A Rare Case of Acute Transverse Myelitis (ATM) and Acute Motor and Sensory Axonal Neuropathy (AMSAN) Overlap.

Zarmina Javed,Waseem T Malik,Omair Ul Haq Lodhi

doi:10.7759/cureus.5426

Zarmina Javed, Waseem T Malik + Show 1 more

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https://doi.org/10.7759/cureus.5426

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Journal: Cureus	Publication Date: Aug 19, 2019
Citations: 5	License type: cc-by

Affiliation: Shifa International Hospital

Abstract

Concomitant acute transverse myelitis (ATM) and Guillain-Barre syndrome (GBS) is described as GBS and ATM overlap. Its presentation varies greatly, thus making the diagnosis difficult. Overlap syndrome is more commonly associated with acute motor axonal neuropathy (AMAN) subtype of GBS. However, we present a case of a middle-aged gentleman with combined ATM and acute motor and sensory axonal neuropathy (AMSAN) subtype of GBS. This combination is quite rare, and only a few cases have been reported so far.

Highlights

Guillain-Barre syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy of the peripheral nervous system which comprises of several subtypes, while acute transverse myelitis (ATM) is an immune-mediated disorder of the central nervous system (CNS) [1,2].Received 07/30/2019 Review began 08/04/2019 Review ended 08/13/2019 Published 08/19/2019The occurrence of Guillain Barre syndrome (GBS) and acute transverse myelitis (ATM), either concurrently or sequentially, is defined as GBS and ATM overlap [3]
We present a case of a middle-aged gentleman with combined ATM and acute motor and sensory axonal neuropathy (AMSAN) subtype of GBS
Twenty three cases of overlap syndrome reported so far [4]. These cases were mostly preceded by gastrointestinal infections such as Campylobacter jejuni while other cases were associated with Zika virus, Mycoplasma pneumoniae, Legionella pneumophila, Bartonella henselae, Influenza virus, and Paramyxovirus [5,6,7,8,9,10]

Summary

Introduction

Guillain-Barre syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy of the peripheral nervous system which comprises of several subtypes, while acute transverse myelitis (ATM) is an immune-mediated disorder of the central nervous system (CNS) [1,2]. The occurrence of Guillain Barre syndrome (GBS) and acute transverse myelitis (ATM), either concurrently or sequentially, is defined as GBS and ATM overlap [3]. We present a rare case of concurrent acute motor and sensory axonal neuropathy (AMSAN) and acute transverse myelitis in a 34-year-old gentleman. How to cite this article Javed Z, Malik W T, Lodhi O (August 19, 2019) A Rare Case of Acute Transverse Myelitis (ATM) and Acute Motor and Sensory Axonal Neuropathy (AMSAN) Overlap. The Magnetic Resonance Imaging (MRI) of the cervical spine without contrast was performed immediately, which showed T2 hyper-intense intra-medullary signal in cervical cord opposite C2-C3 through C4-C5 level. Nerve conduction studies were ordered, which revealed predominant axonal motor and sensory neuropathy affecting lower limbs more than upper limbs (Table 1). After nine days of hospital stay, he was discharged home with 4/5 power in lower limbs, 5/5 power in upper limbs, +1 deep tendon reflexes and normal sensory examination

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