Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Michel de Bandt
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France.
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Mogami R, Pereira Vaz JL, de Fátima Barcelos Chagas Y, de Abreu MM, Torezani RS, de Almeida Vieira A, Junqueira Filho EA, Barbosa YB, Carvalho ACP, Lopes AJ. Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever. J Ultrasound Med 2018; 37:511-520. [PMID: 28786505 DOI: 10.1002/jum.14344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.
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Affiliation(s)
- Roberto Mogami
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João Luiz Pereira Vaz
- Department of Rheumatology, Gafrée e Guinle University Hospital, Federal State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yêdda de Fátima Barcelos Chagas
- Department of Rheumatology, Gafrée e Guinle University Hospital, Federal State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mirhelen Mendes de Abreu
- Department of Rheumatology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Sperling Torezani
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - André de Almeida Vieira
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Yasmin Baptista Barbosa
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio Carlos Pires Carvalho
- Department of Radiology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programe in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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